Table 1 Access to healthcare and structure of T2DM care in the Republic of Ireland

Access to general practice healthcare in the Republic of Ireland

• The General Medical Services (GMS) scheme provides medical care to approximately 40% of the Irish population. It is predominantly means-tested and provides those who are eligible with free general practitioner visits, free hospital care and free medications (except for a prescription levy, currently €2.50 per item to a maximum of €25). A further ~ 5% of the population are entitled to free doctor visits (called a Doctor Visit Card (DVC)) based upon means testing and age-banding (all under-6-year-olds and over-70-year-olds).

• The Long Term Illness (LTI) scheme allows persons with certain medical conditions (T2DM being one) to have free access to medications which treat that condition. All patients with type 2 diabetes mellitus (T2DM) can have free medications under the LTI scheme.

• The GMS and LTI schemes are administered by the Health Services Executive (HSE) and Primary Care Reimbursement Services (PCRS).

• ‘Private patients’ represent approximately 45% of the population and are not entitled to a GMS or DVC card, paying the full cost for attending a GP, out-of-pocket, at the point of healthcare delivery.

Structure of diabetes care in Republic of Ireland

• Before October 2015, structured chronic disease management of T2DM was not universally available in Irish primary care. Approximately ten primary care schemes existed in 2013 and 2014, providing different levels of structured T2DM care, often set up as pilot schemes. This represented a maximum of 250 practices within Irish general practice (approximately 10% of total practices). Up until October 2015, the vast majority of structured T2DM care in Ireland was provided in secondary care, through public hospital outpatients or under the care of endocrinologists in private clinics.

• In October 2015, a new agreement was reached with GPs entitling all GMS patients to a structured diabetes programme in primary care (called a Diabetes Cycle of Care) with two free GP visits per annum. Private patients with T2DM either pay to receive care from their GP or continue to attend secondary care.