A busy GP clinic with 2,600 medical-card patients remains under the threat of closure, despite Health Minister Stephen Donnelly's public statement that the issue has been "sorted," according to the charity that runs the practice.
A report on Tuesday’s Prime Time programme highlighted the charity's fears that its Summerhill Family Practice, located in a section of a HSE primary care centre in Dublin’s north inner city, was in danger of closure due to an unintended consequence of a newly implemented tax measure.
In a studio interview after the report, Minister Donnelly said that the clinic "is not going to close…it is sorted."
However, this interpretation was disputed by Dr Austin O'Carroll, director of the GP Care For All Charity which established and runs the clinic.
"We have had great engagement and great commitments [from Minister Donnelly], we still have no solution in place," he said.
The chairperson of GP Care For All Kevin Kenny said: "We have been told not to close…that, in itself, is nice…but has no substance if not followed through to develop a solution."
The Department of Health on Thursday also appeared to contradict the minister’s assertion that the clinic issue was "sorted."
In response to a question from Prime Time about the solution that appeared to have been found by the Department of Health in relation to the clinic, it said: "The Department of Health and the Health Service Executive (HSE) continue to engage with GP Care For All on this matter, no further update is available at this time. Issues relating to tax law are a matter for the Department of Finance."
A clarification of tax law issued by the Revenue Commissioners last year and implemented from January is at the root of the clinic's problem.
Under the measure, which Mr Kenny describes as a "double taxation", its doctors, who are hired – and taxed – as PAYE workers, are also taxable as self-employed on payments made by the State for medical-card patients.
Since the clinic opened in 2016, that money had been assigned directly by the doctors to the charity to fund the running of the clinic. Taxing it as if it was the GPs’ private income will reduce the amount that will be assigned to the charity, making its operation unviable, the charity says.
Minister Donnelly said on Prime Time that he had instructed his officials that the clinic was to remain open, but did not specify how it was to keep running if a mounting tax liability made its continued operation unfeasible.
Minister Donnelly has been in contact with Austin O’Carroll about the issue at different times in recent months and communication intensified ahead of the Prime Time broadcast, Dr O’Carroll said. Various options to keep the clinic open have been discussed with the minister and his officials, but those options either do not work for the Department of Health and HSE or they don’t work for the charity, he said.
Dr O’Carroll said he felt that the Department of Health and HSE "were not offering us a viable solution and the only possible route for us to survive was to put pressure on the Minister for Finance to legislate for tax change."
In the meantime, the clock is ticking on a practice that is widely regarded in the community - a protest demanding it remain open was held on Thursday.
"There was no general practice here in this area before we started," said Dr O’Carroll, noting that the patient list includes "a huge level of social complexity."
"We have many homeless patients, we have many people who use drugs. We have high rates of migrants and high rates of people from the Roma community."
Mr Kenny said that if the charity continues to carry on, "the risk… is that we will be closed by Revenue, effectively, or have to close to avoid being non tax-compliant, which as directors has considerable implications."
The favoured option for the charity is for an exemption to be added to tax law that would allow its GPs with income from medical card lists to continue to assign that gross income to the charity.
But in response to queries in recent months from TDs, the Department of Finance has indicated that the law will not be revised.
In a statement to Prime Time on Monday, and reiterated on Thursday, the Department stated "it would not be appropriate to propose changes to tax legislation which would treat income belonging to an individual contracted GP as income of an incorporated charity."
Worried that its own directors may be exposed to legal risk should the current situation continue, GP Care for All wrote a letter to the Department of Health in September with the heading, "Request for a Letter of Comfort Regarding Tax Compliance for GPCareForAll".
The charity wrote that "The trustees and doctors are very aware that they are continuing an operation which does not comply to tax legislation."
The letter included a link to an RTÉ article from 2020 about how charity trustees, including David Hall, were sued by the Revenue Commissioners for tax liabilities incurred by the now-deregistered Kerry charity, Animal Heaven Animal Rescue, even though the charity’s tax liabilities long predated their appointment. Mr Hall and other trustees had to defend High Court proceedings taken by Revenue, even though they had been nominated as trustees of the troubled animal charity by another arm of the state, the Charities Regulatory Authority.
The September letter by GP Care For All to the Department also stated: "While we continue to engage in negotiations with the Department and other relevant stakeholders, we are requesting a statement of support and assurance, addressed to the Trustees of GPCareForAll that can applied should any legal or financial proceedings follow on from the continued operation of GPCareForAll."
It also said: "The letter needs to indemnify the trustees and staff of GPCareForAll for any financial or legal consequences which might follow from operating GPCareForAll and engaging in devising a potential solution to the tax compliance issue."
The Department of Health responded, stating that "…the Department of Health and the HSE greatly value the work undertaken by GP Care for All." However, it did not provide the requested indemnity.
Reassured by Minister’s Donnelly instruction that the clinic be kept open, it remains open for the moment. "We were due to have a Board Meeting on Tuesday 19th November and the giving of notice to staff and the winding down of the practice were the main items of the agenda," Dr O’Carroll said.
"In light of the Minister's commitment to date, [the GP Care For All board] will probably not direct to close the practice forthwith, but it needs to be clear that is no definite solution as yet," he said.
