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Health Access Scheme: Rules

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A decision made on 9 December 2020

Decision Reference:  MD-S-2020-0089

Decision Summary Title :

DS – Health Access Scheme Rules

Date of Decision Summary:

8/12/2020

Decision Summary Author:

Senior Policy Officer

Decision Summary:

Public or Exempt?

Public

Type of Report:

Oral or Written?

Written

Person Giving

Oral Report:

N/A

Written Report

Title :

WR – Health Access Scheme Rules

Date of Written Report:

08/12/2020

Written Report Author:

Senior Policy Officer

Written Report:

Public or Exempt?

 

Public

Subject: Health Access Scheme Rules

Decision(s): The Minister decided to introduce the Health Access Scheme.

Reason(s) for Decision: The Council of Ministers has committed to improving access to primary care.  To deliver on this commitment the Minister for Social Security has developed a scheme under which eligible people may access general practice services for reduced fees. The scheme will initially be extended to all members of income support households  (10,800 people) and all pension plus claimants (an additional 1,200 people) under a contract available to all general practices in Jersey.

A standard contract has been agreed with Primary Care Body representatives which will run from December 2020 to February 2022. 

 

Resource Implications: The project has been delivered using manpower and resources from Customer and Local Services, Health and Community Services, Modernisation and Digital, Strategic Policy, Planning and Performance and with support and input from local general practitioners and practice managers.  External support to make changes to a third-party IT system and advise on the activity fee model was commissioned and delivered from a budget of £62,000.

 

The scheme will be funded from the Health Insurance Fund.   Contract costs are estimated at  £1.74 million for 2021.  Additional operational costs are estimated at less than £20,000 per year and will be provided from existing resource.

Action required: Policy officer to coordinate the implementation  of the Health Access Scheme.

 

Signature:

 

 

Deputy J A Martin

Position:

Minister for Social Security

 

Date Signed:

 

 

Date of Decision (If different from Date Signed):

 

Hide report
Health Access Scheme: Rules

Health Access Scheme Rules

 

1. Introduction

The Council of Ministers committed to improving access to primary care in the Common Strategic Policy 2018-2022 and further focussed this commitment on financially vulnerable people in the 2020 Government plan:

 

P.47:“Deliver new models of primary care including the development of a model to support access to primary care for financially vulnerable individuals

 

The Minister for Social Security has brought forward a scheme to offer support to people who may face financial barriers to accessing general practice services to fulfil this commitment.  The Health Access Scheme will improve access to General Practice services by reducing the fee charged to eligible patients and improving price transparency which will help patients to budget for their care.

 

The scheme has been developed in consultation with general practice representatives.  

 

2. Eligibility

a)      The scheme will initially be extended to

  • all members of income support households  (10,800 people)
  • all pension plus claimants (an additional 1,200 people)

b)      Eligibility will be refreshed once a month.

c)       Every household with an open or suspended income support claim on the first working day of the month will be included.

d)      Every pensioner with an open pension plus claim on the first working day of the month will be included.

e)      The monthly list will remain in force until the end of the 6th day of the next month.

f)        A household or pensioner starting an income support / pension plus claim after the first working day of the month will be included in the following month for the first time.

g)       A household or pensioner  with a claim closing after the first working day of the month will remain on the Health Access Scheme until the end of the 6th day of the next month.

h)      Any eligible person can access the Scheme from any participating practice.

i)        A list of participating practices is maintained on www.gov.je.

j)        The list of eligible households and claimants will be held within the business systems of  GP surgeries.  Patient status will be  accessible to the practitioner at the point of creating the bill to the patient.

k)       An eligible individual can opt out of the scheme at any time by contacting Customer and Local Services.

 

 

3. Content of the Scheme

a)      Under contract, participating practices will charge eligible people set fees for their care.  The fee menu supports the delivery of services by Health Care Assistants and Nurses as well as General Practitioners.  Surgery consultations, home visits, telephone or remote consultations and the JDOC out of hours service are all accommodated. 

 

b) Patients are required to pay the following price tariff.

 

Type of Visit 

You Pay 

Children and young people aged 16 and under

GP surgery consultation/telephone consultation 

£0 (free) 

GP home visit 

£20

Adults and those aged 17 and over: 

 

GP surgery consultation/telephone consultation 

£12 

GP home visit 

£30 

Nurse surgery consultation/telephone consultation

£9 

Health Care Assistant surgery consultation 

£6 

 

 

Out of Hours consultations JDOC (Jersey Doctors On Call) Services  

You Pay 

JDOC telephone consultation

£20

JDOC surgery appointment 

£30 

JDOC home visit excluding 11pm to 8 am  

£61 

JDOC home visit overnight (11 pm to 8am)  

£75 

 

 

c)       These fees include the following ancillary services which are provided at the same time as , or as an immediate consequence of a consultation.  No additional charge is made for these services:

 

  • Blood test
  • Urine test
  • Letter of referral
  • Spirometry test
  • Swabs
  • Ear syringing

 

d)      Other services are not covered by the Scheme and the practice may make a charge.

e)      The practice may make administrative charges.  These are not covered by the Scheme

 

 

4. Contract with General Practice

 

A standard contract has been offered to all practices currently operating in Jersey.  Representatives from General Practice participated in the development of the contract which has been recommended to Practices.  Under this contract the scheme will run from 11 December 2020 to 6 February 2022.

 

 

5. Legal Position of the Health Access Scheme

 

The Health Access Scheme is a non-statutory scheme. As such, the terms of the Scheme can be amended or withdrawn without notice at the discretion of the Minister for Social Security. 

 

As a non-statutory scheme, the decision of the Minister for Social Security is final.

 

6.      Cost and Resources

The Health Access Scheme will be funded by the Health Insurance Fund and, as noted in the Government Plan 2021-24, a  review of the ongoing sustainability of health funding will be undertaken during 2021.

 

The project has been delivered using manpower and resources from Customer and Local Services, Health and Community Services, Modernisation and Digital, Strategic Policy, Planning and Performance and with support and input from local general practitioners and practice managers.  External support to make changes to a third-party IT system and advise on the activity fee model was commissioned and delivered from a budget of £62,000.

 

The scheme will be funded from the Health Insurance Fund.   Contract costs are estimated at  £1.74 million for 2021. Additional operational costs are estimated at less than £20,000 per year and will be provided from existing resource.

 

 

 

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