GMS

Examples (vs Pre-2023 Agreement Subsidies)

 

A)

Weighted panel size = 1369 patients

Nurse = 9 years experience

Hours per week: 35 hours

Salary: €52,000

 

Note: The GP is entitled to claim the maximum amount of 1200/1200 for their weighted panel (1200 is the maximum). The maximum salary tier for a nurse is 4+ years.

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Under the new system the GP would be reimbursed as follows:

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Maximum Refundable Salary Amount: €52,000

+ PRSI 11.05%: €5,746

Max. Refund: €57,546

​x Subsidy Ceiling Amount: €43,309.50 (75% of Max. Refund)​

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Claimable Subsidy Amount: €43,309.50 x 1200/1200 = €43,309.50

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The GP would have received a subsidy refund of €27,822.72 under the old system.

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B)

Weighted panel size = 795 patients

Nurse = 6 years experience

Hours per week: 20 hours

Salary: €30,000

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Note: The GP is only entitled to claim 700/1200 pro-rata, until they get above 800 patients on their weighted panel. The maximum salary tier for a nurse is 4+ years.

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Under the new system the GP would be reimbursed as follows:

 

Maximum Refundable Salary Amount: €52,500 x 20/35 = €30,000

+ PRSI 11.05%: €3,315

Max. Refund: €33,315

x Subsidy Ceiling Amount: €24,986.25 (75% of Total Refundable Amount)

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Claimable Subsidy Amount: €24,986.25 x 700/1200 = €14,575.31

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The GP would have received a subsidy refund of €9,455.50 under the old system.

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NEW GRANT

Under this new provision qualifying GPs (those with a weighted panel of 500+) will be eligible to claim an annual Grant of €15,000, specifically for staff hired or additional hours created after July 1st, 2023. This grant is a permanent, reoccurring grant and is open to all GPs who enroll in the agreement. Payment will be monthly from the PCRS, as per the practice subsidies through the pink sheets (not in one lump sum).

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The grant can be allocated for various roles, including Practice Administrator, Practice Nurse, Practice Manager, or the newly introduced position of General Practice Assistant, with the condition that the role or additional hours take effect no earlier than July 1st, 2023. While a practice may not have an immediate need to hire additional staff, they can avail of the grant in 2024 or later.

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However, the grant cannot be used to meet the shortfall between the practice support subsidy in payment and the cost to the practice of employing the practice staff member.

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Pooling

Pooling is an option for group practices with multiple GPs, each having a weighted panel of 500 or more. For instance, in a four-GP practice, where each GP has a weighted list exceeding 500, the grant pool would amount to €60,000 (4 * €15,000).

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Practices not in a formal partnership may collaborate to pool the grant, allowing for the potential sharing of a full-time employee across practices, provided that no practice is more than 30 kilometers away from another in the proposed configuration. This collaboration is generally limited to five GMS practices per configuration, with exceptions considered at the discretion of the HSE following consultation with the IMO.

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Maximum Refundable Salary Amounts

Maximum refundable salary amounts still apply to the new grant. For instance, if a practice with €60,000 at their disposal with the new grant hires a full-time practice administrator at a salary of €42,000, they can claim a maximum of €30,459 (this is the maximum refundable salary amount plus employer's PRSI).

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Remainder of Grant

Any remaining grant funds after hiring new staff or adding hours can be used for further recruitment or extension of hours. 

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Part Time

Refunds under the new grant are calculated based on the total maximum refundable amount (the maximum refundable salary plus PRSI) and the number of hours worked. It is not subject to weighted panel size pro-rating. 

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Even if the GP employs the General Practice Assistant on a higher salary the maximum refund remains the same, as reimbursement cannot exceed the maximum refundable salary amount.

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More examples from the HSE below.

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Example 1

4 doctor group practice

Each doctor in this practice has a weighted GMS panel of over 500 patients. They are entitled to access €60,000 under the new system. However, maximum refundable amounts per grade as set out above apply.

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This practice may employ a full time (35 hours or greater)) nurse paying a salary of €52,500 and employers PRSI of €5,801.25 (total €58,301.25) and be reimbursed the full amount. In the event that the practice was paying a salary of €62,000 they would still only be able to take the maximum nurse subsidy amount of €58,301.25. In the event they were paying €45,000 then the maximum grant payable would be €49,972.50 (€45,000+Emp PRSI €4,972.50).

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Example 2

A single handed GP wishing to employ a nurse for 0.4 WTE (14 hours per week) and paying the nurse €50,000 WTE salary (€20,000 actual salary) would be reimbursed €15,000 towards the cost of the nurse.

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Example 3

A single handed GP wishing to employ a nurse for 0.2 WTE (7 hours per week) and paying the nurse €10,000 actual salary would be entitled to claim €10,000 plus the employers PRSI.

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Example 4

A GP wishing to employ a practice assistant for 0.4 WTE and paying a WTE salary of €35,000 (actual salary €14,000) would be entitled to be reimbursed

1. 1.)  €32,000 (maximum allowable for grade) *14/35-€12,800

2. 2.)  €12,800 +Emp PRSI (8.8%)=€13,926.40

3. 3.)  GP is entitled to €13,926.40 rebate

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New Role - General Practice Assistant

​The newly introduced position of General Practice Assistant (GPA) is claimable under the new grant only and will be subject to a Maximum Refundable Salary of €32,000 (this plus PRSI will determine the refund). If the total annual cost of employing the General Practice Assistant is less than the grant amount, the lower amount will be eligible for claiming. Similar to other roles covered by the new grant, the claimable grant amount will not be pro-rated based on the General Practitioner's panel size.

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According to the IMO, the purpose of the role is to carry out certain basic tasks which would improve patient experience, patient flow through the practice, practice efficiency and free up nurse and doctor time for more clinical tasks.

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A non-exhaustive list of the duties and responsibilities that such a role could undertake is set out below. Each practice will have its own requirements but at all times General Practice Assistants will have the necessary training and indemnity for the tasks they are required to do.

 

Duties and Responsibilities (as set out by the IMO):

• observing, monitoring and recording patients' conditions by taking temperatures, pulse, respirations and weight

• communication with patients, relatives and carers

• assisting with clinical duties

• personal care including infection prevention and control, patient communication and overall

  reassurance, comfort and safety

• promoting positive mental/physical/nutritional health with patients

• checking and ordering supplies/restocking consultation rooms

• covering administrative duties

• taking urine samples

• sterilising equipment

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Maternity Leave Support

GMS GPs who meet the qualification criteria for Practice Support Subsidies will be eligible to claim Practice Support Subsidy for a member of the Practice Team, in respect of whom the GP is either in receipt of a practice support subsidy or the additional Practice Capacity Grant, as described above, during the period when such member of staff is on Maternity Leave.

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In circumstances where the GP is receiving a Subsidy towards the cost of employing the staff member in question the GP will be eligible to claim the weekly value of the Claimable Subsidy Amount for the 26 weeks of the maternity leave period less the value of the Statutory Maternity Benefit payable to the Staff member.

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Where the GP is in receipt of the new Practice Capacity Grant then he/she will be eligible to claim the equivalent of 26 weeks of the annual grant amount in payment for the staff member on maternity leave abated by the value of the Statutory Maternity Benefit payable to the Staff member.

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In circumstances where the cost to the GP of maintaining the salary of the staff member during the maternity leave period is lower than the Net Claimable Subsidy Amount, then the lower amount will be claimable.

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.

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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.

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

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

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

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Note on taking over the panel of a retiring/resigning GP partner:

The 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 combined 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. Such partnership arrangements are ones which have been registered with the HSE.