Gillian Hughes of Medacc Consulting partners with Irish GP Practices to assist in identifying any unclaimed GMS income. The typical amount identified and claimed is between €30 – €220k. I review all potential income streams over a 6 year term.
GMS Claims Review
Our team conduct reviews of all possible income streams including but not limited to stc’s, annual, study, sick, maternity, paternity or covid leave, practice supports payments, HSE grants CDM submissions, vaccination claims, asthma cycle of care & the maternity & infant care scheme. We will highlight all unclaimed income and, assist with the claiming process.
Practice Management Training
Following a detailed review of the practice, we can then provide training to the practice management team on claiming procedures to implement so that no income goes unclaimed in the future. We also highlight systems for income generation for practices, so both the the claims are maximised and revenue generation is optimised.
A GP with a GMS Panel of over 100 patients are entitled to Practice Supports Subsidies. The payment amount available varies with the GMS panel size. The GPA grant of €15,000 is a separate grant that is also available for practices with a weighted panel of over 500. There is an option to divide the nursing support grant between a nurse and a manger for a practice with two GMS lists with a panel of over 100. Practice Support Subsidies can be claimed retrospectively up to 6 years.
The Childhood Immunisation schedule changed for babies born since October 2024. The claiming process for childhood vaccinations also changed. From the 27th of November 2025, all childhood vaccines for children born from October 2024 must be submitted as a E-schedule via the practice management system. In the case where a child born pre October 2024 is vaccination after the 27th of November, a paper submission should be made to the local HSE.
It can be difficult to identify STC’s that remain unclaimed. The STC Finder in Socrates, reviews the consultation notes and picks up key words from the configuration tool, but if the search term is not there, the STC Finder will not pick it up and STC’s will still be missed. The is reports and systems that can be put in place to ensure every STC is claimed. There is a requirement to have each STC signed by the patient. Please contact Gillian directly to go through options.
GMS GP’s with a panel of over 100 patients can claim Annual & Study leave up to a maximum of 35 annual leave days and 10 study leave days. Each Day’s leave is paid at a rate of €197.24 per day. Study leave certs are required for submission. When submitting a claim for any type of leave, an ALF form with the correct signatures and study leave certs attached must be initially sent to the local Primary Care Centre where it will be stamped and approved and sent back to the surgery. Upon receipt, page 2 and 3 of the ALF form is to be sent directly to the PCRS for payment. Historic Study or Annual leave can be claimed for up to 6 years.
The Fridge and the Height & Scales Grant can be paid at any stage of the GMS contract, but it will only be paid once. To assess eligibility, you can contact the PCRS directly. They will confirm if the Grants have been paid to the practice. If the GP is still eligible for payment, the application can be made to the PCRS.
Within the Chronic Disease Management Programme are four programmes consisting of the CDM Annual, CDM Interim, Prevention Programme and the Opportunistic Case Finding.
CDM eligibility GMS/DVC 18+. Each Annual CDM claim with the exception of patients with a diagnosis of Asthma require a blood test. Payment varies between €105, €125 & €150 for either one, two or three diagnosis. The minimum interval between claims is 4 months, however the annual assessments cannot be submitted minimum one year from the previous annual assessment. The recall system for the CDM programme can be structured to match the Patient’s CDM programme to align with their prescription review.
CDM Interim GMS/DVC 18+. The Interim assessment that require a blood test include Diabetes & Atrial Fibrillation. The payment is the same at €105, €125 & €150 for either one, two or three diagnosis. The interim assessment can be completed 4 months after the annual assessment.
Prevention Programme GMS/DVC/ Private Patients 18+. The PP Programme require bloods and payment is set at €82. The interval for the Prevention Programme is a minimum 0f 9 months apart. There can be two claims for the Prevention Programme within 1 calendar year. The Prevention Programme is the only programme available to private patients whom have a history of Gestational Diabetes or Pre-eclampsia with a diagnosis since 2023.
Opportunistic Case Finding GMS/DVC 45+. All patients whom are not eligible for the CDM or PP programme are eligible for the OCF. If the patient does not fit the criteria from the OCF Mediform which includes: Current Smoking Status, BMI, BNP Measurements, History of Gestational Diabetes, Dyslipidaemia, eGFR<60 or History of Sever Mental illness, there is another option called 'Other'. The criteria set for 'Other' which was sent to me by the HSE is displayed below: ''If the GP selects Other they must enter text into the Free Text field, the only restriction is the number of characters Min 10 Max 140. Really what is being documented here is the reason why the GP felt that doing an OCF on the patient is warranted.”
Additional information regarding the CDM programmes can be accessed under the Resources Page
Asthma Cycle of Care is a payment for children from the ages between 2 & 8 with a Medical Card and a confirmed diagnosis of Asthma. The registration fee is €50 followed by a monthly capitation payment. It is very common for practices to have unclaimed income due to unregistered ACOC patients. Please contact Gillian to talk through how to identify eligible patients and review the claiming process.
A GP whom is registered as a training and had a reg in their practice is eligible for the Training Grant. Invoices and proof of payment are required for submission. A list of eligible expenses are included in the resources page.