Other State Contracts

There are a number of additional state contracts other than the GMS under which GPs provide services to patients. These contracts are available to all eligible GPs regardless of whether they hold a GMS contract. Contracts are issued by the CHO. 

The various schemes are laid out below.

GP Practice Management - Female Health

FEMALE
HEALTH

GP Practice Management Immunisations & Vaccinations

Immunisations &
vaccinations

GP Practice Management - Care Programmes

care 
programmes

GP Practice Management - Medical Certification

Medical 
CERTIFICATION

Maternity & Infant Care

This scheme provides services related to pregnancy care for mothers and infants up to six weeks post partum. All GPs (including non-GMS contract holders) are entitled to apply for a contract with the HSE to provide these services. All expectant mothers who are ordinarily resident in Ireland are eligible for services under the Scheme free of charge (patient entitlement to this service is not means tested). 

Elective home deliveries do not form part of this service and GPs cannot provide antenatal visits. Alternative arrangements must be organised through the maternity hospital. 

 

The scheme provides a number of visits as follows:

First Pregnancy = initial examination + 5 antenatal visits + 2 postnatal visits = €242.85

Subsequent pregnancies = initial examination + 6 antenatal visits + 2 postnatal visits = €270.52

If the expectant mother has a pregnancy related illness, e.g. diabetes or blood pressure issues (hypertension), you may claim for up to 5 additional visits. Care for other illnesses which they may have at this time, but which are not related to their pregnancy (eg. chest infection), is not covered by the Scheme.

If a patient miscarries, you can claim an additional visit for the miscarriage visit (if there is one) and one additional visit for a follow-up check.

Doctors are paid fees in respect of maternity care as follows:

 

Claiming Process

The Maternity and Infant Care Scheme has been centralised to PCRS for online claiming through GP Application Suite.

This functionality enables GPs to register and submit claims online for swift processing. Valid claims are paid in monthly PCRS payments as opposed to waiting until the full package of care has been provided and submitting to local offices for manual processing.

 

A user guide and FAQ is available in the PCRS GP Application Suite. 

  • For online GPs: the user guide and FAQ is available in the 'Maternity and Infant' tab on the GP Suite, under the ‘Help’ heading.

  • For manual GPs: this can be found in the 'Information' tab of the GP suite, under the 'Maternity and Infant' heading.

Doctors who have not opted for on-line registration and claiming should submit all new registrations for manual processing to Primary Care Eligibility & Reimbursement Service (PCERS), J5 Plaza North Road, Finglas, Dublin 11, D11 PXTO. For manual claims information, see circular here.

For queries, there is a dedicated support team at pcrs.maternityandinfant@hse.ie or 01 864 8600.

National Cervical Screening Programme (NCSS)

The programme provides free smear tests for:

  • 25 to 29 years old – every 3 years

  • 30 to 65 years old – every 5 years

For a GP to receive payment (€49.10), they must hold a National Cancer Screening Contract at the time the smear test was performed. All completed paperwork must be sent directly to National Cancer Screening Services. The PCRS receive a monthly file detailing the reimbursement for each GP.

Details of paid National Cancer Screening Services claims will be reported on the ‘Detailed Payment Listing’. Any queries relating to payments or non-payments should be directed to National Cancer Screening Services, phone number 061 461390.

More information on the signup process is available here

More information on the scheme is available here.

Termination of Pregnancy

In order to claim payment for termination of pregnancy services the registered GP must submit online claims only to the PCRS through the GP Application Suite. These services are available to those who hold full or limited eligibility and are ordinarily resident in the state. When claiming online input the patients’ medical card number or GP Visit card number or PPSN to verify established eligibility for a public service. Once relevant details have been captured you will be prompted to either save and print in order to capture third party verification or alternatively STC/SS/OOH claim form can be signed and retained for audit purposes.

The Clinical Guidelines and further information are available via the GP Application Suite under the ‘Information’ tab.

GPs who have an interest in providing this service, can access information and sign up form here.

 
 
 

National Free Contraception Service Scheme

All women aged 17-25 (GMS/DVC/Private) who are ordinarily resident in the State are eligible for the scheme, from the date of their 17th birthday to the day before their 26th birthday. Where a woman is now over 26 but had a contraceptive device fitted before her 26th birthday and is now seeking to have it removed, such removal is also covered under the scheme.
 

You are deemed ordinarily resident if you have been living in the State for at least a year or you intend to live here for at least one year. Patients will need to provide their full name, address, date of birth and PPSN to access the scheme. All those aged 17-25 and ordinarily resident in the State are eligible to apply for same.

This scheme is expected to be rolled out further to other age groups in the coming years.

 

Types of Contraception

All contraceptive options which are currently included on the GMS Reimbursement List are covered. This includes contraceptive pill, patch and ring, Mirena, Kyleena and and Jaydess (coils, also known as intrauterine devices or systems; IUS, IUD), Implanon (contraceptive implant) and Depo Provera (contraceptive injection). Emergency contraception is also covered under the scheme. If a patient attends the GP for this, the GP may prescribe same and claim a consultation fee. However, similar to current practice, emergency contraception may be accessed directly from the community pharmacist without attending a GP (in this case, free of charge under the scheme).

 

The Copper Coil is not currently on the GMS Reimbursable List, although it is expected to be added in the coming months. In the meantime, GPs may claim the consultation fee and insertion fee for the Copper Coil but the patient will have to purchase the Copper Coil themselves.

Fees

You cannot charge the patient for any aspect of care administered under this programme. The cost of Implanon and Coil insertion packs and consumables is borne by the GP and is encompassed in the fees payable.

STC Codes

GPs will require the name, address, PPSN and date of birth of the Eligible Person. Claiming will be through the PCRS Suite and will be claimed in the manner that you would normally claim a special item of service. If the person does not have a PPSN you will not be able to claim.

*Where necessary, follow up consultation in relation to the fitting by a Registered Medical Practitioner of a long-acting reversible contraceptive device.

Prescriptions

GPs should use a private prescription and should not use a GMS prescription. You may use HealthLink to send the prescription electronically should you wish. Where possible it is asked that GPs write in the free text portion of the prescription 'FREE CONTRACEPTIVE SCHEME', to help with smoother running of the programme in the initial stages.

Patient Pathway

  • The Patient will have an initial consultation with their GP to discuss the contraceptive options appropriate to for their needs.

  • At the end of this consultation, typically the GP will prescribe the preferred method of contraception. GPs may claim a consultation fee for this consult.

  • The patient will then attend at the pharmacy where they will be dispensed the necessary contraceptive. Patient will need to have their PPSN and DOB on hand at the community pharmacy also. The medication or device is dispensed to the patient free of charge.

  • If the patient is dispensed an implant or coil, the patient will then attend the GP surgery (can be same day) for insertion or fitting of same. The GP does not claim a consultation fee for this but claims the relevant procedure fee.

  • For the coil, there is a follow up consultation, typically at six weeks, for a string check.

  • In all cases if there are complications (e.g., irregular bleeding, excessive cramping and pain, significant mood alteration or other side effects experienced with the contraceptive method initially chosen) and an additional consultation is deemed medically necessary, this is allowable under the scheme and may be claimed as a consultation.

  • Typically, however, the number of consultations will be two per annum for the contraceptive pill, patch or ring. For the coil, it would be expected that there would be two consultations (the initial consultation and 6-week string check) in addition to the fitting of the device. For Depo Provera, consultations will be necessary every 12 weeks. For emergency contraception, one consultation would be necessary.

Patients Outside the Age Cohort

  • Those patients who have a GMS/DVC card can still be claimed under the GMS system using the relevant LARC codes and using a GMS prescription.

  • Private patients outside of the age cohort will continue to be treated as they have been prior to the commencement of the scheme.

  • The exception to this is those patients aged 26 and over who had a LARC fitted before their 26th birthday. In such circumstances removal of the LARC may also be claimed under the new scheme notwithstanding that the patient has passed their 26th birthday. To note, no further consultations / fittings of new a new coil, etc. would be covered as the patient is no longer otherwise eligible for the scheme.

Additional Notes:

  • If you have an arrangement with another GP for fitting LARCs: the GP who has the initial consultation may claim the consultation fee and the GP who fits or inserts the contraceptive device may claim the procedure fee. The GP inserting the device should also claim any follow up consultation relating to the device.

  • If another GP fitted the LARC, but attends a different GP for removal: the GP may perform the removal and claim the appropriate fee for same. It is expected, with this age cohort in particular, that there will be some geographic movement due to attendance at college, moving for work etc.

  • Failed insertion: With regard to the coil, it is recognised that there are times where it may not be possible for the GP to insert the coil. Typically, these consultations are longer and more difficult than those where the coil is successfully fitted. A GP may claim the fitting fee in this instance. In such cases the GP may wish to prescribe an alternative form of contraception or refer the patient to a specialised Gynaecology service and this is encompassed in the fitting fee claimed.

  • Removal/Insertion same day: Yes, you may remove and insert a device on the same day. In that case you will claim the removal fee and the fitting/insertion fee.

  • Contraception consult/insertion same day: Yes, if you are able to accommodate the patient you may have the consultation on contraception options and the patient may then attend the community pharmacist and bring the device to the surgery on the same day for fitting.

  • Contraception advice as part of a termination of pregnancy (TOP) consultation: You may not claim an initial consultation fee under this scheme for this consult, as such advice is covered under the TOP contract and is encompassed by the fees attaching to same. However, where you are fitting a LARC you may claim the insertion fee for same.

Contract

  • You can access further information and the Free Contraception Service Contract here.

  • If you are a fully private GP and have no state contracts, you may sign up to the scheme, but you should not commence services until you have clearance from the HSE. This process may take longer if you have no existing state contracts as you will be required to undergo Garda Vetting and verification through the HSE with additional information (practice account etc) to establish you as a GP under the scheme.

 

Primary Childhood Immunisations

The National Primary Childhood Immunisation Scheme provides for immunisation free of charge to all children with the aim of eliminating, as far as possible, such conditions as Diphtheria, Polio, Measles, Mumps, Rubella and more recently Meningococcal C Meningitis, Rotavirus and Men B.

 

Fees are payable for the registration of infants and each primary immunisation, i.e. Diphtheria/Tetanus/Pertussis, Hib, Polio, MMR and Meningitis C. A bonus is paid if target levels are met for the infant population registered by each practice. For a GP to receive payment, he/she must hold a valid Primary Childhood Immunisation Contract at the time the immunisation was administered.

Primary Care and Reimbursement Service reimburse GP’s from following former Health Boards:

  • Western

  • Mid-Western

  • Southern

  • Midland

 

GP’s outside these regions are reimbursed directly from their own appropriate Community Health Organisation (CHO). Completed claims paperwork (generated from GP practice management system) must be sent directly to the Immunisation Unit of the CHO in all regions. PCRS receive a monthly file detailing the reimbursement for each GP within the areas in which they reimburse. Details of paid Primary Childhood Immunisation claims are reported on a ‘Detailed Payment Listing’ each month. Any queries relating to payments or non-payments need to be directed to the Immunisation Unit within your CHO.

Fees payable are on page 39 of Statutory Instrument No. 692 of 2019.

The schedule as of 2020 and abbreviations are available here.

HSE information regarding vaccines is available here.

Vaccination guidelines for General Practice are available here, including information relating to parental consent.

There is a grant available for the purchase of an immunisation fridge, see here.

Adult Vaccinations

Adult vaccinations are claimed through the PCRS GP Suite. Fees are briefly outlined below, for more detailed information see Statutory Instrument No. 685 of 2020.

GPs can provide vaccinations for public health purposes, such as in the event of an outbreak e.g. measles or meningococcal B disease. GPs can also provide vaccinations for occupational health e.g. provision of hepatitis B vaccine for healthcare workers, and pregnant women. The fee for these is as per 'Public Health Advised Vaccinations' unless otherwise specified.

HSE information regarding vaccines is available here.

Vaccination guidelines for General Practice are available here​.

COVID19 Vaccines are shown on the PCRS Itemised Claims Listing as Special Service code 'AU' for 1st dose, 'AV' for 2nd dose or 'AZ' for booster and display the patient's PPSN as the identifier. 

 
 
 

Domiciliary Palliative Care Scheme

The scheme provides a once-off payment of €223.26 to GPs who provide domiciliary care (for both GMS and private patients) for the final phase of the following terminal illnesses:

  • Advanced Cancer

  • Terminal HIV/AIDS

  • Progressive neurological conditions, i.e. Motor Neurone Disease, Multiple Sclerosis.

 

To claim for palliative care, at least one home visit should be completed by the GP.

 

The procedure for claiming and conditions approved for this programme may vary in each HSE Region, therefore it is advisable to contact your Primary Care Unit (PCU) to establish what the current guidelines are.

When the GP begins palliative care the completed notification form (green) should be forwarded to the PCU for approval. The PCU will notify approval.

 

The GP can claim payment when palliative care has ended (on the date of the patient's death) or two months after the palliative care began – whichever comes earlier. At this time the GP must complete the claim form (blue) and forward to the PCU for authorisation of payment.

 

Alternatively, some practices submit both forms for approval and payment to the PCU on the death of the patient (as sometimes palliative care does not last for a long period of time).

Claiming Process

Heartwatch

The National Heartwatch Programme is being phased out by the Chronic Disease Management (CDM) programme. You can no longer register new patients on the scheme.

The below fees apply to patients already registered who do not yet qualify for CDM.

Hep C & HIV Agreement

This contract is provided in respect of the treatment by the practice of Hepatitis C and HIV patients. It relates specifically to patients identified as a result of the issues arising from the Blood Transfusion Board reports and investigations. Doctors are remunerated for treating HAA cardholders per visit and not on the basis of an annual capitation fee. A fee of €30.53 payable for surgery visits, while a domiciliary rate of €40.27 is payable. 

Therefore a Special Treatment Services form should be signed by the client to enable the General Practitioner to be remunerated in respect of the consultation. The forms are supplied by the PCRS, and returned there when making claims.

Private prescriptions must be issued with authorisation number, not GMS prescriptions. 

 

Patients are entitled to GP, nursing and home help services as well as counselling services, regardless of income. A patient is entitled to have these prescriptions dispensed by a Pharmacist.

Methadone Maintenance Programme

Under the scheme, Methadone is prescribed by GPs for approved clients. GPs are reimbursed a patient care fee i.e. one patient care fee per patient per month and assigned to the GP on the 1st of the month. The fee is according to the GP contract level:

  • Level 1 – €159.97 - GP cares for a transfer patient who have been stabilised in the clinic and is now on a maintenance treatment

  • Level 2 – €176.43 - GP may take on clients for stabilisation and maintenance in general practice

The Central Treatment List maintains information on all persons eligible under Methadone Treatment Scheme. A monthly extract is made available to Primary Care Eligibility and Reimbursement Service for reimbursable purposes.

 
 
 
 

Medical Certifier

GPs may provide medical certificates and reports in respect of the Department of Social Protections's illness related schemes, including incapacity to work certificates and applications for allowances. Fees are outlined below.

Incapacity to Work Certs:

  • MED1

  • MED2

Medical Reports include:

  • MR2

  • MR33

  • Invalidity Pension

  • Disability Allowance

  • Disablement Benefit

  • Partial Capacity Benefit*

  • (*to facilitate return to work (if have reduced capacity to work) and continue to claim) Career’s Allowance/Benefit

  • Carers Support Grant

  • Domiciliary Care

  • Household Benefit

  • Free Travel

Queries can be sent to gpqueries@welfare.ie.