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GMS

Click on the links below to navigate the complex world of the GMS Contract.

 

For Other State Contracts, please click here.

GMS Contract

In order to provide services to medical card patients, a GP must hold a GMS contract issued by the HSE. Medical card patients are registered with a general practitioner of their choice who has a centre of practice within 10 miles of their home. Patient entitlement to general medical services/a medical card is means (income) tested.

Medical card holders are entitled to:

  • GP services & prescription drugs free of charge

  • A public bed in a public ward

  • Free hospital consultant care, medications & investigations

  • Free A&E attendance

Doctor Visit Cards

Doctor Visit Card holders are entitled to the services of a GP free of charge (i.e. the same GP services as a medical card holder). 

Prescribed drugs are not free but may be covered by the Drugs Payment Scheme.

Capitation and STCs are treated in the same way for GMS and DVC patients. DVCs are counted in panel numbers for entitlements and grants, unless otherwise stated (e.g. social deprivation grant only counts GMS cards).

The DVC contract is open to all eligible GPs, a GMS contract is not a requirement.

Anyone can apply for a Doctor Visit Card or a Medical Card, families, single people and even those working full time. The Doctor Visit Card is means tested. One application form is now used for both Medical Cards and Doctor Visit Cards. The HSE will assess each application for a full medical card in the first instance and then for Doctor visit card. Application forms are available in Local Health Office.

GP Agreement 2023

GP visit cards will be available to people on the median income or less in 2023. The process of extending eligibility to individuals and families whose annual reckonable earnings do not exceed the median income (and to all children aged between 6 and 7 years, see here) will commence on a phased basis.The weekly income limit for the GP visit card will be increased in two phases, first on 11 September 2023 and again on 13 November 2023. Weekly income thresholds for everyone over and under 66 will be the same from 11 September 2023.

Department of Health modelling indicates that approximately 340,000 individuals are likely to take up eligibility for a Doctor Only Visit Card under the expansion of care to those earning no more than the median income. This number is in addition to the estimated 78,000 children who it is projected will become eligible under the expansion of care to all children aged 6 and 7 who will receive GMS services in accordance with the terms of the Form of Agreement with Registered Medical Practitioners for the Provision of GMS Services to Child Patients Aged Under 8 Years.

Assignment of Patients Under GMS Contracts

Under current GMS and DVC Contract Terms the HSE have the ability to assign patients to a GP Practice. The current level of assignments is circa 7,500 per annum. As part of the GP Agreement 2023 the table below sets out the maximum patient assignment arrangements which will apply to those GPs who sign up to the Agreement. Contact the IMO if additional patients are assigned to your panel.

Max panel size remains at 2,200 patients. In exceptional circumstances where the additional patients under this Agreement brings the GPs list over 2,200 this will be considered on a GP by GP basis.

GMS Entry

As of March 2012, there are three ways to enter the GMS Scheme:

  1. A GMS vacancy: By means of filling of a GMS vacancy, for example, where a single handed GP dies, retires or resigns and his/her panel is advertised by the HSE as a single handed vacancy

  2. Assistantship-with-a-View: By means of appointment as an Assistant with a view to GMS Partnership with an existing GMS Principal

  3. Open access: By applying for a GMS contract under the new open entry arrangements

Detailed information on entry to the GMS Scheme is available in the ICGP publication, Signposts to Success.

GMS Contract
GMS Entry

GMS
Contract

GMS
fees

GMS ENTITLEMENTS

GMS
SUPPORTS

Services Not Covered by the GMS

A number of services are not covered under the GMS contract and patients can be required to pay directly for these services:

  • Minor surgery

  • Phlebotomy services

  • Warfarin monitoring

  • Dressings

  • Medical examinations and reports for legal purposes

  • Examinations relating to insurance policies

  • Examinations relating to fitness to drive, including eye test

  • Pre-employment examinations

  • School entry examinations

  • Sports medicals/reports

  • Travel vaccinations

  • Some family planning services

  • Pregnancy tests

  • Screening services (cervical smears - if falling outside the guideline of the national cervical screening programme)

GMS Remuneration

GMS GPs are remunerated by the Primary Care Reimbursement Service (PCRS) in numerous ways:

Schemes reimbursed via Community Healthcare Organisation (CHO):

  • Palliative Care

  • Primary Childhood Immunisation (in certain areas)

Services Not Covered by GMS
GMS Remuneration

PCRS

PCRS supports the delivery of primary healthcare by providing reimbursement services to primary care contractors for the provision of health services to members of the public in their own community. Almost all payments for publicly funded healthcare services provided in the community by General Practitioners, Community Pharmacies, Dentists and Optometrists/Ophthalmologists are made by the PCRS.

PCRS GP Handbook

PCRS Online GP Suite

The PCRS GP Handbook 2020 is available here - it provides detailed information and administrative arrangements for GPs.

The majority of GPs are registered to access the GP Suite. The benefits of this facility include:

  • Online claim entry which is available 24/7 (STC/Vaccinations)

  • Panel Management:

    • Downloadable and printable Itemised and Panel listings (5 year archive)

    • Confirm a client’s Medical Card eligibility status, at the point of service

    • Online registration for Cycle of Care

    • Add a new baby

    • Complete a sensitive renewal

    • Complete a patient reinstatement

    • Remove a patient from a panel list

    • Complete a Change of GP

  • Access to a Suite of Reports e.g. Benzo Listings, Prescribing Analysis, Summary, Non-Dispensing

  • Order Stationary e.g. GMS prescriptions

 

To register for GP Suite GPs must complete PCRS Security Certificate Requisition in order for PCRS to issue security certificate to download onto a practice PC. If you have any queries on how to use the Suite please contact the Doctors Unit directly on 01 8647100.

PCRS Queries

When submitting written queries regarding payments made or general queries, ensure to quote the GP's GMS number and a brief explanation as to the nature of your query. Queries may be submitted via the below methods.

By Email: PCRS.DoctorsQueries@hse.ie

By Phone: 01 864 7100


By Fax: 01 89414895

In writing:

Doctors Unit

Primary Care Reimbursement Service

J5 Plaza, Exit 5, M50

North Road, Finglas

Dublin 11, D11PXT0

PCRS

Capitation Rates - as of August 2023

Details of the GMS patient panel are issued to the PCRS on the 1st of each month. This information should reflect panel size for the practice as on the 1st of the current month. Payments are issued to the GP contract holder on the 15th of each month (approx.). Patients registering with a GP mid-month are not paid to the doctor for that month and where patients are taken off the panel mid-month, the doctor receives payment for the entire month.

The below 'Post-2023 Deal' rates became effective from 1st August 2023 to those GPs who opt in to accept the terms of the 2023 GP Agreement. The capitation increases are applicable to both existing and new GMS/DVC patients. All capitation rates will continue to attract 10% superannuation.

*70 or more residing in the community

**70 or more residing in a private nursing home for continuous periods in excess of 5 weeks

In order to encourage greater use of rosters and rotas, an annual supplementary out of hour payment of €3.64 per patient is also reimbursed in addition to the annual capitation. All Under 12 capitation fees include this.

*Subject to dataset(s) return.

Capitation Rates

Diabetic Cycle of Care

The Diabetic Cycle of Care is gradually being replaced by the Chronic Disease Management (CDM) programme below. As of early 2022, all GMS Diabetic patients over the age of 18 should be transferred to the CDM Treatment Programme.

 

GPs are entitled to further enhanced capitation for each GMS/DVC patient over 18 years old, diagnosed with Type 2 Diabetes on their panel (it does not apply to private patients). Registration of Diabetic patients is via the PCRS online portal. Once registered, the once off registration fee will issue. This registration fee is superannuable.

Once registered with the PCRS patients with Type 2 diabetes receive two visits a year. These should be organised at approximately 6 monthly intervals. The enhanced capitation for the Diabetes Cycle of Care is also superannuable, however, it is subject to the return of the dataset from the two visits.

Diabetic Cycle of Care
Chronic Disease Management

Structured Chronic Disease Prevention & Management Programme

The Structured Chronic Disease Prevention & Management Programme consists of three components:

  1. Opportunistic Case Finding (OCF)

    • The Opportunistic Case Finding Programme aims to identify those at high risk for the Preventive Programme (PP) and those with undiagnosed listed Chronic Disease for the CDM Treatment Programme.

  2. Prevention Programme (PP)

    • The Annual Preventive Programme focuses on patients at high risk of Cardiovascular Disease and/or Diabetes

  3. Chronic Disease Management (CDM) Treatment Programme

    • The CDM Treatment Programme comprises of 2 reviews per annum, for patients with the diseases detailed below.

Read the January 2022 circular here.

This programme is designed to enable the GP to divide his/her patient population into the following three groups for focused patient care:

  1. General Population

  2. High Risk Population

  3. Diagnosed Chronic Disease Population

Note: This programme only covers patient’s resident in the community. Nursing home patients are excluded as this the programme was designed as a practice-based programme.

CDM Treatment Programme

The CDM Treatment Programme was introduced in 2020 and is now available for adult GMS/DVC patients aged 18 years and over who have a diagnosis of one or more the following diseases:

  • Asthma

  • Type 2 Diabetes

  • Chronic Obstructive Pulmonary Disease (COPD)

  • Cardiovascular Disease including:

    • Stable Heart Failure

    • Ischaemic Heart Disease

    • Cerebrovascular Disease (Stroke/TIA)

    • Atrial Fibrillation

The above disease definitions are available in the appendices of the 2019 GP Agreement.

Eligible patients aged 18 years and over who are registered under the Diabetes Cycle of Care and the Heartwatch Programme need to be transitioned on to the new CDM Treatment Programme. Payments under the Diabetes Cycle of Care and the Heartwatch Programme will cease for such patients were a data return under the CDM Treatment Programme is received by the PCRS.

Combinations of Chronic Diseases

To reflect the more complex consultations which take place when co-morbidities exist the fee rate is higher for patients who have multiple conditions. There are seven separate conditions four of which are listed under Cardiovascular Disease. These are all individual conditions. For example, if a patient has 2 of these cardiovascular diseases then the GP is paid at the fee rate for a patient with two chronic conditions, the same way that if a patient has type 2 diabetes and one of the named cardiovascular diseases.

CDM Treatment Programme Review Structure

To support patients in managing their chronic condition(s) there are two scheduled reviews in a 12 month period (Annual Review & Interim Review) as set out in the GP Agreement with an interval of at least four months between each scheduled review. Each 12 month period is a 12 month window which commences on the anniversary of the initial Chronic Disease Treatment Registration visit. Following the first Treatment Programme review, the next review (Interim Review) should take place no earlier than 4 months after. If an Interim Review does not take place within the 12 month window the next review will be an Annual Review. No more than two reviews can be submitted within the 12 month window. The rules as set out above apply to the MCDM reviews also.

It is envisaged that each of the scheduled reviews will require a visit to the GP and to the Practice Nurse. The scheduled reviews should be planned so they are of optimal value to the patients and the practice team; for example, if the patient is due to have a consultation with their GP, any planned investigations should be carried out by the Practice Nurse prior to the GP consultation thereby ensuring that results of such investigations are available to the eligible patient’s GP for each scheduled review. Where blood tests are less than three months old at the date of the in surgery CDM Treatment Programme Review the blood results can be populated from the existing patient chart or record, otherwise the bloods will need to be repeated and results available prior to the GP consultation.

A written Care Plan must be agreed and issued to the patient following the completion of the review.

Claiming Process

You will be required to submit a data return to the HSE, in the required format, following each of the scheduled reviews through your GP Practice Management System. Reimbursement of 50% of the relevant annual fee, as set out in the table below, will issue to you from the PCRS following receipt of each data return. 10% superannuation is also payable in relation to each visit.

Payment for the bloods required under this programme are included in the fee payable per eligible patient, however you may claim an ECG STC when they are undertaken as part of a review. 

The below table represents the total annual fee available per patient on the CDM Treatment Programme.

*Subject to two dataset returns.

Modified CDM Treatment Programme

The CDM Treatment programme was modified in July 2020 due to COVID-19, to allow GPs to conduct reviews by phone/video. This modified programme will run until the 31st December 2022 and will apply to patients aged 18 years and over.

 

The Modified CDM Treatment review involves a remote consultation but attracts a lower fee (see below modified fee structure in comparison to the in surgery visits). 10% superannuation is also applicable.

During the course of a remote modified review you may determine, using your clinical judgement and in consultation with the patient, that your patient requires a review in the surgery for a full chronic disease review, including phlebotomy. You may request that this patient attend in person and following completion of the physical exam you can make the full data return. A written Care Plan must be issued by you to the patient following the completion of the CDM review regardless of whether the review is the modified review or an in-surgery review.

Once you have claimed for a modified review you cannot then claim for a full review, so GPs who decide that the patient requires an in-surgery review should not submit the claim for the modified review if they intend on later claiming for the full in-surgery CDM review. Once a modified review is submitted, it is not possible to add to it later to transform it into a full review.

Opportunistic Case Finding

Opportunistic Case Finding (OCF) commenced in January 2022 for eligible GMS/DVC patients aged 65 years and over and involves a process whereby, on an opportunistic basis (i.e. when a patient attends for another issue and the patient is not already registered on the Structured CDM Programme) they are offered an OCF assessment which is undertaken in accordance with a set of risk criteria and appropriate tests/assessments are carried out to identify those with an undiagnosed chronic disease or those at high risk of developing a chronic disease. OCF assessments will be carried out in line with the 2019 GP Agreement.

The fee per OCF is €60 (no superannuation).

OCF Risk Criteria

The following are the risk criteria for the patients who the GP could select for assessment as these patients tend to have a higher prevalence for Chronic Disease:

  • Current smoker

  • BMI ≥ 30 approx. i.e. obese

  • History of gestational diabetes

  • Dyslipidaemia (HDL less than 0.9 or triglycerides greater than 2.82) (previously recorded)

  • Moderate or severe chronic kidney disease ([eGFR less than 60 mL/min/1.73 m2], [previously recorded])

  • History of severe Mental Illness

  • Irish Travellers, Roma, African & Asian Ethnicities (given high incidence of CVD in in this population cohort)

Outcome of OCF

After the OCF, the patient can be categorised into one of the following three patient populations and relevant action taken:

  1. Diagnosed with Chronic Disease​​

    • Register on CDM Treatment Programme​

  2. High Risk of developing Cardiovascular Disease and/or Diabetes

    • Register on Prevention Programme (PP)​

  3. Low Risk (General Population)

    • Not registered on either programme. 

    • OCF assessments should not be carried out on the same individual patient more frequently than every 5 years.​

 

Patients can be registered on the Prevention Programme (PP) or the CDM Treatment Programme on the same day as the OCF assessment. You must submit the OCF review before the PP or CDM review.

Prevention Programme

The Prevention Programme (PP) commenced in January 2022 for eligible GMS/DVC patients aged 65 years and over who, following an OCF assessment, are deemed a high risk of developing:

  • Cardiovascular Disease

  • Diabetes

The fee per PP is €83 (+10% superannuation).

Patients can be deemed High Risk because they have one of the following:

  • QRISK3 ≥ 20%

  • Stage 1 hypertension (≥ 140/90) with target organ damage*​​

  • Stage 2 hypertension (≥ 160/100)

  • Pre-diabetes

  • BNP greater than 34 pg/ml or NT pro BNP ≥ 125 pg/ml

*Note:  Stage 1 hypertension (≥ 140/90) and no target organ damage does not fit the criteria for this programme. 

Eligible patients who are found to be High Risk require active review of risk factors and may be registered on the Prevention Programme (PP) after an OCF review. On the PP they will receive one scheduled review annually (minimum interval 9 months - two will be accepted in a 12 month period). This scheduled review will require two visits, one to the Practice Nurse and one to the GP.

  • A review of risk factors in line with the 2019 GP Agreement will be carried out and the self-management Care Plan will be reviewed and additional supports provided and/or referrals made. ​

    • All patients should be given health promotion advice, advice on lifestyle modification and have risk factors and interventions recorded.

    • Patients diagnosed with pre-diabetes should be referred to the Diabetes Prevention Programme for pre-diabetic education.

  • Appropriate medical treatment (e.g. for hypertension, smoking cessation, blood lipids) will be reviewed and prescribed and appropriate blood tests carried out.

  • All high risk patients should be actively managed and have self-management supported by an annual visit to the practice nurse and a personalised care plan agreed and documented.

 

A written Care Plan must be issued by the participating GP to the eligible patient following the completion of the PP review.

Nursing Supports

In line with the objectives of the original Agreement, to augment Practice Nursing capacity, the following grant payment rates will apply:

  • CDM Treatment Programme & Modified CDM (MCDM) - a grant of €28.75 per registered eligible patient for CDM or Modified CDM (MCDM) will be paid in 2022 provided that all CDM/MCDM data returns for registered eligible patients during 2020 and 2021, have been submitted within 12 months of the first review undertaken in 2020 & 2021. For new CDM Treatment Programme registrations occurring during 2022, the grant payment will be made provided that one data return has been received by the HSE in respect of the registered eligible patient on or before the 1st of July 2022 at 23:59:00.

  • Prevention Programme (PP) - a grant of €14.35 per registered eligible patient will be paid in 2022 provided that the Prevention Programme data return has been received by the HSE on or before the 1st of July, 2022 at 23:59:00.

  • Opportunistic Case Finding (OCF) – a rate of €3.20 will be paid in 2022 per patient assessed under the OCF Programme provided that the data return has been received by the HSE on or before the 1st July, 2022 at 23:59:00.

Under 8 Contract

GPs who take up this contract will receive a standard annual capitation payment of €125 in respect of every child aged under 6 registered on their panel. This rate includes the provision of two periodic wellness assessments at age 2 and 5. The enhanced capitation rate of €125 is superannuable. This enhanced rate includes the supplementary out of hours fee.

In addition to providing GP care for all under 6’s the contract includes the provision of periodic wellness checks for children once at age two and once at age five, which are focused on health and wellbeing and disease prevention. A grant is available for the purchase of height measure & weighing scales, see here.

From August 2023, the contract will now be referred to as “The Form of Agreement with Registered Medical Practitioners for the Provision of GMS Services to Child Patients aged under 8 years” (Under 8 Contract). The process of extending eligibility to all children aged between 6 and 7 years will commence on a phased basis.

Revised capitation rates are now in place:

  • 6-7 year olds (universal - all children in this age cohort are entitled to a DVC) = €100

  • 8-12 year olds (those entitled to GMS/DVC based on family income) = €100

Under 8 Asthma Cycle of Care

GPs are entitled to further enhanced capitation for each child aged between 2-8 years old and diagnosed with asthma on their panel. Registration of Asthmatic Under 6 patients is via the PCRS online portal. Once registered, the once off registration fee will issue (see appropriate fees above). This registration fee is superannuable. The enhanced capitation for the Asthma Cycle of Care is also superannuable.

The enhanced capitation in year one post registration includes two visits, one at three months post registration and an annual review visit. One visit is required in the subsequent years, up to and including the age of 7. The enhanced capitations are subject to the return of the datasets through the GP. 

Under 8 Contract

Dispensing GPs

In order for a GP to become a Dispensing GP no pharmacy must be located within 3 miles (4.3kms) of the GPs practice premises and the GP adheres to the following:

  1. Dispensing arrangements and procedures must be wholly computerised providing greater efficiency, effectiveness and accountability. GPs will be required to input the details of each dispensing through the PCRS GP Application Suite.

  2. A Dispensing GP must ensure that they dispense, in any calendar year, a minimum of 70% of the items prescribed for patients on their dispensing panel. Where a Dispensing GP fails to meet the required level they will be formally advised and should the practitioner fail to achieve the minimum 70% dispensing/prescribing level in three successive years they will no longer retain a dispensing status.

  3. In respect of drugs/medicines dispensing a Dispensing GP is required to comply with HSE Dispensing Guidelines.

  4. Dispensing GPs are required to obtain third party signature in respect of all drugs/medicines provided to eligible dispensing patients.

Further information is available in the PCRS GP Handbook 2020.

Dispensing GPs
Practice Support Subsidies

Practice Support Subsidies

GMS GPs with a panel of 100+ patients are entitled to claim a contribution towards the employment of practice nurse/practice manager and practice secretary. A partnership/co-operative of GPs in a single location can claim for a practice manager only when they are not maximising their nursing subsidy. The practice manager subsidy is not available to single-handed practitioners.

The calculation of Practice Support Subsidy is based on the following factors:

  • The panel size (weighted)

  • The 'relevant experience' of the nurse or secretary

  • PRSI rate

  • The number of hours worked

Panel weighting refers to the process by which medical card patients over the age of 70 are considered at a 2:1 ratio, i.e. counted twice when the panel size is being calculated. Practice Support Subsidy is the only circumstance in which panel size is weighted. A GP with a weighted panel of 1,200 patients or more will be entitled to the full subsidy of 40 hours per week per subsidy and those GPs with weighted panels of less than 1,200 patients will be entitled to the subsidy on a pro rota basis (in 12 increments from 100-1,200). 

The current formula for calculating subsidy payments to GPs is based on a weighted average panel size for the previous twelve months (based on a rolling twelve months). This resulted in situations where a GP, at the HSE request, took over another panel and combines it with his/her own had to wait for twelve months to elapse before he/she received the full weighted average relevant to the now combined panel size. Under the terms of the 2019 GP Agreement, the calculation of practice support subsides for a GP in such circumstances should be based on the combined weighted average of both panels. It was agreed to extend this new rule set where, subject to HSE prior approval, a GP takes over the panel of a retiring/resigning partner.

GPs in partnerships or group practices, approved by CHO, may aggregate their panels when applying for the subsidy. However, only one full time (or equivalent number of part time hours) secretary and nurse/manager per GMS GP in the practice can be claimed. A GP in receipt of a Rural Practice Allowance is deemed to have a weighted panel of 1,200 for the purpose of computing the practice support subsidy.

For example:

In a two GMS GP partnership, with a weighted panel of 2,350, the practice will qualify for one full subsidy of 1,200 and one subsidy pro rata for 1,100.

1,200 = 40 hours per secretary and nurse/manager 

1,100 = (40 ÷ 12) x 11 = 36 hours per secretary and nurse/manager 

Total = 76 Hours per secretary, 76 hours per nurse/manager

You may combine hours of several part-time secretaries or nurses to claim the full subsidy. If you only have 55 combined nursing hours, you may claim for 21 hours for a practice manager. 

Payments for practice secretaries and nurses are tiered, based on ‘relevant experience’.  Relevant experience is the number of years for which a Practice Support Subsidy has been claimed (or registered with the HSE) for the employee in question. It can include time spent employed in other practices, so when submitting to the CHO for approval, ensure to outline previous experience and if possible proof of previous employment in other practices. It is also important to register all new staff with the CHO when they commence employment, even if the practice will not be claiming a subsidy for them at that time, as they will then climb the tiers for future subsidies. In the case of a practice manager, the first tier of nursing payment is made regardless of experience. See below for the full time allowances (as of July 2013). A subsidy cannot exceed the salary paid to the employee by the practice.

The GP may claim for both a practice secretary and a practice nurse, where the same person carries out both duties. You must submit a separate PSN/1 form for each post, outlining the hours spent on each role.

The CHO must be informed and approve any change in the contract of employment for an existing practice nurse, secretary or manager before the change is submitted to the PCRS. A completed PSN/1 form with a copy of the revised contract and all required supporting documentation should be submitted to the CHO. The same procedure applies when recruiting a new practice nurse, secretary or manager. The termination of employee contracts must also be notified to your CHO and PCRS immediately.

You may request a breakdown of your Practice Support Subsidy payments from the PCRS.

How to Claim Practice Support Subsidies

PSN/1 forms may be obtained from the CHO. The form is completed and sent with a contract of employment to the CHO for approval, along with supporting documentation if necessary. Registration of nurses requires their Bord Altranais certificate and proof of practice insurance cover for the nurse (page usually found within surgery insurance documentation). The GMS numbers of all the GPs in the partnership or group practice should be included on the form, in the section 'Reg. No(s)'. Upon approval, the form is sent by the CHO to the PCRS and page 3 will be returned to the GP for notification of approval. 

 

If the terms of employment change in respect of an employee, e.g. an increase in hours, a new PSN/1 form must be completed and submitted to the CHO. If there is an increase in salary, a letter must be sent to the CHO and a copy to the PCRS stating the salary increase and effective date.

 

If an employee is on maternity or sick leave and intends to resume duty, and a temporary nurse, secretary or manager is employed on the same contract terms, a letter should be sent to the CHO and PCRS stating the name of the employee and duration of employment.

 

Payment is made monthly one month in arrears. In January of each year, claim forms PSN/1P are sent to GPs. These forms must be completed and returned to the PCRS so that payments can be reconciled and continued.

Practice Staff Changes

The CHO must be informed and approve any change in the contract of employment for an existing practice nurse, secretary or manager before the change is submitted to the PCRS. A completed PSN/1 form with a copy of the revised contract and all required supporting documentation should be submitted to the CHO.

The same procedure applies when recruiting a new practice nurse, secretary or manager.

The termination of employee contracts must also be notified to your CHO and PCRS immediately.

Indemnity

Indemnity Refund

GMS GPs with panel size of 100+ can apply to their CHO for a refund of their Medical Indemnity Insurance. In order to claim a refund a GPs must submit a cover letter with their renewed Medical Indemnity Insurance certificate to their CHO.

 

Once a refund is approved, the CHO will forward claim to PCRS for payment. Details of payment will appear on the GP’s monthly Itemised Listing under ‘Capitation Summary’. The refund is calculated as a percentage of the net premium paid by the GP. The net premium is the gross premium less the benefit which the doctor receives as a tax rebate on the total amount.

Calculation of refund of medical indemnity premium:
(a) Doctor's premium (gross) = €6,629.44
(b) Multiplied by 90% (amount allowable by Revenue Commissioners) = €5,966.50

(c) Tax allowance (amount at (b) multiplied by the marginal rate of tax @ 40% ) = €2,386.60
(d) Net premium (i.e. amount at (a) less amount at (c)) = €4,242.84
(e) Refund based on panel size of 1,100 (i.e. 75% of net premium) = €3,182.13

Rural Practice Support Framework

Other Grants/Supports

Rural Practice Support Framework

The Rural Practice Allowance (RPA) was updated to become the Rural Practice Support Framework (RPSF). GMS GP practice units in an area which has a population of less than or equal to 2,000 within a 4.8km radius of the practice unit’s principal practice address will be eligible for the new Support Framework.

  • GP’s are required to live within a reasonable distance of the centre, subject to the prior approval of the HSE. This is an alternative to the previous arrangements where the GP was required to live in the immediate centre in which his/her practice is located.

  • An eligible practice unit may consist of a single handed practitioner, a partnership or a group practice. 

  • There will be no change to entitlements of a practice unit in the event of a new GP establishing a practice in their area.

  • The support also available in a modified form where there are two eligible GMS practice units in a qualifying area.

There are certain restrictions on qualifications for the Support Framework. These are:

  • Where there are three practice units or more in a qualifying area the Framework will not apply.

  • No practice unit may benefit from more than one Rural Practice Support Framework arrangement. A practice unit may not benefit from Rural Practice Support Framework and Rural Practice Allowance at the same time.

A GMS practice unit which meets the criteria above will be eligible for maximum allowable practice support subsidies, annual and study leave locum contribution and medical indemnity refund and a financial allowance of €22,000 per annum which is reimbursed every quarter i.e. January, April, July and October.

For further information (not including financial allowances as these have since been updated), please see IMO circular here.

Social Deprivation Practice Grant

In the 2019 GP Agreement, funding was allocated to support and maintain GP services for communities with a high degree of social deprivation. This grant is a practice support and does not attach to the individual GP but to the entire practice. The below are minimum criteria for application and do not in themselves confer eligibility for grant support:

  • The main centre of practice should be in an urban area. For clarity, urban is defined using the CSO definition as having a population of 1,500 or more.

  • Practices that are in receipt of rural practice supports are not eligible to apply for the social deprivation support.

  • Practices must have a minimum practice size of 350 GMS patients (for the purpose of this document a GMS patient is a holder of a Medical Card and excludes DVC holders) in order to be eligible to apply for the grant.

  • Practices must also have a minimum number of 200 GMS patients living in disadvantaged areas (using Pobal indices) to qualify for the allowance.

  • All patients in long-term care facilities are be excluded from this exercise as the address of the nursing home/care centre may create a distortion in terms of trying to assess the true socio/economic profile).

The grant amount is according to the number of patients in socially deprived areas:

200-400 = €7,500

401-800 = €10,000

800+ = €12,500​​

2021/2021 Process

  • Practices that received a grant from the 2020/2021 allocation and who have submitted the required vouched receipts for last year’s grant to the satisfaction of the HSE are not required to submit an application for the 2021/2022 process.​ Such practices will be assessed based on the details contained in their 2020/2021 application.

  • However, new applicants will be required to submit an application to the HSE. The application process for new applicant Practices for 2021/2022 is now open (details below).

  • The funding allocation for 2021/2022 covers the period 1st of July 2021 to the 30th of June 2022. Practices who are approved for a grant may include Relevant Costs (defined below) incurred during that period.

  • See 10th May 2022 circular here.

Relevant Costs/Vouching
The grant may be used for costs incurred in engaging additional medical personnel, additional nursing hours, additional key worker hours, additional counseling hours or additional practice admin hours (i.e. Relevant Costs). It shall be a matter for the practice to ensure that the staff are suitably qualified, registered with the relevant professional body (where required) and are appropriately indemnified (where appropriate). These are examples only and are not exhaustive but highlight that the grant must be used for additional services and associated costs.

  • However, for the avoidance of doubt the grant cannot be used to make payments to GPs in the practice who hold GMS Contracts.

  • It cannot be used for stand-alone equipment or other practice expenses, IT or running costs etc.

  • The grant cannot be used to cover costs of practice nurses and/or practice secretaries contracted hours for which a subsidy is already in payment.

    • However, the practice may include the cost of additional hours for such staff under this grant provision.

Practices previously in receipt of Social Deprivation Grant:

GP Practices who complied with the 2020/ 2021 process (i.e. submitted vouched expenses) and qualify for a grant under the 2021/2022 allocation process have received 50% of their total approved grant amount in the April 2022 payment and will receive the balance of the payment in the June payment.

  • A certified memo from their Accountant must be submitted to the HSE National Contracts Office for compliance purposes on or before the 31st of July 2022. Click the link for the Social Deprivation Certification Form for completion.

  • Failure to provide a certified memo as per the attached, may lead to recoupment of the grant allocated.

New Applicants - Application Process:

For new applicants they are required to complete the attached application form and return it to the National Contracts Office by email to urban.deprivation@hse.ie on or before 26th May, 2022. See circular here to view full application details and application form. 

  • As part of this application process, please refer to Mapping Guide in the circular. 

  • The HSE reserves the authority to have the mapping carried out in support of an application audited at a future date and the practice shall fully co-operate with the HSE in this regard.

  • A record of the application should be kept by the practice. An e-mail acknowledgement will issue to the practice from the National Contracts Office.

  • Only one application per practice should be submitted, as the grant is a practice support that applies to the practice and not to the individual GPs. Group practices, partnerships etc. should nominate one GP to complete the application and be responsible for it. The grant will be paid under the GMS number of the nominated GP.

Enhanced Package for GPs Working in Areas of Deprivation (Winter 2020/2021)

Additional funding for the initiative was secured as part of the 2020/2021 winter plan supports. The initial level of funding was to apply to 100 practices but with the enhanced package the initiative facilitated over 160 practices which on application met the eligibility criteria. In 2021, each practice received grants of either €13,000, €17,000 or €22,000 on a once off basis - the amounts are now as above.

Social Deprivation Practice Grant

Other Grants

The below grants are available in most areas. You will need to contact your Primary Care Unit to check availability and obtain application forms.

Immunisation Fridge Grant:

A once off grant of €1,270 per GMS practice is available to cover the cost of purchasing an immunisation fridge. This grant is only available if the practice has never received this grant, not the particular GMS GP. Following purchase of an immunisation fridge, you are required to submit detailed original invoices and receipts (not photocopies) for expenditure incurred. If a grant has previously been issued to your practice, you will not be reimbursed.

Height Measure/Weighing Scales Grant:

GPs with an Under 6’s contract can avail of a once off grant for the purchase of a height measure and weighing scales. Multiple GPs in the same practice can claim this grant (a separate invoice must be submitted for each). The maximum grant is €60 for a height measure and €126 for a weighing scales. Completed forms, accompanied by proof of purchase, should be returned to your Primary Care Unit. Only equipment purchased after the 30th June 2015 qualifies for contribution towards purchase and doctors seeking refund must hold an Under 6 contract. You must retain a copy of completed form for your records.

Other Grants
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