A better quality of medical care is promised to patients in the report of the Medical Manpower Forum.
If its proposals are implemented, patients will be more likely to be seen by a fully trained doctor or by a consultant than at present.
Hospital clinics will continue into the night, a move which in theory should dramatically cut waiting times for outpatient appointments.
Some grades of nurses will be able to begin treatment of undiagnosed patients coming to a hospital and to make other decisions. Details have still to be worked out.
The forum was established by the former minister for health and children, Mr Cowen, in 1998. It included representatives of the Department of Health; health boards, medical unions, training bodies, hospitals and regulatory authorities such as the Medical Council and Comhairle na nOspideal.
The present Minister, Mr Martin, received its report in November and is to bring it to Government and publish it shortly.
The theme of the report is that too much medical care in hospitals is delivered by trainee doctors, and the quality of training needs substantial improvement.
Patients wait a long time to be seen by doctors who may well be in the early stages of training, it says. These doctors order more tests than would be needed by experienced doctors, send patients on to other junior doctors, and in some cases are reluctant to seek advice from senior doctors.
The implications for both diagnosis and treatment are serious, it says.
The report suggests inexperienced doctors keep patients in acute beds for longer than necessary: consequently other patients have to queue longer for a bed.
Patients should be seen by suitably trained doctors, 24 hours a day, seven days a week, it says. This means creating hundreds of extra consultant posts. It notes that to bring Irish numbers up to Scottish levels, an extra 630 consultants would be needed.
The concept of a consultant provided service also means contracts would have to include flexible working arrangements. One outcome would be that clinics could be held outside normal daytime working hours.
If the forum has its way, the consultant will be more likely to be a woman than at present.
The report complains that although women make up 53 per cent of non-consultant hospital doctors, they comprise only 28 per cent of the new consultants appointed since 1996.
Patients should have the opportunity to be treated by a woman doctor, it asserts, and it calls for corrective measures which include flexible working hours and interview panels that include women.
It is unclear how long it would take to implement the report. The changes in doctors' working conditions, especially consultants, would have to be negotiated with the Irish Medical Organisation and the Irish Hospital Consultants' Association.
Both bodies have accepted the need for flexibility, but bargaining will be tough. Changes in nurses' work will require substantial preparation involving the Irish Nurses' Organisation and SIPTU.
Clerical and administrative staff, care assistants and hospital porters will all face changes in work practices and these will have to be agreed with their unions.
pomorain@irish-times.ie