End of Year Checklist for Consultants in Full-time Private Practice - December 2019
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
End of Year Checklist for Consultants
in Full-time Private Practice
December 2019
1
President’s Message Dear Colleagues, During 2019 the Association together with a significant number of consultants in private practice engaged in extensive discussions with representatives of the main health insurers. Fee levels were increased under the current VHI three-year agreement in 2018 and 2019 by 4% and 3% respectively. A further increase of 3% is scheduled for 1 July 2020. A series of specialty group meetings was conducted with Laya in September and its new Schedule effective from 1 January 2020 will provide for an overall average rate increase of 10% over an 18 month period which will be phased as follows: 3% from 1 January 2020; 2% from 1 June 2020; and 5% from 1 June 2021. Discussions will commence with Irish Life Health in the early new year in advance of a new Schedule issuing next May. For some time the Association has been highlighting the fact that the cost of obtaining appropriate and required levels of clinical indemnity has become prohibitive for many specialties. Indemnity costs more than doubled in most specialties, and in some specialties quadrupled, between 2012 and 2015. Furthermore, costs have continued to increase in the interim. The Association has called on the government to engage in a significant process of Tort Law Reform in order to reduce the level of costs associated with the resolution of adverse We are continuing to engage with indemnifiers, the State Claims Agency, and the departments of Health and Justice on this issue. The Association has also been in discussions with a consortium involving Berkshire Hathaway International Insurance Ltd (BHL), and its subsidiary MedPro, as they assess the feasibility of offering medical malpractice liability coverage to Irish consultants. Members were previously requested to provide details, including claims histories, to the Consortium for the purpose of its analysis. We will advise members in due course on further developments. On behalf of the National Council and the executive staff of the Association, I would like to take this opportunity to thank you for your continued support. We look forward to successfully addressing the concerns of our members over the next year. Finally, I wish you and your families a happy Christmas and a successful 2020. Dr Donal O’Hanlon President 2
Dear Member,
This end of year checklist provides Consultants with a summary overview of issues arising in
private practice that may require your attention on a regular or annual basis. If you are short on
time you should review the summary on page 4 and act on the key financial and related matters
without delay. Should you have any queries regarding the items highlighted below, please do not
hesitate to contact the Secretariat.
Yours sincerely
Martin Varley
Secretary General
Table of Contents
Summary: End of Year Checklist .................................................................................................... 4
1. Medical Council Registration Requirements........................................................................... 5
2. Medical Indemnity .................................................................................................................. 7
3. Health Insurance Schedules and Payments ............................................................................ 5
4. Medical Defence Union........................................................................................................... 7
5. Practice Rights......................................................................................................................... 7
6. Medico-legal ........................................................................................................................... 8
7. Staff and Employment Issues. ................................................................................................. 8
8. Data Protection Legislation and GDPR .................................................................................. 11
9. Pension & Revenue Issues ..................................................................................................... 11
10. Retiring & Retired Consultants.............................................................................................. 12
11. Financial Services .................................................................................................................. 12
3Item Summary End of Year Checklist
Links are provided in the body of the text in the main section of the
Checklist
Medical Council Ensure you adhere to all Medical Council Registration requirements.
Requirements See Section 1 for details.
Direct Debit Payments for Ensure that any payment made by Direct Debit is actually processed
Medical Indemnity and by your bank. This is particularly important in the case of medical
Medical Council indemnity and Medical Council registration fees.
Health Insurers’ Schedules Verify new Schedule descriptions and rates as published, including
the revised Laya Schedule due to be available from 1 January 2020
and the Irish Life Health and VHI Schedules issued in May 2019 and
July 2018 respectively. See Section 3.
Health Insurer Payments Reconcile all outstanding payments with private health insurers,
paying particular attention to pended claims. See Section 3.
Check F45 forms supplied by health insurers to ensure that the
Professional Services Withholding Tax amounts are consistent with
own accounts. See Section 3.
Medico-legal Review medico-legal fees and notify requesting solicitors accordingly.
See Section 6.
Staff & Employment Review key aspects of and requirements under employment
Issues legislation. See Section 7.
Data Protection Review data protection requirements in light of GDPR. See Section 8.
Flat-rate expense Check that you are benefiting from the €695 flat-rate expense
allowance allowance in your tax credits each year. You can claim a tax rebate
for the previous 4 years, therefore claims for 2014 need to be made
by 31 December 2018. See Section 9.
4Medical Council Registration
1. Medical Council
Registration Members should note the following Medical Council requirements:
Requirements
Under the Medical Practitioners Act, 2007 it is an offence to
practise unless appropriately registered.
Certificates of Registration should be available for inspection at a
Consultant’s place of work.
The Medical Practitioners (Amendment) Act 2017 makes it a legal
requirement for Consultants to have appropriate medical
indemnity.
Inspection by Private Institutions
Members are advised to have ready proof of registration to hand and
ensure that their affairs with the Medical Council in respect of
registration are in order.
CPD – Professional Competence Requirements
Since May 2011, all doctors are legally obliged to maintain their
professional competence. This applies to all fully registered doctors,
whether retired or part time. Registered medical practitioners must be
enrolled on a Professional Competence scheme and should be aware
of the deadline for entering their CPD Credits in order to obtain their
Annual Statement of Participation.
Every practising consultant should have Professional Indemnity as
2. Medical
follows depending on their practice:
Indemnity
All private practice must be indemnified by the consultant personally
through membership of a medical defence organisation such as the
Medical Protection Society or a broker/insurer.
The benefits of the non-indemnity services include representation
before the Medical Council, Dental Council, assistance at Coroner
Inquests, advice/representation where a consultant is involved in any
form of inquiry or review etc.
Medical Practitioners (Amendment) Act 2017
The Medical Practitioners (Amendment) Act 2017 came into effect on
6 November 2017 and has introduced new mandatory legal
requirements for all medical practitioners currently registered or
applying to register with the Irish Medical Council regarding levels of
professional medical indemnity. For further details see National
Circular Gen 17 – 086 available here.
Clinical Indemnity cover for medico-legal work
Members should note that all consultants require clinical indemnity
cover for medico-legal work.
During 2019, the Association engaged in detailed discussions with
3. Health Insurance representatives of the main health insurers in relation to their
Schedules and respective Schedules of Benefit.
Payments
5VHI’s current Schedule of Benefits was introduced with effect from 1
July 2018 and will expire on 30 June 2021. Fee levels were increased
under the three-year agreement from 1 July 2018 by 4% and from 1
July 2019 by 3%, with some slight variation depending on specific
procedure codes. A further increase of 3% is scheduled for 1 July 2020.
Laya Healthcare has confirmed it will issue a revised Schedule of
Benefits effective from 1 January 2020. It has been confirmed that rate
adjustments relating to participating professional fees will apply and
an overall average rate increase of 10% over an 18 month period will
be implemented as follows:
3% increase effective from 1 January 2020
2% increase effective from 1 June 2020
5% increase effective from 1 June 2021
Irish Life Health issued a revised Schedule with effect from 1 May 2019
which will remain in place until 31 May 2020. The Schedule confirmed
an increase in professional fees for most procedure codes of 2.5%,
ranging to 6% for some benefits, with a small number of codes where
the increase was limited to 2%.
Claims Processing & Payment Delays
Members experiencing difficulties with regard to payment delays and
pended claims should contact the Association for assistance.
Registration with health insurers
Consultants are advised to ensure that their registration details with
the respective insurers are kept up to date to reflect the structure of
their practice. In particular, if you operate as part of group practice or
partnership, health insurers will require you to keep them updated as
to the composition of the group or partnership and any changes in
membership.
F45 – Professional Services Withholding Tax
Members are reminded to check that their F45 forms, supplied by
health insurers detailing the total amount of Professional Services
Withholding Tax (PSWT) deducted from professional fees, are
consistent with one’s own accounts. In the past, significant errors
have been discovered in F45 forms. In such cases, application should
be made to the health insurer for an F43 Certificate detailing the
correct amount. Revenue has issued some useful information on PSWT
at the following link. Further information is set out below in relation to
health insurer payments to groups and companies.
Payments by health insurers to Groups and Partnerships
The Revenue Commissioners issued an eBrief (No. 34/13) in August
2013, which is available here. The eBrief refers to amendments
introduced under the Finance Act 2013 and provides that where a
professional service is provided by a partnership then the accountable
person, which includes authorised insurers, can make the relevant
payment to the partnership or to the individual/practitioner who
provided the professional service.
Payments by health insurers to companies
6Members were advised by IHCA National Circular Gen 13-056,
available here that Section 522 of the Taxes Consolidation Act, 1997
had been amended to provide that health insurers may make
payments not only to an individual practitioner who provides
professional services to a subscriber/member, but also to an employer
of the practitioner in circumstances where the practitioner provides
the services in his capacity as employee rather than on his/her own
account.
In effect, the newly amended Section 522 provides statutory authority
for health insurers to make payments to companies as well as to
individual practitioners. The Revenue Commissioners issued an eBrief
No. 83/14 dated 29 September 2014, available at the following link
here.
4. Medical Defence MDU cessation of occurrence based cover
Union and
Members are advised to be aware of the significantly different terms
Challenge
applying to “claims made” coverage offered by the MDU and
Challenge. Accordingly members are advised to obtain 100% clarity
with regard to the terms for “run off” coverage that may or may not
be available from the respective organisations and the cost of
purchasing run-off cover at retirement.
Members are advised to ensure that their arrangements with private
5. Practice Rights
hospitals, clinics or facilities in relation to practice rights or admission
privileges are formalised and evidenced in writing. Furthermore,
members are reminded to safeguard their entitlements by taking all
necessary steps to ensure their on-going registration with the Medical
Council and maintaining appropriate professional indemnity insurance
arrangements.
Pro Forma Letter
6. Medico-legal
Consultants are regularly requested to provide opinions in medico-
legal matters. The fee charged by a consultant in this regard is entirely
his or her own affair. Under competition law, the Association is not
permitted to provide advice or recommendations on fee levels.
Members are strongly advised to respond to requests for medico-legal
opinions by using the pro-forma letter available on request from the
Secretariat. By so doing you will minimise the potential for confusion
or disagreement at a later time in the matter of fees.
Clinical indemnity cover for medico-legal work
All consultants require clinical indemnity cover for medico-legal work
undertaken for persons who are not patients or former patients.
Attendance in Court and service of Subpoenas
Members are advised to review the Pro forma Letter available on
request from the Secretariat for the purpose of providing advance
notice of their fee arrangements in medico-legal matters to the
relevant parties if requested to go on standby to attend in court.
7Application of VAT
The European Court of Justice has determined that non-medical
services such as the provision of medico-legal reports and fees for
standby or attendance in court are liable to VAT. Revenue have
accepted the ruling that where income from such services exceeds
€37,500 p.a. then the Consultant should register with Revenue here.
VAT is charged on medico-legal reports at the standard rate of tax of
23%. Certain reports specified in Schedule 1 of the VAT Acts are
exempt from VAT (e.g. Examinations for RTA, Gardaí). Revenue’s Tax
and Duty Manual has further information and a full list of taxable
medical services, available here.
7. Staff and Contracts of Employment
Employment
The Terms of Employment (Information) Acts, 1994-2014 requires
Issues
employers to provide a written statement to employees setting out
terms of employment. The Act applies to any person working under a
contract of employment or apprenticeship or employed through an
employment agency or in the service of the State. The statement
detailing the terms and conditions of employment must be given to a
new employee within two months of commencing employment.
Information to be included in the statement:
Full name of the employer and the employee
The address of the employer in the state
The place of work or a statement indicating that the employee
will be required to work at various places
Job title and/or nature of the work
Date of commencement of employment
If the contract is temporary, the expected duration
If the contract is fixed term, the date on which the contract
expires
The rate of remuneration or method of calculating
remuneration
Details of how remuneration is paid i.e. weekly, monthly etc.
Terms and conditions relating to hours of work (including
overtime)
Terms and conditions relating to paid leave
Terms and conditions relating to incapacity
Terms and conditions relating to pensions and pension
schemes if applicable
Period of notice which the employee is entitled to receive and
required to be given on termination
A reference to any collective agreement which affects the
terms of employment
Details of rest periods and breaks.
The statement must be signed and dated by the employee or on his or
her behalf. The employer is obliged to keep this statement for a period
of one year after the termination of the employment.
8The employer may include additional terms and conditions e.g.
requirements regarding shift work
grievance procedure
disciplinary procedure, including company rules and
regulations
deductions from pay
provision for lay off/short time.
Minimum Notice and Terms of Employment Acts 1973 to 2001
Employees are entitled to statutory minimum notice or pay in lieu
except where they are dismissed for misconduct. The statutory
entitlements to minimum notice are based on periods of continuous
service and are as follows:
Service Notice
13 weeks - 2 years 1 week
2 - 5 years 2 weeks
5 - 10 years 4 weeks
10 - 15 years 6 weeks
over 15 years 8 weeks
An employee must give an employer at least one week's notice unless
the employment contract specifies to the contrary. The above notice
provisions do not apply, however, where the employer is entitled to
terminate the employment contract summarily; that is, immediately
without notice, on account of the employee’s gross misconduct.
Employers and employees may agree longer periods of notice.
Annual Leave
All employees are entitled to paid annual leave as follows:
4 working weeks where at least 1,365 hours have been worked
in the leave year or
one third of a working week where the employee works at
least 117 hours in a calendar month or
8% of the hours worked in a leave year (subject to a maximum
of four weeks).
Periods of sick leave are not counted as hours worked, but maternity
leave and parental leave are.
Holiday pay must be paid in advance. If the pay is static it is the normal
rate for the working hours in the week immediately preceding the
holiday. If it varies it is the average for the normal working hours in the
13 weeks before the holiday.
The employer can determine the time of annual leave but must give
one month’s notice and have regard for the employee’s family
circumstances. Annual leave must be taken within the leave year or by
agreement within six months of its end. Pay cannot be given in lieu. If
an employee falls ill on annual leave, it shall not be counted as annual
leave.
Public Holidays: All employees are entitled to public holidays but may
at the option of the employer be given either a paid day off on the day,
9a paid day off within a month, an extra day’s annual leave or an
additional day’s pay.
Maternity Leave
Rights under Maternity Protection Acts 1994 and 2004 apply to all
pregnant employees, all employees who have given birth in the
previous 14 weeks, and all employees who are breastfeeding up to 26
weeks after the birth, provided they have notified their employer of
their condition. No minimum length of service is required.
Qualifying employees are entitled to:
26 consecutive weeks’ maternity leave for women who
commenced maternity leave on or after 1 March 2007, to
include at least 2 weeks before the expected date of birth and
at least 4 weeks after the birth
16 weeks additional maternity leave to be taken immediately
following the 26 week period (optional)
Social welfare payment, if applicable, during the 26 weeks
maternity leave.
It is at the employer’s discretion whether to pay a top-up amount
which, when added to the employee’s social welfare payment, would
equate to the employee’s normal salary. The employee’s contract of
employment should be checked in this regard.
Paternity Leave
With effect from 1 September 2016, new parents (other than the
mother of the child) are entitled to paternity leave from
employment or self-employment following birth or adoption of a
child. The Paternity Leave and Benefit Act 2016 provides for
statutory paternity leave of 2 weeks. The provisions apply to births
and adoptions on or after 1 September 2016. You can start paternity
leave at any time within the first 6 months following the birth or
adoption placement.
Parental Leave
The Parental Leave (Amendment) Act 2019 provides for a phased
extension to the maximum period of unpaid parental leave and
extends the maximum age of the child for whom parental leave can be
taken from 8 to 12 years. Parental leave for parents of eligible children
has increased from 18 working weeks to 22 working weeks from 1st
September 2019 and will increase from 22 working weeks to 26
working weeks from 1st September 2020.
Force Majeure
Force Majeure leave is paid leave that arises when injury or illness of a
close relative (as specified in the relevant legislation) makes the
immediate presence of the employee indispensable. The force
majeure provisions now extend to persons in a relationship of
domestic dependency, including same-sex partners. Maximum
allowance is 3 days in 1 year or 5 days over 3 consecutive years. Part
of a day is counted as a full day.
10Members can access further employment rights information at
http://www.workplacerelations.ie/en/ and are advised to contact the
Secretariat if there are any issues of specific concern. In some
circumstances, it may be necessary to retain independent professional
legal advice.
The Association has recently issued a detailed Guidance Document on
8. Data Protection GDPR and data protection (link). It is strongly recommended that you
Legislation and read the Guideline and ensure that appropriate actions are taken, as
GDPR may be required depending on your specific circumstances, to adhere
to GDPR requirements. Consultants who satisfy the GDPR definition of
a ‘Data Controller’ or ‘Data Processor’ should note that GDPR
compliance is not discretionary. Enforcement actions for non-
compliance include the imposition of significant fines. The Guideline
document will help you to determine your status and whether you are
affected.
9. Pension & Tax Relief on Pension Contributions
Revenue Issues Members are reminded to ensure that they are in receipt of the correct
level of tax relief on their pension contributions having regard to the
current limits which depend on whether you are a sole trader,
proprietary director and drawing a salary as an employee.
Tax Relief on other financial products
Members should note that tax relief is available in respect of payment
of premiums on a policy to secure the continuance of income and
payment of benefits during disablement through accident, injury or
sickness. See details here.
Income tax relief is not generally available on life insurance premiums
unless the policy qualifies under Section 785 of the Taxes
Consolidation Act, 1997, e.g. Pension Term Insurance. Consultants
who contribute to a Group Life Scheme may, however, qualify for tax
and PRSI relief depending on their circumstances and are advised to
take advice from a qualified financial adviser in this regard.
Flat Rate Employment Expenses
A standard flat rate expenses allowance (deduction) is set at €695 for
all Hospital Consultants. The deduction includes registration with the
Irish Medical Council. Guidance from the Revenue Commissioners is
available here.
Consultants are advised to check that they are benefiting from the
€695 allowance in their tax credits each year. You can claim a tax
rebate for the previous 4 years, therefore claims for 2015 should be
made before 31 December 2019.
10. Retiring & Professional Competence for Retired Members
Retired Retired members who still engage in clinical work and/or medico-legal
Consultants work should acquaint themselves with Medical Council and College
requirements. There is now a legal obligation to declare to the Medical
Council that you are maintaining your professional competence.
11Failure to comply may result in a complaint to the Medical Council’s
Preliminary Proceedings Committee.
Standard Fund Threshold
In 2010, budgetary measures were introduced to reduce the Standard
Fund Threshold (SFT) for the capital value of pension funds from €5.4m
to €2.3m with effect from 7th December 2010. In 2014, the SFT was
further reduced from €2.3m to €2.0m with effect from 1st January
2014. The reduction in the SFT means that an increased number of
hospital consultants could potentially incur a tax liability in respect of
the capital value of their public superannuation (if any) and private
pension entitlements at point of retirement. Up until July 2015, a
mechanism existed whereby members affected by the SFT reduction
could apply for a Personal Fund Threshold (PFT) to protect
superannuation entitlements in excess of the SFT, up to a maximum of
€2.3m as at 1 January 2014. (This replicated a similar mechanism that
had existed previously for Consultants who were eligible to apply for
the PFT in respect of the 7th December 2010 reduction from €5.4m to
€2.3m).
While the deadline to apply for a PFT has now passed, affected
members may still be eligible to apply for a PFT at point of retirement
on a ‘look back’ basis if, for example, you accrued significant public
sector pension entitlements before you entered into private practice.
Following detailed submissions and representations by the IHCA, the
Department of Finance and the Revenue Commissioners confirmed
that Professional Added Years (PAYs) would be taken into account
when calculating the PFT of a hospital consultant who exceeds the SFT
or a PFT at point of retirement.
Consequently, the ‘look back’ arrangements were put in place and they
are relevant for Consultants who receive Professional Added Years as
part of their reckonable service at point of retirement. Members are
advised to contact the Secretariat for further information in this
regard. A copy of IHCA National Circular Gen 15-019 dated 9th April
2015 link includes more detailed information and associated
documentation.
IHCA Group Scheme
11. Financial
Services Lyons Financial Services provides a suite of financial risk and pension
products to IHCA members, namely: Income Protection, Specific Illness
Cover, Life Assurance and Additional Voluntary Pension Contributions
(AVC). The risk products are underwritten by Friends First.
Lyons Financial Services can be contacted at Tel: (01) 801 5808 or by
email to ihca@lfs.ie.
12You can also read
