LRC Recommendations / Framework Agreement

1. Outstanding National Pay Increases including Benchmarking (associated Appendix A items)
2. Review of GMS Scheme and all Publicly Funded Primary Care Schemes
3. Outstanding Industrial Relations Issues (Appendix B items)
4. Doctor Visit Only Medical Cards

LRC Recommendations

1. Outstanding National Pay Increases Including Benchmarking

   GMS Scheme

   • The following payments plus accumulated arrears shall be paid to GPs:
     • 2% under Partnership 2000 from 1/7/1999
     • 2% under Sustaining Progress from 1/7/2004
     • 2% under Sustaining Progress from 1/12/2004
     • 1.5% under Sustaining Progress from 1/6/2005

   Publicly Funded Health Schemes

   • Sustaining Progress increases shall apply to the publicly funded schemes

   Initial Review Payments (Benchmarking 1)

   • The following Initial Review Payments (Benchmarking 1), with accumulated arrears shall be paid to GPs in respect of the GMS Scheme as follows:
     • 1/12/2001 - 2.45%
     • 1/1/2004 - 4.9%
     • 1/6/2005 - 2.4%
     • 9.75% award

   Co-operation Necessary for Agreement on Payment of Benchmarking Award
   (Appendix A Items)

   1. Emergency Planning
      Agreement to participate in the implementation of emergency planning at both local and national level. Protected time for GPs with appropriate funding.
      
       
   2. Implementation of ICT
      Acceptance of the role of the GP in the ongoing development of technology to support best business practice
      
       
   3. Piloting, auditing and mainstreaming of good risk management practices
      
       
   4. Development of a joint co-operative approach to the management of the client register
      
       
   5. Disposal of clinical waste in accordance with best practice and legislative requirements to be jointly reviewed in order to meet the requirement of individual practices and the safe disposal of clinical waste
      
       
   6. Probity Issues
      Both parties will work in partnership to develop appropriate governance arrangements to ensure accountability throughout the system
      
       
   7. Establishment of Warfarin Clinics
      Current arrangements shoud continue pending outcome of review process
      
       
2. Review of GMS Scheme and all Publicly Funded Primary Care Schemes
   
   • Terms of reference for review of GMS and other publicly funded schemes involving GPs agreed between the parties
     
      
   • Review to be conducted under the auspices of the Labour Relations Commission
     
      
   • Central Joint Working Group to be established
     
      
   • Two standing sub-committees to operate simultaneously, one dealing with exclusively GMS contract issues and the second with additional publicly funded primary care services.
     
      
   • In the event of the Central Joint Working Group failing to reach agreement, provision for matters in dispute to be jointly referred to the Civil / Public Service Arbitration Board
     
      
   • Review to be completed by end of March 2006
     
      
3. Outstanding Industrial Relations Issues
   • Appendix B Items
     1. DMO Pensions:
        • 2% Partnership 2000 increase from July 1999 to apply
        • 3% special increase to be applied from 1 st June 2005
          
           
     2. Director / Assistant Director of GP Specialist Training Schemes
        All pay arrears to be paid subject to validation of claims in respect of locum payments
        
         
     3. Non EU Nationals
        Issues arising from Report of Workload Review to be referred to an agreed adjudicator. Findings to be issued no later than 1 st October 2005.
        
         
     4. Mother & Infant Care Scheme
        Status quo to remain pending the re-examination as part of review of publicly funded services.
        
         
     5. Primary Childhood Immunisation Scheme
        Status quo to remain pending the re-examination as part of review of publicly funded services.
        
         
     6. GP Unit Doctors
        A complete review of any outstanding national wage round increases to be completed and notified to the LRC by December 2005.

        Joint Working Group to be established to review role, function, terms and conditions of GP Unit Doctors and to report by December 2005.

     7. GP Trainers
        A Joint Sub-group to review the GP Trainers Contract will be established. Group to report by December 2005.
        
         
     8. CME Tutors
        HSE and DoHC to meet with IMO in relation to the role of CME Tutors and to clarify and agree issues in relation to their terms and conditions of employment.
        
         
     9. Special Items of Service (Implanon)
        Management agrees to re-examine the position in relation to the payment of a special item of service fee in respect of Implanon with effect from a current date.
        
         
     10. GP Out of Hours Co-Operatives
         Both parties agree to prioritise the review of GP Out-of-Hours Co-operatives, the outcome of which will be considered in the final analysis of the overall review provided for in the agreement.
         
          
     11. District/Community Hospital Medical Officers
         The District/Community Hospital Medical Officers are a salaried grade who received benchmarking increases.
         
          
     12. Medical Indemnity Insurance Refunds
         In the context of an overall agreement on the range of issues currently in negotiation, management agrees to re-examine the position in relation to reducing maximum panel size for refund of medical indemnity insurance from 1,500 to 1,200 with effect from a current date.
         
          
     13. Cervical Screening
         The national roll-out of Cervical Cancer Screening Process remains a policy issue at Government level.
         
          
     14. Transparency Issues & other outstanding GMS Issues
         A subgroup will be established under the auspices of the Labour Relations Commission in order to address outstanding issues in the context of the administration of the Scheme.
         
          
4. Doctor Visit Only Cards
   • The fundamental matter of “Practice Supports” be identified as an issue requiring specific attention in the Review of the GMS / Publicly Funded Primary Care Schemes
     
      
   • The outstanding “technical issues” be addressed under the auspices of the LRC – (Transparency issues and other outstanding GMS issues)
     
      
   • A once-off payment of €35 to be paid to each GP for each of the first 200,000 patients admitted under the D.V.O.C Scheme. This payment will be in addition to the normal ongoing payments.
     
      
   • The IMO will co-operate with the immediate introduction of the Doctor Visit Only Card
     
      
   • A new contract to treat Doctor Visit Only Card patients will be issued. The parties and their legal advisors should meet immediately and resolve any issue that may arise over this new contract
     
      
   • The Practice Manager grant should be paid at the minimum point of the practice nurse scale from 1/6/05 pending the completion of the review
     
      
   • Entry to the GP Visit Card Contract
     GMS entry arrangement same as Over 70's agreement to apply. Those in practice for one year prior to 1 July 2005 to get limited contracts to treat DVOC patients initially and after two years if in partnership or 5 years if in single handed practice to be eligible to take on any medical card patient.

     Doctors who currently hold limited GMS contracts will also be eligible to hold DVOC contracts

   Benefits of LRC Recommendations

   Arrears Payments
   Outstanding National Pay Awards
   2% P2000 increase from 1 July 1999	= €30m
   2% SP increase from 1 July 2004	= €7m
   2% SP increase from 1 Dec 2004	= €3.5m
   Initial Review Payments (Benchmarking 1)
   2.45% from 1/12/01
   4.9% from 1/1/04
   2.4% from 1/6/05
   Arrears to 1 June 2005	= €53m
   Total arrears to 1 June 2005
   From P2000, SP & Benchmarking Payments	=€93.5m

   
   
   
   • Significant additional arrears due in respect of Programme Directors / Assistant Programme Directors of GP Specialist Training Schemes and GP Unit Doctors
     
      
   • Potential for significant additional payments arising from specific reviews provided for in Appendix B
     
     

     Annual Ongoing Benefit of National Pay

     Agreements plus Benchmarking 1 = €63m

     Plus additional benefits of 200,000 DVOCs = €30m

     Annual Ongoing Benefit = €93m

     Plus once off registration benefit of €7m

     Plus Non EU Nationals Arbitration Award (tbc)

     
     
      
   • Fundamental review of GMS Contract and Publicly Funded Schemes
     
      
   • The IMO agreement for this Review is contingent on the Review being completed and appropriate fees / rates of payment being agreed and implemented in advance or contiguous with the publication of the benchmarking report in the Civil / Public Service agreed for 2007
     
      
   • Otherwise normal benchmarking arrangements / increases recommended to apply

   Summary of Benefits of Agreement

   • Arrears payments in the region of €100 million
   • Ongoing additional payments in the region of €100 million per annum
   • Processes and timeframes for progressing outstanding industrial relations issues
   • Terms of reference for fundamental review of GMS and Publicly Funded Primary Care Schemes agreed
   • LRC to oversee review and drive process

   GP Committee Meeting Wednesday, 22nd June 2005

   • Unanimous decision to recommend acceptance of LRC recommendations in ballot of members