The Government is facing potential conflict in the country's hospitals in the New Year following confirmation by Minister for Health Mary Harney that she will begin recruiting consultants under a new "public-only" contract if she does not strike a deal on the matter with existing senior doctors within months.
In an interview with The Irish Times, Ms Harney set a deadline of "spring" for agreement on a new contract with consultants. She said that if this was not reached the Government would leave existing consultants with their current contract and move to appoint hundreds of new specialist doctors under revised terms and conditions which would include restrictions on private practice rights.
However, in a national circular sent to members in recent days the Irish Hospital Consultants Association (IHCA) signalled that it would refuse to co-operate with any such recruitment programme.
Medical sources suggested this weekend that existing consultants could refuse to serve on interview panels or to shortlist applicants for new "public-only" posts.
Medical sources also questioned the practicality of consultants on two separate contracts operating side-by-side given the new requirements for team working in hospitals.
Ms Harney said that she was "not going to sit around all year trying to get something agreed".
"We will have to move on and appoint new people based on a new contract." She said that if this happened, existing consultants would continue to do the public/private mix allowed by the existing consultants' contract, but new consultants would not.
Over a decade there would be a transformation in how consultants worked, she said. "About 1,000 current consultants are over 55 and they will be replaced [over a 10-year period], and we need a further 1,600 on top of that. So over the next decade in Ireland we will probably be employing over 2,500 [ new] consultants".
She said her issue with existing consultants was not about how much they were paid but rather with how business was done. As far as possible she wanted to keep consultants in the one hospital.
She said her aim was to ensure that public hospitals would fulfil the needs of everyone. She envisaged a situation where a patient in the public system could see a consultant as fast as if they went private.
"The reality is that if you have private health insurance or can afford to pay, you have speedier access to our health system. And that's something I want to change."
She said that the new public-only contract was central to this. She said that if she succeeded in her plans, the numbers taking out private health insurance would fall as people saw that they could get treatment when they wanted it in public hospitals. "The key to doing that is increasing the number of consultants. We need to double them almost, and the key to that is the new contract because they are not affordable at current contract prices and under current conditions."
So far the two rounds of talks on a new contract for consultants which have taken place have been beset by a number of acrimonious disagreements.
Health service managers have also failed to produce a position paper on their reform proposals and this will not now be tabled until the end of January.
In its circular the IHCA said that all consultants may have to adopt the "exceptional discipline and solidarity" exhibited by psychiatrists in refraining from applying for membership of mental health tribunals if certain threats are carried out by the HSE/Department of Health regarding the contract negotiations It said that the bar on members applying for these posts had stood successfully for 16 months.
The Irish Medical Organisation said that the unilateral introduction of a separate contract for new consultants would be unworkable.