Wednesday 25 April 2018

GPs charge €60k to care for elderly in nursing homes

Residents given bills despite being entitled to free treatment

Health Minister Simon Harris. Picture: Mark Condren
Health Minister Simon Harris. Picture: Mark Condren

Maeve Sheehan and Wayne O'Connor

GPs are demanding fees of up to €60,000 a year for attending elderly residents in private nursing homes who are entitled to free doctor services.

Medical practices are charging substantial 'retainer fees' regardless of the fact that the vast majority of nursing home residents have over-70s free GP visit cards, and often a medical card as well.

An internal survey by Nursing Homes Ireland (NHI), the representative association, has found that 30pc of private nursing homes were asked for a retainer fee by GPs, but only around 13pc agreed to pay. The average annual retainer fee charged by GPs ranged from €300 to €40,000 a year, according to the report.

However, the Sunday Independent has been told that a number of Dublin nursing homes are paying retainer fees of more than €5,000 a month -or €60,000 a year - to GP practices so that their residents can access medical care.

The vast majority of homes are absorbing the cost of the GP fees, but some are passing it on to their residents, presenting another layer of hidden costs in nursing home care.

One home in Dublin charges a mandatory fee of €100 a month, or €1,200 per year, per resident for 'doctor services'. Another home in Kildare bills residents for the quarterly €25 or annual €100 fee that the GP charges to see them.

The Department of Health told nursing homes as long ago as 2011 that GPs must not charge fees. A letter from a senior official to the NHI said GPs were paid an annual fee for each patient in a private nursing home.

Health Minister Simon Harris has said the GP charges are "very discouraging". In a letter to Senator Padraig O Ceidigh, who raised the issue on behalf of NHI in June, Mr Harris noted the "disparity in the level and frequency of GP services provided to nursing homes from one unit to another".

He said GP services to nursing home residents would be "dealt with" as part of the ongoing review of their State contracts.

Now the Government will for the first time monitor additional charges enforced on nursing home residents as part of a new review of the sector.

It is also examining the legislative steps it can take to ensure residents are treated fairly.

Minister for Older People Jim Daly has told Department of Health officials he wants to see data collected on additional charges in homes.

This will be separate to work carried out by Hiqa and the minister said it would "capture the lived experiences of residents in nursing homes" nationwide.

"I will continue to consider all options up to and including legislation to ensure absolute fairness and transparency on this issue," Mr Daly said.

Government officials are now looking to establish a method of collecting the data on extra charges.

The demand for retainer fees by GPs was highlighted by a number of the 335 homes contacted by the Sunday Independent as part of an investigation published last weekend. The internal NHI survey found that 18pc of homes were asked by GPs to pay the fee but refused, a further 13pc agreed to pay a retainer to GPs, while the remainder said they were not asked to pay a fee. Of those that paid, 87pc did not pass the retention fee on to their residents.

A quarter of the homes paying a GP retainer fee are in Dublin, with the next highest numbers in Kildare and Meath. Homes in Cavan, Mon-aghan, Mayo, Louth and Westmeath also reported paying the additional fees.

One home told the NHI surveyors that a GP asked for a fee of €15,000 to take on residents. The home refused to pay the fee and since then has faced "severe difficulties" in finding doctors for new residents.

A second home reported that one GP practice in south Dublin stopped providing care to its residents after the home refused to pay a retainer.

According to the survey, the retainer fee paid to GPs ranged from €300 per resident a year to €40,000 a year.

One GP charged €500 per resident a year, in return for visiting the home once a week and being 'available' to take calls.

National Association of GPs CEO Chris Goodey denied that doctors were charging to see residents who are entitled to free care.

"There are situations where GPs are employed by nursing homes, where they do not have a resident GP," he said.

"They are put on as medical directors or they look after governance, they help to comply with Hiqa issues but they are not to see patients."

GPs have claimed the fees they are paid by the State under the medical card scheme do not cover the administrative work they are being asked to complete in nursing homes, such as paperwork relating to medication.

Their capitation fees under the general medical card scheme have been cut in recent years.

The problem has been exacerbated by a shortage of doctors, particularly in rural areas.

Mervyn Taylor, of the advocacy group Sage, said: "If further supports or incentives are needed then the representative bodies for GPs should say clearly and publicly what they want and nursing homes should not be taking it out on the residents."

NHI CEO Tadhg Daly said: "Nursing home residents must retain equal access to the wide range of health services that are essential to support and promote their healthcare needs."

Stephen McMahon, director of the Irish Patients' Association, said: "This is eye-opening and sheds a new light on the extra charges nursing home residents face. Any monitoring of the sector by Government is welcome."

Sunday Independent

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