A charity-run GP clinic in Dublin’s north inner city has said it will have to close at the end of this year unless changes are made to recent taxation legislation that has created “insurmountable operational challenges”.
Since 2016 GP Care For All has operated at the Summerhill Family Practice based in the Primary Care Centre in Dublin 1, serving a disadvantaged population and high proportion of homeless people.
The charity has been operating under a salaried GP model, with income coming directly into the practice, rather than the GP.
However, the organisation said due to legislative changes introduced earlier this year, namely the application of Section 1008A of the Taxes Consolidation Act 1997, there is an “unsustainable financial strain on the charity”.
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Under these changes, from January 2024, the income generated from the doctors’ General Medical Services (GMS) contracts is taxed as if it belongs to individual doctors, as opposed to the practice itself.
Kevin Kenny, chairman of GP Care For All, said an “unintended consequence” of this means the model under which it operates is no longer permitted.
“We were totally tax compliant, and doctors were salaried. But this doesn’t hang together as a model any more. The consequences are terrible for us as a charity, our patients and our doctors,” he said.
As a result, Mr Kenny said the practice would need to cease operating at the end of December unless “immediate change is made to legislation”.
Amanda Farrelly, general manager of the service, said GP Care For All provides necessary medical care for many people who would otherwise not be able to access it.
There are 2,613 patients on registered GMS lists, of whom 920 are children. A 2023 review of its patients found 309 patients were regarded as homeless, and were living in hostels or hotel accommodation
They are forced to turn away 10-15 people per day, she said, due to being at capacity. They also support many migrants and refugees.
“There are particularly older people in the area and you know by them that it’s possibly the only time they left the house that week. It’s a support to people, not just from a medical perspective,” she said.
“A lot of children come with foster parents because they’re in care. It’s hugely, hugely important. It’s not just a medical practice, it is a community hub. An awful lot of people do not have the knowledge or ability to get the help they need, and we help with that.”
Dr Austin O’Carroll, trustee of GP Care For All and operator of the North Inner City GP Training Scheme, said it is “extremely challenging to attract GPs to open in deprived areas” and stressed “how vital quality healthcare is to their lives”.
Responding to a recent parliamentary question on the issue, Minister for Finance Jack Chambers said although the guidance was widely reported as a tax change, “it did not, in fact, introduce a change to the tax treatment of GPs. Instead, it simply clarified the existing legal and administrative position”.
“It should be noted that because there are a number of business arrangements and models in the GP sector, including partnerships, companies, employees and employers, it would not be appropriate for tax legislation to seek to accommodate all contracts and business practices in the sector,” he said.
A spokeswoman said the Minister for Health said he is aware of the challenges faced by GPCareForAll and has “asked officials in the Department of Health to engage with representatives from the organisation to explore possible ways forward”.
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