Dr Keely, an IMO GP committee member, and TD Kevin Humphreys spoke in interview on Thursday afternoon 22nd September on GP payments for social welfare benefit certificates. This followed the Labour TD's public statement on the matter the previous evening. Below is a transcript of the 16 minute interview.

SCOTT WILLIAMS
The Department of Social Protection paid doctors almost €30 million last year to write medical certs for social welfare recipients.  The payments were made to GPs and other doctors for medical certs and reports needed to support illness benefit and other medical claims.   Minister for Social Protection Joan Burton said in a written parliamentary response to Labour’s Kevin Humphreys employees can apply for illness benefit if they’re sick for more than three days; Doctors were paid €8.25 per cert issued in addition to the consultation fee for such reports.  Now currently the Department of Social Protection is processing an average of more than 55,000 certs a week and on an annual basis that’s something like three million.  One practice with 13 doctors was issuing an average of a 180 certs a week and that practice received €83,000 because of the work. But given that the average cost of going to the doctor is already somewhere between fifty and sixty euro is it not unnecessary to top up a doctors remuneration this way does the frequency and amount of certs being issued mean that they’re too easily obtainable for workers or does it mean and doesn’t it also follow by extension and that this would translate into an unnecessary number of working days lost.  Joining us is Doctor Jim Keely, GP and a member of the Irish Medical Organsiation GP Committee.  Good evening Jim.

JIM KEELY: GP & MEMBER OF IMO
Good evening Scott.

SCOTT WILLIAMS
And also joining me in studio is Labour’s Kevin Humphreys, good evening Kevin.

KEVIN HUMPHREYS: LABOUR
Good evening Scott and Jim.

SCOTT WILLIAMS
And I’ll start Kevin with you and the points, what is the point precisely that you’re making.

KEVIN HUMPHREYS: LABOUR
Well the point I’m making is, like if you visit your doctor you’re paying somewhere between €50 & €60 for a consultation fee, he tells you whether you’re fit for work for a week, two weeks or three weeks and if he certifies you for social welfare payment he gets an additional payment of €8.25 and this seems to be now getting challenged by some GPs, seemingly you can now go to your GP and get certified without any payment and if that’s the fact I actually quite welcome it because it means that if you’re not fit for work whether it’s flu or not you can then arrive down to your doctor and just receive your social welfare certificate with no payment, I think that would be very welcome. But I think what we all know what really happens is that you go down have your consultation and if the doctor certifies you if your sick for a week or two weeks he then gives you the certificate.  Can I just say as well Scott…?

SCOTT WILLIAMS
I’m actually confused, (inaudible) just to be very clear about this.  So you can get certified without paying a consultation fee to the doctor, not paying the fifty euro.

KEVIN HUMPHREYS: LABOUR
Well that’s what I heard on your sister radio station this morning by a GP saying that it’s a separate…I don’t get paid I only get paid for the cert and if somebody comes into me I can give him a cert without a consultation as such.  But my understanding is you pay between fifty and sixty euros and then if the doctor certifies you for social welfare payment for sick payment he gets and additional payment of €8.25…

SCOTT WILLIAMS
In addition to his consultation.

KEVIN HUMPHREYS: LABOUR
In addition to his consultation fee, alls I’m saying is to me represents a double payment, the other thing.

SCOTT WILLIAMS
That’s if it’s the  reality now

KEVIN HUMPHREYS: LABOUR
If that is the reality but to me that’s what it seems.  But the other thing that’s quite horrifying is that there’s 55,000 certs a week been going out there and the other element is which GPs have been telling me that not all GPs claim their €8.25 because they feel they’ve already received a payment.  So can I just say this is not against all GPs, I’m saying there is approximately two and a half thousand GPs that are claiming this, it’s costing the state up to €30 million taking the figures over the four years there’s some reports element within that and I’m just saying, this is a dual payment most people pay their consultation fee other people have a medical card fee at €8.25 on top of that is just a little bit too much in these times when we can least afford it.

SCOTT WILLIAMS

I want to go to Jim Keely and you’re also saying there Kevin finally if I’ve got you correctly was you’re saying there are in fact also some GPs that don’t claim the €8.25 at all.  Jim Keely how would you respond to this? 

JIM KEELY: GP & MEMBER OF IMO
I’m not sure I understood anything or everything that Deputy Humphreys said and again I’m listening to somebody who I believe does just not understand how the system works.  He obviously doesn’t understand how general practice works, how it’s funded and how GPs are engaged with all the different departments within the Department of Social Protection, Department of Health, HSE, he obviously doesn’t understand that there a multiple contracts that GPs have with different departments all of which are an obligation on the GP if requested by the patient at the time and it’s the patient who requests and it’s the Department of Social Protection that requires the certification.  It’s not a case of the GP handing the patient a cert and saying here, it’s a case of, it’s a requirement for the patient and it’s a requirement for the Department of Social Protection.

SCOTT WILLIAMS
And is it conditional on a consultation?

JIM KEELY: GP & MEMBER OF IMO
It would be conditional on a diagnosis and consultation that you actually certify the individual as being ill, if it is a case that they need certification for one week, two weeks, three weeks, you can make that judgement you can decide that this individual is going to require a certain amount of certs and may I just say that this is at the request of the Department of Social Protection that we do this.  There’s a fail safe system and I think Deputy Humphreys is implying that there’s too many certs.  The Department of Social Protection has its own fail safe system and when it sees a certain amount of certs coming through with a particular diagnosis for an individual, it requests to see that individual and it makes the decision that that person should continue receiving certs from the GP and it’s the Department of Social protection that asks us to continue issuing the certs.

SCOTT WILLIAMS
Now just to understand this Jim, what I picked up (inaudible) you have this arrangement, there is, I will come back to you in a sec. Kevin.  There is an arrangement, there is a consultation, the GP actually sees the individual concerned and takes appropriate action.  Now somebody with a broken leg I guess who can’t drive or who is lorry driver, you take a view how long it will be before that leg is better.

JIM KEELY: GP & MEMBER OF IMO
Absolutely, you’re going to be estimating how many weeks they’re going to be unavailable for work. 

SCOTT WILLIAMS
And then does a cert for a number of weeks issue as a result of that or is it issued on a weekly basis? 

JIM KEELY: GP & MEMBER OF IMO
It’s issued on a weekly basis and that is a stipulation that comes from the Department of Social Protection under certain circumstances maybe a long term illness.

SCOTT WILLIAMS
And just let me ask you this in the case of for example my hypothetical lorry driver with the broken leg, weekly, so the patient will present weekly to the GP and receive a certificate if one is required? 

JIM KEELY: GP & MEMBER OF IMO
Yes

SCOTT WILLIAMS
And there an €8.25 charge for each one of those.

JIM KEELY: GP & MEMBER OF IMO
There isn’t a charge, what is in existence and this is what the deputy doesn’t know that there is a contract between GPs and the Department of Social Protection that when the cert is issued that a payment follows certification.

SCOTT WILLIAMS
Alright okay, so give me the word charge, so an €8.25 payment will issue.

JIM KEELY: GP & MEMBER OF IMO
Yes exactly

SCOTT WILLIAMS
Right and that’s the terms of the current contract.

JIM KEELY: GP & MEMBER OF IMO
That’s in the terms of the contract which is eight years old.  The reason for that contract is because the Department of Social Protection asked the GPs to agree to an ongoing certification of patients at their request so that they could monitor following the issuing of certifications the requirement for every individual.

SCOTT WILLIAMS
Okay Kevin Humphreys come back to you.  Jim has explained this is a service required by the Department of Social Protection that the doctors are delivering, there’s a contract in place and the payment issues when they provide the service.  Where’s your issue?

KEVIN HUMPHREYS: LABOUR
He doesn’t understand that.

SCOTT WILLIAMS
Well I’m asking Jim now does he?

JIM KEELY: GP & MEMBER OF IMO
He doesn’t.  

KEVIN HUMPHREYS: LABOUR
Okay Jim, okay sorry, you’re too used to telling people what they think they know.  Can I just say to you I do understand Jim, I understand very clearly and I’m looking for this to be reviewed in the comprehensive spending review.  Somebody with a broken leg, your example, goes sees the doctor pays his €55 and is certified for ten twelve weeks whatever it takes for the leg to heal whatever the reason and whatever the contract, to receive a further €8.25 every week for those ten weeks that that lorry driver out sick to me is simply wrong.  I don’t really worry about contracts, it’s black and white.

JIM KEELY: GP & MEMBER OF IMO
That doesn’t explain where it comes from, it comes from the fact that the Department of Social Protection during negotiations in 2003 accepted that there was a workload involved in the processing and production of these certifications, they don’t just appear from nowhere they have to come through the surgery they have to be processed, we have to be sure that we’re giving the right person the right cert, we have to be sure that the individual who requires the cert gets it.

SCOTT WILLIAMS
So is it almost like an admin fee then?

JIM KEELY: GP & MEMBER OF IMO
Absolutely, it’s part of an overall fee that covers the administration of the service at the request of the Department of Social Protection.  

SCOTT WILLIAMS
So it’s actually Kevin, it’s an admin fee.

KEVIN HUMPRHIES: LABOUR
Look it Jim, we all know exactly what happens, most people have visited their GP and if you get your first cert you go down to your secretary you receive your second and third cert and you get your final cert.  I’m sorry Jim let me finish please.

SCOTT WILLIAMS
Yeah, I’ll bring you in, in a second.

KEVIN HUMPHREYS: LABOUR
And sometimes you have to even have a further consultation for your last visit to certify that you can go back to work which is probably another €55 or €60 this by all means is covered now Jim you may have all these contracts under the sun all I’m saying is €8.25 for what’s getting carried out is over the top, that thirty million could well be spent better in the HS system, in the hospital service and I just don’t agree with it and I want it reviewed, I would actually like to see it being done away with.

JIM KEELY: GP & MEMBER OF IMO
I think you’ve got to understand Scott that this is a system that has been in existence for many, many years which is to the benefit to the Department of Social Protection because it is a way for them to monitor and to administer…

SCOTT WILLIAMS
Jim I do accept that but I suppose what I’d counter to you with is just because they’ve done it that way it doesn’t mean we have to continue doing it, would you accept that, that anything is open to examination and scrutiny.

JIM KEELY: GP & MEMBER OF IMO
Everything and anything is open to examination, scrutiny and negotiation and it’s something that has been there for a long time that has worked quite well for the individual, quite well for the patient and quite well for general practice because it is a service we are willing to provide, unfortunately it’s not something that can be provided just at the stroke of a pen.

SCOTT WILLIAMS
Right

KEVIN HUMPHREYS: LABOUR
Jim it hasn’t worked very well for taxpayers and I really don’t accept that you are already getting paid for that service and with consultation fee.

JIM KEELY: GP & MEMBER OF IMO
That just shows that you don’t understand it is not part of any other service or contract.

KEVIN HUMPHREYS: LABOUR
Right Jim can I go down to my doctor and get my first cert without paying a consultation fee.

JIM KEELY: GP & MEMBER OF IMO
You mean without your GP actually seeing you and examining you?

KEVIN HUMPHREYS: LABOUR
No, you’re saying we can get you know there’s a fee for the cert and administration, can I go down to my GP and say look, I’ve a bad back or look obviously my leg is broken it’s in a cast can I have a cert for ten weeks?

JIM KEELY: GP & MEMBER OF IMO
You’re quite entitled to do that.  

KEVIN HUMPHREYS
And you don’t have to make a payment?

JIM KEELY: GP & MEMBER OF IMO
How do you want General Practice to continue?

KEVIN HUMPHREYS: LABOUR
I’m not, I’m quite happy to pay, I’m quite happy to pay my consultation fee of €55 what I’m not happy with is that for every cert that is issued after that that there’s a state payment of €8.25 and that’s not what I’m happy with.

JIM KEELY: GP & MEMBER OF IMO
It is a contract we have with the Department of Social Welfare

KEVIN HUMPHREYS: LABOUR
And it’s wrong it’s wrong I don’t really care about contracts.

JIM KEELY: GP & MEMBER OF IMO
And it works quite well

SCOTT WILLIAMS
Jim let me ask you, would you comment please on what Kevin said there that there’s a number of GPs who don’t…

JIM KEELY: GP & MEMBER OF IMO
I honestly can’t comment on that because.

SCOTT WILLIAMS
Don’t claim the money he says.

JIM KEELY: GP & MEMBER OF IMO
No there’s no, no claiming the money, once the cert is processed the payment follows.

SCOTT WILLIAMS
The check is in the post.

JIM KEELY: GP & MEMBER OF IMO
It’s an automatic payment.

SCOTT WILLIAMS
How often do you get paid?

JIM KEELY: GP & MEMBER OF IMO
It’s every three months.

SCOTT WILLIAMS
Okay, every quarter so whatever’s approved and is that shown then as income to the practice.

JIM KEELY: GP & MEMBER OF IMO
Absolutely, it comes in obviously because it comes from a Government Department.

KEVIN HUMPHREYS: LABOUR

And practices have costs and when you look at one particular practice okay with thirteen doctors with an income of €82,938.35 that covers an awful lot of administration.

JIM KEELY: GP & MEMBER OF IMO
Absolutely so how many administrative staff do you think thirteen doctors would need

KEVIN HUMPHREYS: LABOUR
Well you know that’s the real question for valuation.

SCOTT WILLIAMS
I actually don’t know, how many admin staff does thirteen doctors need Jim I actually don’t know? 

JIM KEELY: GP & MEMBER OF IMO
Well I can tell you our practice here has four admin staff for three GPs.

SCOTT WILLIAMS
So four, for three.

JIM KEELY: GP & MEMBER OF IMO
 Three GPs and we could not function without them.

KEVIN HUMPHREYS: LABOUR
And how much do you pay for a consultation?

JIM KEELY: GP & MEMBER OF IMO
I’m not allowed to discuss my fees over the phone.

SCOTT WILLIAMS
That amounts to advertising which he is not allowed do.

JIM KEELY: GP & MEMBER OF IMO
 Again that’s obvious that Deputy Humphreys doesn’t know what he’s talking about, he actually asked that question.

SCOTT WILLIAMS
It was a genuine error.

KEVIN HUMPHREYS: LABOUR
 It was an error but what I’m saying to you is, there’s an awful lot of practices right through the trica has already told, so hold on just let me finish. 

JIM KEELY: GP & MEMBER OF IMO
 Blanket statements again.

KEVIN HUMPHREYS: LABOUR
 Sorry you’re the king of the blanket statements at this stage and I’m quite sorry because you’ve been defending yourself behind a contract that’s been there for several years.

SCOTT WILLIAMS
Kevin Humphries make your point.

KEVIN HUMPHREYS: LABOUR
We have to reform several areas that’s within the profession (inaudible) far to high in the economy very few GP practices have reduced their charge to the public.

JIM KEELY: GP & MEMBER OF IMO
Scott I don’t think, again he’s obviously forgetting that we were part of FEMPI one and FEMPI 2, we have had.

KEVIN HUMPHREYS: LABOUR
So you’ve dropped Croke Park Agreement at this stage.

JIM KEELY: GP & MEMBER OF IMO
Absolutely, we have taken…

KEVIN HUMPHREYS: LABOUR
Where you covered by it? 

JIM KEELY: GP & MEMBER OF IMO
Sorry


KEVIN HUMPHREYS: LABOUR
Where you covered by the Croke Park Agreement? 

JIM KEELY: GP & MEMBER OF IMO
Of course, who’s that, Deputy Humphries?

KEVIN HUMPHREYS: LABOUR
It is yeah, I’m just asking a straight question.

JIM KEELY: GP & MEMBER OF IMO
You don’t know that either, you don’t know that either.

KEVIN HUMPHREYS: LABOUR
I’m asking you were you covered.

JIM KEELY: GP & MEMBER OF IMO
Of course we were covered by the Croke Park Agreement.

KEVIN HUMPHREYS: LABOUR
But you’re sole traders.

JIM KEELY: GP & MEMBER OF IMO
Well then look I think Deputy Humphries you need to go off and do a little bit more research.

KEVIN HUMPHREYS: LABOUR

I think you need to do as well because your doctors and your hospitals are covered by the Croke Park Agreement.

JIM KEELY: GP & MEMBER OF IMO
I said we were, we are covered by the Croke Park Agreement.

KEVIN HUMPHREYS: LABOUR 
I’m asking is the GPs covered by the Croke Park Agreement.

JIM KEELY: GP & MEMBER OF IMO
Of course we are, of course we are.

KEVIN HUMPHREYS: LABOUR
Well that’s not my information.

JIM KEELY: GP & MEMBER OF IMO
Well listen Scott I think that answers the question.  

SCOTT WILLIAMS
Well clearly Kevin you have your view on this, this is a matter for Joan Burton is it not? 

KEVIN HUMPREYS: LABOUR
Well I think it’s a matter for the comprehensive spending review, we have to look at all professional fees, we have to look at the cost to this economy.

JIM KEELY: GP & MEMBER OF IMO
And we have had our professional fees cut, in FEMPI 1 and FEMPI  2 we are governed by the Croke Park Agreement and we were quite happy like everybody else…

KEVIN HUMPHREYS: LABOUR
So all the GPs have cut their consultation fees.

JIM KEELY: GP & MEMBER OF IMO
I cannot vouch for every GP

SCOTT WILLIAMS
Jim I’ve no agenda on this but it occurs to me that within the confines of the CRE the comprehensive review of expenditure which Brendan Howlin is undertaking, I want to ask Kevin, Kevin to your knowledge is this matter covered in that document.

KEVIN HUMPHREYS: LABOUR
I will be raising it with Minister Howlin and asking him to review this under the comprehensive spending review.

SCOTT WILLIAMS: LABOUR
Well I don’t think Jim Keely would mind it being raised Jim, would you? 

JIM KEELY: GP & MEMBER OF IMO
I don’t have a problem with anything that is necessary in this current climate.

SCOTT WILLIAMS
Right, so we’re all agreeing then are we, what a shame.

KEVIN HUMPHREYS: LABOUR
Well I’m delighted he’s open now for this charge of €8.25 for certification to be reviewed under that.  

JIM KEELY: GP & MEMBER OF IMO
I think Scott the Deputy needs to do his homework. 

SCOTT WILLIAMS
The Deputy needs to do his homework… 

KEVIN HUMPHREYS: LABOUR

Well I don’t accept that now at all, and I really think professional fees need to be looked at.

SCOTT WILLIAMS
I need to move on, Jim Keely GP and member of the Irish Medical Organisation GP Committee, thank you very much for taking the call and Kevin Humphreys thank you very much indeed for coming in and Kevin is the Labour Party TD for Dublin South East.