Proposed Government Plan 2023-2026 (P.97/2022): eighteenth amendment Free GP visits for children and young people

STATES OF JERSEY

PROPOSED GOVERNMENT PLAN 2023- 2026 (P.97/2022): EIGHTEENTH AMENDMENT

FREE GP VISITS FOR CHILDREN AND YOUNG PEOPLE

Lodged au Greffe on 28th November 2022 by Deputy C.S. Alves of St. Helier Central Earliest date for debate: 13th December 2022

STATES GREFFE

2022  P.97 Amd.(18)

PROPOSED GOVERNMENT PLAN 2023-2026 (P.97/2022): EIGHTEENTH AMENDMENT

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PAGE 2, PARAGRAPH (c) –

After the words "Appendix 2 – Summary Table 3 to the Report" insert the words –

 ", except that a new line should be inserted in Summary Table 3 to include a transfer of £800,000 from the Health Insurance Fund to the Consolidated Fund to allocate funds for the provision of a scheme to allow children and young people from 0 years to 17 years of age to receive free G.P. consultations;"

PAGE 2, PARAGRAPH (e) –

After the words "Appendix 2 – Summary Tables 5(i) and (ii) of the Report" insert the words –

", except that, in Summary Table 5(i) the Head of Expenditure for Health and Community Services should be increased by £800,000 to allocate funds for the provision of a scheme to allow children and young people from 0 years to 17 years of age to receive free G.P. consultations;"

Note:  After this amendment, the proposition would read as follows –

THE STATES are asked to decide whether they are of opinion

to receive the Government Plan 2023–2026 specified in Article 9(1) of the Public Finances (Jersey) Law 2019 ("the Law") and specifically –

1. to approve the estimate of total States income to be paid into the Consolidated Fund in 2023 as set out in Appendix 2 – Summary Table 1 to the Report, which is inclusive of the proposed taxation and impôts duties changes outlined in the Government Plan, in line with Article 9(2)(a) of the Law;
2. to  approve  the  proposed  Changes  to  Approval  for financing/borrowing for 2023, as shown in Appendix 2 – Summary Table 2 to the Report, which may be obtained by the Minister for Treasury and Resources, as and when required, in line with Article 9 (2)(c) of the Law, of up to those revised approvals;
3. to approve the transfers from one States fund to another for 2023 of up to and including the amounts set in Appendix 2 – Summary Table 3 in line with Article 9(2)(b) of the Law, except that a newline should be inserted in Summary Table 3 to include a transfer of£800,000 from the Health Insurance Fund to the Consolidated Fund to allocate funds for the provision of a scheme to allow childrenand young people from 0 years to 17 years of age to receive free G.P. consultations;

4. to approve each major project that is to be started or continued in 2023 and the total cost of each such project and any amendments to the proposed total cost of a major project under a previously approved Government Plan, in line with Article 9(2)(d), (e) and (f) of the Law and as set out in Appendix 2 - Summary Table 4 to the Report;
5. to  approve  the  proposed  amount  to  be  appropriated  from  the Consolidated Fund for 2023, for each Head of Expenditure, being gross  expenditure less estimated  income (if  any),  in  line  with Articles  9(2)(g),  10(1)  and  10(2)  of  the  Law,  and  set  out  in Appendix 2 – Summary Tables 5(i) and (ii) of the Report, exceptthat, in Summary Table 5(i) the Head of Expenditure for Health andCommunity Services should be increased by £800,000 to allocate funds for the provision of a scheme to allow children and young people  from  0  years  to  17  years  of  age  to  receive  free  G.P. consultations;
6. to approve the estimated income, being estimated gross income less expenditure, that each States trading operation will pay into its trading fund in 2023 in line with Article 9(2)(h) of the Law and set out in Appendix 2 – Summary Table 6 to the Report;
7. to approve the proposed amount to be appropriated from each States trading operation's trading fund for 2023 for each head of expenditure in line with Article 9(2)(i) of the Law and set out in Appendix 2 – Summary Table 7 to the Report;
8. to approve the estimated income and expenditure proposals for the Climate Emergency Fund for 2023 as set out in Appendix 2 – Summary Table 8 to the Report; and
9. to  approve,  in  accordance  with  Article  9(1)  of  the  Law,  the Government Plan 2023-2026, as set out at Appendix 3 to the Report.

REPORT

Deputy Southern brought forward P.125/2019 as amended, the "Affordable access to Primary Care Scheme" which was approved by the States on 04/02/2020. This requested the Minister for Health and Social Services to –

 "devise a scheme which improves access to primary care by reducing financial barriers for patients who are financially, clinically or socially vulnerable".

Shortly after, in response to the outbreak of the Covid-19 pandemic in 2020, the Minister devised a different scheme which reduced the cost of G.P. consultations for all patients, rich and poor alike, and made Covid-19 consultations, along with some other services, free.

As part of this scheme, telephone or face-to face consultation fees for children and young people between the age of 4 and 17 was set at £10. This level of fee, whilst welcome when compared to the previous level of £40, still has problems associated with it. As the Children's Commissioner pointed out in 2020 –

 "Any fees to access health care services present barriers to children and young people from accessing their right".

This arrangement for the delivery of primary care lasted for 4 months until 09/08/2020. After this period the delivery and costs of primary care reverted to the pre-Covid-19 rates. The cost for the patient co-payments for a G.P. consultation, including children and young people, was between £40 and £45 which lasted until the Minister provided a scheme which met the criteria in P.125/2019.

P.81/2020 GP Fees and Income Support was debated on 16/07/2020  following a proposition from Deputy Southern . The proposition asked the States to decide -

"to  request  the  Minister  for  Health  and  Social  Services  in consultation with the Minister for Social Security and the Council of Ministers, as appropriate, to review his recent decisions on the level of co-payments to be charged to various groups of patients for the delivery of primary care, and to –

1. add to the list of those eligible for free primary health care through G.P. consultations, members of households in receipt of Income Support; and
2. identify and bring forward for approval by the Assembly an appropriate source of funding for the foregoing."

This proposition was rejected along with the two propositions I presented at the same States sitting, namely P.80/2020 and P.80/2020 Amd. This proposition and amendment was in respect of extending limits of co-payments for G.P consultations: young people and pregnant women.

On 8/12/2020 the Government announced the Health Access Scheme in response to P.125/2019 as amended. This commenced on 11/12/2020 and provided for free face-to- face GP consultation fees for under 16's and £12 fees for over 17's who those islanders who are in receipt of Income Support and Pension Plus. Other islanders are required to

pay a fee, although there are G.P practices that do not charge for children under the age of 5 years old.

The current primary care system is unaffordable to many and inaccessible to many children young people who may be in dire need of G.P. services to address their physical and mental health needs after the pandemic.

Where some who are ill may put off that visit to the doctor until they are so ill that they need far more expensive hospital treatment. For many, the recent times have seen largely struggle and debt as jobs and hours have been lost and family incomes reduced. The last thing we should be doing is to add the stress of high doctor's bills to the anxiety many are suffering as they try to make ends meet in these times of hardship.

Financial and manpower implications

A new patient subsidy was introduced in July 2022 for all patients seeing a nurse, paramedic or pharmacist (£20.28 from the HIF) or a health care assistant (£10.00 from the HIF). This subsidy is not means-tested subsidy in the same way as the Health Access Scheme. The subsidy is paid directly to General Practices for all Allied Health Care Professional appointments. There is also additional funding from the HIF set aside to pay  for  salaries  for  additional  nurses,  paramedics,  pharmacists  and  health  care assistants. This additional and more diverse health care workforce means that not all consultations will need to be charged at the GP rate.

The census data shows there are approximately 17,500 children and young people aged under 18 who, on average saw a GP 1.8 times per year. This equates to around 32,000 GP  visits  per  year.  If  nurse/HCA  visits  are  a  further  10%  an  additional  3,200 consultations  could  be  added  to  this  total  to  give  35,200  consultations  per year. Practices currently charge around £22 for children and young people under 18 and based on these figures, the Government would require a budget of approximately £800,000 per year.