By Dara Gantly. The Government could possibly face a bill of in excess of €160 million if the IMO demands a refund of payments GPs would have received if a change to the capitation rate for the over-70s had not been implemented in January 2009.
The IMO informed the Minister for Health in January that it was prepared to assert its right to negotiate on behalf of GPs in relation to all aspects of the GMS contract, even through the courts, and threatened to pull out of the agreement struck with the Government on a reduction in GP fees for over-70s patients if Dr James Reilly failed to recognise the IMO’s rights.
The IMO maintains that the agreement for a reduction in fees on the over-70s was contingent to the amendment of the Competition Act, so as to remove any ambiguity of the trade union’s entitlement to negotiate the contract and fees. It believes the contract is analogous to an employment-type relationship, and as such, competition law has no bearing on negotiations.
In an interview with Irish Medical Times, IMO CEO George McNeice now says that if the Government decides not to change the Act, it will have to refund the GPs the amount of money they have lost in relation to the new fee. “I don’t know what the figures are, but it would be substantial over the years,” the CEO stated.
IMT understands that in 2008, an estimated 136,455 over-70s patients were reimbursed at the higher rate of €672. In January 2009, the capitation rate for those individuals aged 70 years requiring a medical card, regardless of income, reduced to €308.77 per annum — a drop of over €360.
Thus, if the numbers of eligible over-70s remained the same, and excluding subsequent FEMPI cuts, the difference in pay over the past three years and four months could amount to more than €162 million.
“You can’t decide, ‘Well, I’ll implement one part of the deal but not the other’. You either implement it all or you don’t implement it,” McNeice said of the over-70s deal.
Despite a pledge in the Croke Park agreement to make “appropriate changes to the Competition Act and a transformation agenda for GPs”, this commitment has not been honoured, mainly due to a letter of advice from the Competition Authority to Hawkins House in August 2011.
This letter stipulated that while the IMO could negotiate on non-fee-related elements of the contract, discuss with the Department an outline offer and relay this offer to its members, it would always be the Minister who ultimately makes the final decision on what the State will pay.
However, McNeice told IMT that if the Government tried to unilaterally change the contract – or if the Competition Authority tried to impose its will – the union would go to court, and as far as the European Court, if necessary.
“In the IMO accounts, we have made provision for legal fees that could arise out of this. We are also planning to set up a legal fund just for GPs, with contributions from GPs only, to take this action when it is necessary – if it becomes necessary.
“If this thing isn’t resolved there will be a row of some description. So if you are going to have a row you have better make sure it is the right one at the right time, and that you win it,” he added.