The Health Insurance Organisation (HIO) announced on Friday that new regulations governing replacements between Gesy personal doctors will come into force next month to curb abuses that allowed some GPs to effectively manage thousands of additional patients through substitute arrangements.

The changes introduce limits on both the number of doctors a physician may replace simultaneously and the total number of beneficiaries that can be served through replacement agreements.

Under the new framework, a GP will be permitted to replace up to four colleagues at the same time, provided the combined number of patients under their care does not exceed 5,000, including beneficiaries already registered on their own list.

The reforms follow criticism raised last year in parliament regarding practices adopted by some doctors who had already reached the legal ceiling of 2,500 registered patients but continued accepting more through permanent replacement arrangements with colleagues.

The issue was discussed before the House human rights committee after complaints from parents who discovered their children had been registered under pediatricians they had never met, despite continuing to receive care from their original doctor.

During those discussions, the HIO acknowledged that existing regulations had created a “loophole” which some providers exploited through continuous replacement agreements.

The organisation informed GPsthis week that substitutions will now only be permitted under specific conditions including illness, vacation leave, maternity or paternity leave, conference participation, professional obligations and family or personal reasons.

The total duration of replacement due to absence or incapacity will be capped at 90 days per calendar year.

Doctors requiring longer absences will need to submit a special request to the organisation or temporarily suspend their registration as Gesy providers.

Additional restrictions are being imposed on doctors operating within the same polyclinic or medical premises.

In those cases, continuous replacement arrangements linked to co-location will be limited to 60 days per request.

The regulations also introduce new obligations requiring doctors to directly inform patients whenever a replacement arrangement is activated.

Concluding its guidance to doctors, the organisation stressed that substitute arrangements “do not replace the obligation of the personal physician to provide the prescribed healthcare services to the beneficiaries registered on his list.”