Income Support: Free GP Access (P101/2014): Ministerial Comment

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A decision made on 27 June 2014:

Decision Reference: MD-S-2014-0081
Decision Summary Title :	DS - Comment on P.101 - Free GP Access		Date of Decision Summary:	26 June 2014
Decision Summary Author:	Policy Principal		Decision Summary: Public or Exempt?	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:	N/A
Written Report Title :	WR - Comment on P.101 - Free GP Access		Date of Written Report:	26 June 2014
Written Report Author:	Policy Principal		Written Report : Public or Exempt?	Public
Subject: Minister’s comment on P.101 Income Support: Free GP Access
Decision(s): The Minister decided to present a comment to the States with regard to Deputy Southern’s proposition, P.101/2014 Income Support: Free GP Access
Reason(s) for Decision: Deputy Southern has lodged P.101/2014 Income Support: Free GP Access. The proposition seeks introduce a new benefit to the income support scheme, where people who have a HMA will become entitled to free GP consultations, fully funded by the Health Insurance Fund. The attached comment contains the Social Security Minister’s response to the proposition.
Resource Implications: None
Action required: Policy Principal to request the Greffier of the States to arrange for the comment to be presented to the States as soon as practicable.
Signature:		Position: Minister
Date Signed:		Date of Decision (If different from Date Signed):

Income Support: Free GP Access (P101/2014): Ministerial Comment

Comment P.101 Free GP Access

Members are strongly urged to reject the original proposition of Deputy Southern and support the amended proposition as proposed by Deputy Hérissier.

Household Medical Accounts (HMAs) are set up by the Department, in a voluntary arrangement, to assist people who have difficulty budgeting for GP costs but these accounts are not created according to a medical criteria; HMAs should not be confused with the benefits which are in place to help people with a clinical need. Bearing this distinction in mind, the proposition is asking that a sub-set of Income Support claimants are awarded free GP access while others, who may have a similar or even greater need, are not considered. Adopting this proposition would create an inequity in the income support scheme and run counter to the core principle, where the amount of benefit awarded is flexed according to household circumstances, including medical need.

The standard Income Support weekly benefit includes an amount to pay for up to four GP visits each year. The Income Support benefit also includes a clinical costs component which provides additional financial support for people who need to make more frequent visits to their GP. This component pays an additional £163.80 to £327.60 per annum to depending on the magnitude of need, and is currently paid to over 2,000 households.

Further, people with health conditions and disabilities may also claim personal care components and mobility components. The clinical care, personal care and mobility components are awarded following a medical assessment and therefore targeted to people who require this additional support. Claimants may also apply for a special payment to assist with medical costs; during 2013 Special Payments for GP costs totalled £564,300.

Support given via Special Payments and the medical components in Income Support is offered in addition to Medical and Pharmaceutical Benefit funded by the Health Insurance Fund.

The proposition suggests that the cost of giving a sample of Income Support claimants fully funded GP access is in the region of £360,000. However the cost of such a scheme requires a far more detailed examination. The Assembly is aware that the primary health care services are under review following P.82/2012 - Health and Social Services: A new way forward. The Department is working with the Health and Social Services Department and Primary Care professionals to consider the future of primary care services. Any change to payment or funding mechanisms requires detailed consideration in order to assess the impacts and unintended consequences on both patient and clinical behaviour. The primary care review will draw upon health economics and modelling expertise, in order to mitigate the risk of a new mechanism being introduced which adversely affects services, access or equity. Any significant changes to medical benefits should be informed by this wider strategic review.

The proposition further suggests that the Health Insurance Fund can be used to pay for the new scheme. The HIF is under mounting pressure as the Island’s population ages and costs associated with pharmaceutical and medical benefit increase. The UK Government Actuary’s review of the Health Insurance Fund will be available next month and it would be unwise to make a commitment to offer free, unlimited services ahead of the Actuary’s advice. In addition the Treasury and Resources Minister has confirmed that he will hold the Department to the previously announced savings in the Income Support budget of £3 million in 2014. This means that no funding is available from the Income Support Budget unless other areas of tax funded benefits are reduced.

Access to primary care for those on low incomes remains a matter of concern; however this issue is already highlighted in the Social Security Business Plan for 2014 and work is already planned to take place in the second half of the year.

Project 16/2014

Investigate options to improve support for GP costs within low income groups, within existing budgets

The amendment lodged by Deputy Hérissier recognises that the delivery of primary health care is being reviewed and that broader questions need to be addressed regarding access to primary care, low income and high need. An investigation, as suggested by the amendment, will offer valuable information to the wider primary care review.

The Proposition as presented does not receive my support as it is poorly targeted and would pre-empt the outcome of work already being undertaken. I urge members to reject the proposition and support the amendment.

Standing Order 37A: Presentation of comment relating to a proposition

This comment has been submitted outside the deadline set out in standing order 37A. The comment is late because the deadline has been brought forward and it was not possible to finalise the comment before the earlier noon Thursday deadline.