Mr. Patrick Burke:

The payments to GPs are by and large capitation bids. This means that once one controls the register, notices of births and deaths and reviews on eligibility, one is controlling that aspect of the service. Capitation is like a salary that is paid to GPs, but the HSE has control over it. There are additional payments for annual, sick, maternity, paternity and study leave to GPs but they must provide the name and ID of a Locum to avail of it. Certain subsidies are given for GP practice secretaries and nurses but they must provide, P35s and PPS numbers of the persons employed. All of that expenditure is controlled. Some time ago we identified trends in the GP out of hours service or special services with which we were not happy. We challenged the GP community and in cases where we were not satisfied with a trend, we did not make a payment. It was not a question of making a payment and looking to claim it back. We unilaterally did not make a payment. We negotiated with the GPs on the ambiguities that constitute a claim in an out of hours setting, and after a mediated process we have agreed with GPs and advised them on the explicit definition. In the cases in which we had challenged the GPs and had not made the payments, we asked them to make a case on the validity of the claim as part of the mediated process. In some cases we offered settlements. If we were satisfied that the claims for out of hours services were valid and could verify them, we made a payment. Where we were not, we made a settlement, and in the cases with which we were not happy, we made no payment at all. During the past two to three years, when we have not been happy with a claim presented to us we simply do not pay.