Capitation should constitute the majority of payments to GPs, marking a departure from the current GMS GP contract, where nearly 30 per cent of payments are non-capitation based, according to an unpublished document seen by the Medical Independent (MI).
The document, compiled in 2014, stated that GP benefits and practice supports/input subsidies appeared to have “gradually built up over time, like barnacles on a boat”.
Setting GP Fees for Under-Six Year-Olds in Ireland — Towards a Methodology was commissioned by the HSE and carried out by the ESRI and Trinity College Dublin.
“The fee schedule should be based largely on capitation and there should be a small fee for service element,” it stated.
Several options were recommended as to the cap of 2,000 patients per GMS contract holder.
It suggested changing the cap to 2,000 patients per GP in the practice of a GMS contract holder.
“Irrespective of whether the cap is maintained in its current form… the cap should be raised, depending on how many practice nurses the GP practice employs.”
The under-sixes contract set a general limit of 2,200 total patients per GMS GP.
The timetable set out by Government for the introduction of free GP care could result in a new contract being produced without the necessary research, the document warned.
It also appeared to question the payment of practice subsidies and supports to GPs.
“The HSE pays for pharmacy services, dental services and ophthalmic services, for example, exclusively on the basis of fee schedules, with no practice support or other benefits. It is not clear on what grounds GPs should be treated differently.”
It recommended several changes to the draft GP contract published in 2014, in favour of primary care teams to help deliver preventative care and chronic disease management.