The Government is close to finalising a €200 million agreement with family doctors which would involve the introduction of new services for medical-card patients with chronic illnesses such as diabetes or cardiovascular conditions.
It would also involve the restoration of funding, cut from general practice during the austerity years, in return for co-operation with reforms.
The proposed accord would see the Irish Medical Organisation (IMO) dropping its objection in principle to the Government's plans to extend free GP care to further cohorts of children, potentially up to age 12 .
However the implementation of any such extension of free GP care beyond the existing cut-off point of age six would require further negotiations and the Government would have to pay GPs more money to put in place such services.
The proposed agreement, which has been under negotiation between the IMO and health service management for the last year or so would, effectively, come in three separate parts.
Close to collapse
The first element of the proposed deal would see the Government invest about €120 million up to 2022 to improve the financial stability of general practice which doctors have warned was close to collapse as a result of several rounds of cuts.
This additional money would come as part of a productivity arrangement and, in essence, would equate to the total sum removed from general practice under these cuts over recent years.
However under current proposals there would not be a “like-for-like” reversal of each individual cutback introduced under financial emergency legislation over the last decade. It is understood the parties have been looking at increasing capitation payments paid to doctors for caring for each individual patient on their list.
In return for this investment to improve financial stability GPs would, under the new proposals, agree to co-operate with structural changes in the health services such as the new regional health organisations and the introduction of new ehealth initiatives such as the unique health identifier for all patients.
It is understood the proposed agreement would not involve GPs providing additional hours of service for medical card patients.
New structured care
In addition, the proposed accord would also provide for the introduction of new structured care by GPs of patients with conditions such as diabetes, chronic obstructive pulmonary disease and cardiovascular conditions. This could involve GPs seeing patients with such illnesses on a set number of occasions per year. There would be additional funding to GPs for this initiative which could cost more than €70 million.
The proposed deal would also see the IMO agreeing to enter talks with Ministers if they wanted to press ahead with its plans to extend existing arrangements for free GP care for children as is promised under the current programme for government. However, any such extension of free GP care would not be covered by the proposed new agreement. This would require further talks and the Government would have to pay more to GPs for taking on such services.
Three elements
It is understood that GPs would be free to accept any or all of the three elements of the proposed deal.
Talks between Department of Health and Department of Public Expenditure representatives and the IMO are expected to continue this week. Government sources said the "back had been broken" on a number of key issues. It is understood a deal could be reached within the coming days or early next week.
