RTE Radio Morning Ireland- 22nd September 2011
Irish Medical Organisation

RTE Radio Morning Ireland- 22nd September 2011

Dr Ronan Boland spoke with Rachael English on GP fees for social welfare benefit certs


The below is a transcript of the radio interview:

Rachael English:
 
The Department of Social Protection is paying GPs and other certifying doctors almost half a million euro per week for completing and signing medical certificates.  Under the Illness Benefit Scheme doctors get paid €8.25 from the State for each certificate they sign for people who are out of work for more than three days, now this is separate to patient consultation fees.  Dr. Ronan Boland is the President of the Irish Medical Organisation and he joins us on the line.  Good morning.
 
Dr. Ronan Boland: (President, IMO)
 
Good morning Rachael.
 
Rachael English:
 
Now at a time when the State is desperate to save money, and we’ve just been hearing about it there, how can this payment be justified?
 
Dr. Ronan Boland:
 
Well Rachael before dealing directly with that question I feel that I must, on behalf of the IMO, respond to the remarks of Deputy Humphries which were carried extensively on RTE Radio and TV News last night.
 
Rachael English:
 
Just to clarify, this is Labour’s Kevin Humphries, the man who received this information through a Dail question.
 
Dr. Ronan Boland:
 
Correct, the information is in the public domain anyway but the Deputy alleged that doctors were coining it for a service that he believed the doctors were already paid for.  Now while his analysis may be newsworthy and perhaps populous it actually displays a fundamental lack of understanding of how general practise works and how it’s funded.  The work that GPs carry out on behalf of the Department of Social Protection is quite separate from any medical care funded through the medical card scheme and it’s funded accordingly through a separate and standard contract and to be quite frank the notion that successive Governments have paid doctors twice for the same work through separate contracts for decades is patently absurd and I would in fact be calling, on behalf of the IMO this morning, for Deputy Humphries to withdraw those remarks because they really are not based on any analysis of the facts.
 
Rachael English:
 
And yet when people look at this they’ll see that a doctor receives €8.25 for every cert signed, so what exactly does a doctor have to do to get that €8.25?
 
Dr. Ronan Boland:
 
Well let’s be clear it’s not simply a matter of signing a piece of paper, if one looks at the matter in more detail, the doctor is obliged to carry out, technically to carry out an examination, which isn’t always feasible, for example if a patient has a broken leg or on crutches you’re not going to bring in that patient every week when they’re possibly unable to drive to examine them, but in theory at least each of those patients should be examined on a weekly basis and a clinical impression forms whether that patient is fit or unfit for work and the doctor is certifying on behalf, is working in this case on behalf of the Department of Social Protection, to ensure that patients are, and clients as the case may be of the Department of Social Protection, are not out of work and in receipt of benefits for longer than they should be on medical grounds.
 
Rachael English:
 
But if you do examine a patient don’t you get paid for that separately, you charge them a consultation fee?
 
Dr. Ronan Boland:
 
No, absolutely not, and that’s an important point to clarify.  There are two main categories of patients that attend doctor’s surgeries, there are patients who are in possession of a medical card and there are private patients.  If a medical card patient is seen for the purposes of Social Welfare certification it’s clearly quite separate from a treatment, medical treatment provided under the medical card scheme, and on that basis there’s a separate contract which the State pays for and has paid for for as long as general practise has been structured, for decades.  In respect of a private patient who doesn’t have a medical card, if a patient is seen by a doctor solely for the purposes of establishing their entitlement to certification the doctor is specifically precluded from his contract, his or her contract with the Department of Social Protection, to charge a separate fee, so the only fee that the doctor will receive is the fee that is received from the Department of Social Protection.  The doctor is not entitled to receive anything over and above the fee of €8.25 payable by the State.
 
Rachael English:
 
Okay, but in many cases isn’t this just a case of a doctor signing a form to say yes, I’ve seen this person, I think they’re still unfit for work, €8.25, it sounds like a lot of money for not an awful lot of work, in fact as Brendan Ogle might put it, does it not sound like gravy?
 
Dr. Ronan Boland:
 
No, quite the opposite in fact, it represents a very significant body of work.  If I could illustrate in my own practise patients who are in receipt of certificates have to contact the practise every week, the doctor has to look individually at each of those patients, collect records, to see all or as many of those as required, or repeat assessments, and the forms have to be filled.  I would add to that as part of the contract if a doctor doesn’t fulfil all of his or her obligations there are very severe sanctions, including significant fines and/or rescinding of the doctors contract if the doctor doesn’t fulfil his or her obligations.
 
Rachael English:
 
Are you saying categorically then no change?
 
Dr. Ronan Boland:
 
Well what I’m saying is, not alone am I saying the fees in question have not been renegotiated since 2003/2004 when this scheme was last revisited, I’m also saying that under the emergency legislation which the State brought in in 2009 the Financial Emergency Powers Legislation, the State has looked at every single fee which it pays to doctors and to other professionals.
 
Rachael English:
 
Okay, so you are essentially saying no change.
 
Dr. Ronan Boland:
 
No, what I’m saying if you’ll allow me is that in actual fact we have been through a process in 2009 where the Department of Social Protection looked at the fees payable under the scheme themselves and they have sweeping powers, as do all Government Departments, to reduce those fees and doctors have taken reductions of €120 million across all public schemes which in actual fact is five times the total amount payable into the scheme, and the outcome of the Department of Social Protection, the last review of the scheme was, that they chose not to reduce the fees in regard to this particular scheme.
 
Rachael English:
 
Okay.  Dr. Ronan Boland, President of the IMO, thank you for joining us this morning.
 
 
 

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