Proposal to hold private fees in HSE account

Private practice fees earned by public hospital consultants in future would have to be lodged in a holding account maintained by the HSE under proposals from the health service management.

Under the plan, consultants with private practice rights would receive payment from this account on a quarterly basis.

As widely expected, the management proposals envisage two types of contract for hospital consultants. The proposed type A contract would not permit doctors to treat private patients.

The type B contract would allow consultants to treat public and private patients in public hospitals or in the proposed new co-located private hospitals to be developed on State land.

No off-site private practice would be permitted.

In addition, the management proposal stated that no public hospital resources, such as secretarial support, could be used to support private practice in private out-patient clinics or outside the public hospital itself.

"Participation in private practice for type B contract-holders would be to a maximum of 20 per cent of total clinical output," the proposals state. "In this context, performance information will be employed to validate performance between private and public practice."

Management also proposed that the 20 per cent maximum ration would apply to each individual consultant.

Under the plan, consultants appointed to type B contracts would be subject to a contractual requirement that all fee income from private practice was lodged in a holding account maintained by the hospital.

"Billing procedures will be effected and administered by the hospital. On a quarterly basis, subject to a consultant's private output not exceeding 20 per cent, the associated income is transferred to the consultant's own account.

"In the event of a consultant's private output exceeding the 20 per cent maximum ratio of his/ her total output in any quarter, the total fees earned will be reduced on a proportionate basis," according to the management proposals.

Management has also proposed that public hospitals should be able to contract in consultant expertise from the private sector on a contract-for-service basis (non-salaried, non-pensionable basis) for defined sessions, tasks and outputs.

It also suggested that it could enter into contracts with private hospitals (rather than individual consultants) to provide required consultant services.

It is understood that the reaction from consultant organisations to the management proposals was negative. The negotiations will resume next week.

The medical bodies are expected to see a wider range of contract options from management. The Government has set a deadline of the end of March for the completion of the talks process.