The Health Insurance Organisation (HIO) is tightening the rules governing substitute doctors under the General Health System (GHS) from June 1, closing a loophole that allowed some personal doctors to build patient lists far beyond the legal limit.
Under current arrangements, a personal doctor may cover up to 2,500 registered patients. Some doctors had been circumventing this cap by registering additional patients with colleagues they then permanently substituted, effectively supervising thousands of patients through the back door.
The practice was raised in parliament’s Human Rights Committee following public complaints from parents who discovered their children — though still being seen by their original paediatrician — had been registered with GHS doctors they had never heard of.
The HIO acknowledged the loophole during those parliamentary discussions and pledged to act. On Thursday it notified all GHS personal doctors of the new regulations.
From June 1, a personal doctor may substitute for up to four colleagues simultaneously, but the total number of patients covered — including those on the doctor’s own list — may not exceed 5,000. Doctors will also be able to appoint more than one substitute for the same period of absence.
Substitutions will only be permitted for specific reasons: illness, annual leave, maternity or paternity leave, attendance at conferences, professional commitments, and personal or family reasons.
The total duration of substitution on grounds of inability to practise may not exceed 90 days per calendar year. For longer absences, the doctor must submit a special request to the HIO or temporarily suspend their registration as a GHS provider.
When a personal doctor is unable to cover a duty shift at a GHS out-of-hours clinic, they must appoint a substitute exclusively for that shift and not for the general care of their registered patients.
The new rules also govern co-location arrangements, where doctors share premises in a medical centre. In such cases, continuous substitution may not exceed 60 days per request, and co-location substitutions apply only between doctors sharing the same premises.
Personal doctors are now required to inform their patients of any absence, its duration, and the substitute doctor’s details. Notification may be given in person, by automated telephone message, SMS, email, or by a notice posted prominently at the practice.
The HIO said in its circular that substitute arrangements operate solely in accordance with GHS regulations and do not replace a personal doctor’s obligation to provide healthcare to their own registered patients.
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