Significant questions remain on how new deal on work practices will be carried out

ANALYSIS:The roster changes have the potential to generate big savings by cuts to the overtime and premium rate bill

IF THE flexibility and work practice changes agreed between the Government and medical organisations are put in place it could have dramatic implications for the workings of the hospital system.

However, the timescale for the changes envisaged by Minister for Health James Reilly appears quite ambitious and there are still significant questions on how the deal will be implemented.

In essence there are two parts to the reforms. The first, brokered after intensive talks at the Labour Relations Commission, involves major changes to the way consultants are rostered.

The second, which is being introduced unilaterally by the Government, is a simple cut in pay for doctors appointed in future to any of the four existing categories of consultant positions.

Proposals set out by Dr Reilly over recent months for a new entry level grade of consultant – the so-called consultant level 1 post which was to have no private practice rights – have been quietly dropped.

In future the pay rate for a category “A” consultant – who can only treat public patients – will fall from €166,000 to €116,000. There will be pro-rata cuts in the pay rates for the three other categories of consultants as they are appointed.

The Government also shelved proposals in earlier drafts of the deal to restrict private admission rights for doctors who failed to sign forms to allow payments from insurance companies in a timely fashion.

It also dropped proposals which would have obliged consultants in situations where they unavoidably had to break the cap on private practice levels to treat patients over this threshold free of charge.

The new deal gives significantly increased powers to clinical directors to roster consultants to maximise patient throughput and to increase the presence of senior clinicians in hospitals across the day. Some consultants will continue to work on a Monday to Friday basis, across a day running from 8am to 8pm. Others will be rostered on any five out of seven days including weekends (although only on a one-in-five week basis). They will continue to receive on-call allowances.

For the first time consultants in areas such as emergency medicine, intensive care, neonatology and obstetrics will be rostered on a 24-hour basis, although each will only work an eight-hour shift. These consultants will be eligible for premium rates in accordance with public service norms – which includes double time at weekends.

The deal specifies that clinical directors will have regard to consultants’ seniority when determining rosters.

Such rostering arrangements have the potential to generate significant savings by reducing the existing overtime and premium rate bill. This alone currently runs to nearly €40 million per year.