Holly Cairns
Question:769. Deputy Holly Cairns asked the Minister for Health to detail the measures his Department is taking to increase capacity in the GP service; and to ensure GPs can avail of cover when needed. [33873/23]
View answerGeneral Practitioner Services
Questions (769)
Written answers
GPs are self-employed practitioners and therefore may establish practices at a place of their own choosing. There is no prescribed ratio of GPs to patients and the State does not regulate the number of GPs that can set up in a town or community.
Under the GMS scheme, the HSE contracts GPs to provide medical services without charge to medical card and GP visit card holders. Currently there are 2,545 GPs contracted to provide services under the GMS Scheme.
While the HSE provides a contribution towards locum expenses for leave taking purposes to GPs under the GMS contract, as private practitioners, locum cover is arranged by the GP concerned as necessary. The relevant HSE Community Health Organisation will assist a GMS GP in providing locum cover where possible.
The Government is aware of the workforce issues currently facing general practice, including the limited access to GP services in certain areas, and is working to ensure that general practice is sustainable in all areas into the future.
Under the 2019 GP Agreement additional annual expenditure provided for general practice has been increased now by €211.6m. This provides for significant increases in capitation fees for participating GMS GPs, and new fees and subsidies for additional services. Improvements to GP’s maternity and paternity leave arrangements and a support for GPs in disadvantaged urban areas, have also been provided for. In addition, the enhanced supports package for rural GP practices was increased by 10%.
These measures will make general practice in Ireland a more attractive career choice and will see an increase in the number of GPs working in the State, improving access to GP services for patients throughout the country.
As was announced last week, agreement has been reached with the IMO to extend eligibility for GP visit cards to people who earn up to the median household income and to children aged 6 & 7. Approximately 500,000 additional persons are expected to become eligible for free GP care under this expansion, the largest expansion of access to GP care without charges in the history of the State. This new GP agreement includes additional capacity supports to enable the expansion and retention of staffing within general practice. It includes additional supports for GP Out of Hours services.
In addition, the number of doctors entering GP training has been increased in recent years, rising from 193 in 2019 to 258 in 2022, with 285 new entrants places made available for this year and 350 places now planned for next year. Furthermore, the joint HSE and ICGP programme to bring up to 100 non-EU GPs to Ireland in 2023 will help to quickly improve access to GP services, particularly in areas with limited access. It is planned to bring to Ireland up to 250 more non-EU GPs by the end of 2024.
Lastly, the strategic review of GP services is to commence shortly and will be completed this year. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice, including issues related to GP capacity, and will set out the measures necessary to deliver a more sustainable general practice into the future.
General Practitioner Services
Questions (770)
Holly Cairns
Question:770. Deputy Holly Cairns asked the Minister for Health the number of GPs practicing in each county, from 2019 to date, in tabular form. [33874/23]
View answerWritten answers
GPs are private practitioners, most of whom hold a contract with the HSE for the provision of health services such as the GMS contract for the provision of GP services without charge to medical card and GP visit card patients. As GPs are self-employed, they may establish practices at a place of their own choosing.
At the start of the year, 2,545 GPs hold a GMS contract and a further 571 GPs hold some other contract with the HSE for the provision of health services such as services under the Primary Childhood Immunisation Scheme or National Cancer Screening Service.
In relation to the number of GPs in each county with HSE contracts for the years 2019 to date, as this is a service matter I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible
Health Services
Questions (771)
David Cullinane
Question:771. Deputy David Cullinane asked the Minister for Health the timeline for extension of the free contraception scheme to girls aged 16; the timeframe for further extensions; what consultation his Department has undertaken to progress this issue; and if he will make a statement on the matter. [33881/23]
View answerWritten answers
The free contraception scheme for women was launched in September 2022, initially for women aged 17-25 who are ordinarily resident in Ireland. The scheme has now been expanded to include 26-year-olds from January 1st, 2023, and will be expanded further, in September, to include women aged 27-30. Approximately €32m has been assigned to support the scheme in 2023.Funding through Budget 2023 was also allocated to expand the scheme to 16 year-olds subject to legal advice and consultation across Government. The proposal is under consideration by the Department of Health’s Legal Unit regarding potential legal issues arising.
In order to provide comprehensive information from a range of key stakeholders to the legal advisors, a consultation exercise was commenced in 2022, with opinions sought from a number of Government Departments, the HSE's clinical consent experts, the Ombudsman for Children's Office, the RCPI Faculty of Paediatrics and representatives of the voluntary sector. The consultation process closed in early March, with input from the majority of stakeholders.
The proposal is under active consideration by the Department of Health’s Legal Unit regarding potential legal issues arising and may be referred to the Office of the Attorney General for a final opinion. Should legal advice confirm there are no legal impediments to extending the scheme to 16 year olds, a legislative amendment to Section 67E of the Health Act 1970 will be required.
General Practitioner Services
Questions (772, 773)
David Cullinane
Question:772. Deputy David Cullinane asked the Minister for Health the full details of the GP visit card expansion agreement announced on 4 July 2023, in tabular form; the categories and timelines for implementation; the first- and full-year cost of measures; and if he will make a statement on the matter. [33889/23]
View answerDavid Cullinane
Question:773. Deputy David Cullinane asked the Minister for Health the full details of additional supports agreed for GPs, in tabular form; the timeframe for implementation by measure; the first- and full-year cost of measures; and if he will make a statement on the matter. [33890/23]
View answerWritten answers
I propose to take Questions Nos. 772 and 773 together.
I propose to take PQ 33889/23 & PQ 33890/23 together.
As was announced on the 4th of July 2023, eligibility for GP visit cards will be extended to people who earn up to the median household income and for children ages 6 & 7 years old.
Approximately 78,000 children aged 6 & 7 who currently access GP care on a private basis will benefit from this measure.
Approximately 430,000 additional persons, who otherwise would have attended their GP on a private basis, are expected to become eligible for free GP care under this expansion, the largest expansion in GP care without charges in the history of the State.
Ensuring that more people can afford to visit their GP gives access to healthcare in the right place - one of the central commitments in the Programme for Government. It also removes the burden on people who may defer GP visits because they simply cannot afford it.
This expansion in care will be implemented with the agreement of the IMO and will put in place a series of capacity supports to allow GPs to recruit additional staff, as well as increases in fees to take account of the likely increase in demand for services. The total financial package will amount to approximately €130 million in a full year, and an estimated €31 million in 2023.
Agreed Fee changes
|
CapitationChildren aged 6 & 7 |
€100 |
|
Eligible children aged 8 – 12 |
€100 |
|
Eligible individuals aged 13 – 69 |
10% increase |
|
Capacity supportsAdditional staff |
Maximum of €15,000 per GP with a minimum panel size of 500 |
|
Retention practice support staff |
Existing subsidy increased to 75% of reckonable salary + employer’s PRSI |
|
ContraceptionLong-Acting Reversible Contraception |
Alignment of fees with Universal scheme rates |
|
Consultations |
1 consultation per annum per GMS patient aged 31 - 44 |
Revised Capitation Rates
|
Cohort |
Annual Capitation |
|
Child Patient Aged between 6 and 7 years (inclusive) |
€100.00 |
|
Child Patient Aged between 8 and 12 years (inclusive) |
€100.00 |
|
Male patient aged 13 years and less than 16 years |
€70.71 |
|
Male patient aged 16 years and less than 45 years |
€90.26 |
|
Male patient aged 45 years and less than 65 years |
€180.29 |
|
Male patient aged 65 years and less than 70 years |
€189.92 |
|
Female patient aged 13 years and less than 16 years |
€71.52 |
|
Female patient aged 16 years and less than 45 years |
€147.60 |
|
Female patient aged 45 years and less than 65 years |
€198.10 |
|
Female patient aged 65 years and less than 70 years |
€211.87 |
Revised GMS Contraception Rates
|
Applicable Services Rendered by a Registered Medical Practitioner on behalf of the Health Service Executive under the General Medical Services Scheme. |
|
|
Description |
Amount |
|
Consultation provided to an eligible woman aged between 31-44 years (inclusive) for the purposes of obtaining a prescription for accessing relevant products. |
€55.00 |
|
Fitting by a Registered Medical Practitioner of a relevant product that is a Coil for an eligible woman aged over 30 years. |
€160.00 |
|
Removal by a Registered Medical Practitioner of a relevant product that is a Coil for an eligible woman aged over 30 years. |
€50.00 |
|
Fitting by a Registered Medical Practitioner of a relevant product that is a contraceptive implant for an eligible woman aged over 30 years |
€100.00 |
|
Removal by a Registered Medical Practitioner of a relevant product that is a contraceptive implant for an eligible woman aged over 30 years |
€110.00 |
The estimated full year cost of implementing this agreement is set out below.
|
Item |
FYC (€m) |
|
Capitation fees |
€41.34 |
|
Out-of-Hours |
€2 |
|
Capacity Supports |
€30.71 |
|
Contraception |
€5.54 |
|
Median Income Card Costs |
€50.80 |
|
Total |
€130.39 |
The applications process for patients will be introduced on a phased basis.
- Applications for children aged 6 & 7 will open on 11 August 2023.
- Applications for the first group under the median-income expansion will commence on 11 September 2023.
- Applications for the full group under the median-income expansion will commence on 13 November 2023.
The new capitation rates will be applicable from 1st August 2023 for GPs that sign up to the new agreement by 9 August.
Question No. 773 answered with Question No. 772.
Health Service Executive
Questions (774)
Peadar Tóibín
Question:774. Deputy Peadar Tóibín asked the Minister for Health the number of cases taken against the HSE/letters of claims issued, regarding or alleging the misreading of smear tests in each of the past ten years and to date in 2023. [33891/23]
View answerWritten answers
The State Claims Agency (SCA) has a statutory remit to manage personal injury claims on behalf of Delegated State Authorities including the Health Service Executive. I have been informed by the SCA that the information below has been extracted from the National Incident Management System (NIMS) according to the below criteria.
The information contained in this report has been extracted from the National Incident Management System (NIMS) and is accurate as of 30/06/2023.
Criteria used
Claims received between 01/01/2013 to 30/06/2023.
Cervical Cancer NSS claims received between 2013 & 2023 YTD
|
Claim Received Year |
Number of Claims |
|
2013 |
0 |
|
2014 |
1 |
|
2015 |
0 |
|
2016 |
2 |
|
2017 |
1 |
|
2018 |
86 |
|
2019 |
52 |
|
2020 |
95 |
|
2021 |
103 |
|
2022 |
39 |
|
2023 YTD |
6 |
|
Total |
385 |
Table 1: Claims received between 01/01/2013 & 30/06/2023
79 of the 385 cervical claims received are associated psychological claims brought by family members
Definitions:
National Incident Management System (NIMS):
Incidents (which include claims) are reported using the “National Incident Management System”, hosted by the State Claims Agency (SCA). An incident can be a harmful Incident (Adverse Event), no harm incident, near miss, dangerous occurrence (reportable circumstance) or complaint.
Claim:
A claim refers to notification of intention to seek compensation for personal injury and/or property damage where it is alleged the State was negligent. The application may be in the form of a letter of claim, an InjuriesBoard.ie application, or a written/oral request.
Claim Received Year:
Official date that the claim was received on NIMS.
Health Services
Questions (775)
Peadar Tóibín
Question:775. Deputy Peadar Tóibín asked the Minister for Health the number of CervicalCheck smear test samples sent abroad to foreign laboratories for testing in each of the past five years and to date in 2023; and if he can provide this figure as a percentage, in each year, of the number of smear tests carried out by CervicalCheck during that time. [33892/23]
View answerWritten answers
As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
Health Services
Questions (776)
Peadar Tóibín
Question:776. Deputy Peadar Tóibín asked the Minister for Health the number of women who took cases to the CervicalCheck Tribunal; the number of cases which were settled in the tribunal; and if he will make a statement on the matter. [33893/23]
View answerWritten answers
Twenty-six [26] claims (of which two were combined) have been lodged with the Tribunal since March 2021. Twenty [20] claims were lodged by women and six [6] claims were lodged by or on behalf of the statutory dependants of women. Fifteen [15] claims have settled between the parties. Seven [7] cases were the subject of a Notification issued pursuant to s. 12 of the CervicalCheck Tribunal Act, 2019 which means that the claimants were notified by the Tribunal that it was not in a position to hear and determine the claim for want of either respondent or third-party consent in circumstances where such consent was either not forthcoming or had been withdrawn. One [1] case was struck out when an ‘Unless Order’ came into effect. Three [3] cases remain pending and are at an advanced stage in the proceedings.
Health Services
Questions (777)
Peadar Tóibín
Question:777. Deputy Peadar Tóibín asked the Minister for Health the reason the terms of reference provided by his Department for the Expert Panel Review of Cervical Screening (details supplied) only sought an examination of slides of women who developed invasive cervical cancer, rather than seeking to determine if there had been missed opportunities to identify abnormal cells in the slides of women who had not at the time of the review developed cancer, but may still have had their slides misread; and if he will make a statement on the matter. [33894/23]
View answerWritten answers
As the Deputy will be aware, the RCOG expert panel provided an independent analysis of their slides to women diagnosed with cervical cancer from 2008 to 2018, who had been screened by the CervicalCheck programme and produced an Aggregate Report, published in December 2019.
The key conclusions of the RCOG Expert Panel were that the CervicalCheck programme has undoubtedly saved the lives of many of those who participated in the Review; that the programme is working effectively and that women can have confidence in the programme.
In July 2023, the World Health Organization’s International Agency for Research on Cancer (IARC) published a report on Recommendations of Best Practices in Cervical Screening Programmes, which includes best practice on audit, quality assurance and communication.
One international best practice approach to quality assurance is for a programme to undertake an audit of invasive cervical cancers (after diagnosis and confirmation of cancer) and to review the entire screening pathway of these cases to determine if there were opportunities for learning and improvement.
By reviewing the slides of women who had developed cancer after a negative screening test / negative triage, the RCOG review showed that Ireland’s false negative rate was within international norms. It found that Ireland’s cervical screening programme is effective in identifying the majority of people amongst an apparently healthy population who may have an increased chance of cancer.
The National Screening Service and CervicalCheck have been developing an audit and communications process in line with the WHO/IARC international best practice, and in line with Dr Scally’s recommendations.
It is important to note that audit is one element of a broader Quality Assurance or Quality Improvement exercise of any screening programme. The purpose of an audit is not to examine individual care. An audit looks at system-level data and audit recommendations feed into ongoing quality improvement.
A new patient-requested review process has been developed in CervicalCheck, and designed in conjunction with patients, including the 221+ Group. Under the Patient Safety Act 2023, it will be mandatory to fully disclose the results of these reviews to women. These new personal cervical screening reviews will be offered to women, who have previously attended screening, after they get a diagnosis of cervical cancer.
It is important to remember that population-based screening programmes are for healthy people without symptoms. If anyone becomes aware of symptoms, or if they have concerns or worries, they should contact their GP who will arrange appropriate follow-up care.
Departmental Expenditure
Questions (778)
Peadar Tóibín
Question:778. Deputy Peadar Tóibín asked the Minister for Health the amount paid, per year, to a company (details supplied) by the HSE and his Department; the details of the cases being handled by year, by the company; the cases still to be resolved by the company; and a timeline for when these cases are expected to be resolved. [33895/23]
View answerWritten answers
Following a review of records, my Department has used the company referred to once in 2015 and details are supplied below -
|
Date paid: May 2015 |
Details : HR Training |
Amount: €1,230 |
I have asked the HSE to respond directly to the Deputy.
Medical Cards
Questions (779)
David Cullinane
Question:779. Deputy David Cullinane asked the Minister for Health to outline, in tabular form, the cost of increasing the medical card income threshold by €5,000, €10,000, €15,000 and €20,000; to further breakdown the cost by income thresholds and the number of additional people covered by increasing each threshold; and if he will make a statement on the matter. [33899/23]
View answerWritten answers
Eligibility for a Medical Card is primarily based on a financial assessment which is conducted by the HSE in accordance with the Health Act 1970 (as amended). The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn a week and still qualify for a card. It is specific to the individual’s own financial circumstances.
Persons aged 69 and under are assessed under the general means tested medical card thresholds which are based on an applicant’s household income after tax and the deduction of PRSI and the Universal Social Charge. Certain expenses are also taken into account. Persons aged 70 or older are assessed under the over 70s medical card income thresholds which are based on gross income. It should be noted that in November 2020, the weekly gross medical card income thresholds for those aged 70 and over were increased to €550 per week for a single person and €1,050 for a couple. This increase ensures that a greater proportion of those aged 70 and over now qualify for a medical card. Furthermore, the Deputy may be aware that, since 2015, every individual aged 70 and over has automatic eligibility for a GP visit card.
As provided for in Budget 2023, eligibility for GP visit cards will be extended to people who earn up to the median household income and to all children aged 6 & 7. Approximately 500,000 additional persons, who otherwise would have attended their GP on a private basis, are expected to become eligible for free GP care under this expansion. The extension of GP visit cards to children aged 6 & 7 will commence on 11 August. The extension of cards to those who earn the median household income or less will commence on 11 September and will be completed in two phases with the second phase commencing on 13 November.
Modelling scenarios normally used to determine estimated cost increases for medical card eligibility will likely be affected by these planned changes. Per request by the Deputy, it will be necessary for there to be opportunity for the extension of eligibility for GP services to commence and become operationalised before being able to accurately reflect the impact of this significant change in eligibility on estimated costs for amendments to medical card income thresholds more generally.
Hospital Services
Questions (780)
David Cullinane
Question:780. Deputy David Cullinane asked the Minister for Health the estimated cost of cutting private activity in public hospitals by 10%, 20% and 30%; and if he will make a statement on the matter. [33900/23]
View answerWritten answers
The removal of private practice from public hospitals is a core principle of Sláintecare, ensuring that public healthcare facilities are used for public patients only, and that public patients can access public hospitals based on clinical need. Currently, the Irish Public Health System provides for two categories of eligibility for persons ordinarily resident in the country, i.e. full eligibility (medical cards) and limited eligibility. However, under Section 52 of the Health Act 1970, a person may waive their eligibility to public services and opt to be treated privately. In 2022, the public and publicly funded hospitals received approximately €432 million euro in income from the private patient charge levied under section 55 of the Health Act 1970.
Health Services
Questions (781)
David Cullinane
Question:781. Deputy David Cullinane asked the Minister for Health the estimated cost of reducing external professional fees in public healthcare by 10%; and if he will make a statement on the matter. [33901/23]
View answerWritten answers
As this question relates to expenditure at an operational level, I have referred it to the HSE for direct response.
Health Services
Questions (782)
David Cullinane
Question:782. Deputy David Cullinane asked the Minister for Health the estimated cost of reducing external consultancy fees or spend in the healthcare system by 10%; and if he will make a statement on the matter. [33902/23]
View answerWritten answers
As the question relates to expenditure at an operational level I have referred it to the HSE for a direct response.
Health Services
Questions (783)
David Cullinane
Question:783. Deputy David Cullinane asked the Minister for Health the estimated cost of reducing agency spend in the public healthcare system by 5%, 10% and 20%; and if he will make a statement on the matter. [33903/23]
View answerWritten answers
As this is an operational matter for the Health Service Executive, the HSE has been asked to respond directly to the Deputy.