ANALYSIS:After four years of often tortuous negotiations, medical organisation leaders will spend the next 48 hours considering proposals which health service management is expected to represent as its final offer for a new hospital consultants' contract. Martin Wallreports.
Although the Department of Health and the HSE has put forward new higher salary scales for the two types of contract envisaged as well as new arrangements for doctors with existing off-site private practice rights, senior figures in the medical organisations believe that the overall package has changed for the worse in recent days.
There are serious concerns among senior medical negotiators at proposals to change existing eligibility arrangements for the treatment of private patients in public hospitals. They argue that these measures were flagged by management only at the last minute in the talks process.
They believe that these proposals, to be introduced by the Government as part of new eligibility reform legislation in the months ahead, would put in place more restrictions on private practice in some disciplines.
For example, private outpatient rights for radiologists, pathologists and consultants in emergency medicine would be terminated.
There is also concern that a bonus scheme of up to 20 per cent, which had been proposed earlier, is not mentioned in the new documentation. In addition, management has argued that the new salary scales would not be subject to any further increase by the review body which is currently examining top-level pay in the public sector.
While there are some significant amendments, the broad thrust of the new proposals put forward by management are similar to those set out in a draft contract which was proposed as part of the stalled negotiations earlier this year.
Consultants in future would work virtually exclusively in the public sector (or in co-located private hospitals) as part of teams under a clinical director over an extended day.
All consultants would work a 39-hour working week (compared with a 33-hour commitment at present). Medical organisations have told members that the proposed 39-hour week would be a nett commitment and is exclusive of lunch or any other breaks.
Under the new contract, hospitals would immediately introduce a more flexible day for consultants which would run from 7.00am to 10.00pm.
There would also be a "structured" consultant presence in hospital for five hours, mornings and afternoons, on Saturdays, Sundays and bank holidays.
Management has envisaged that weekend cover would be paid for at the normal hourly rate on Saturday while a premium rate would apply for Sundays.
The proposed new contract also envisages that there would be a commitment to have consultants in certain specialties such as obstetrics, anaesthesia, emergency medicine, neonatology/paediatrics present in the hospital on a 24/7 basis.
For other specialties it is proposed that there should be a timetable put in place for the introduction of 24/7 arrangements as well as rosters which would see consultants work five over seven days.
Management has also proposed that there should be "freedom to implement local arrangements regarding specific commitments above and beyond those provided for in a new contract".
Management has proposed that consultants taking the type A contract - under which they would work exclusively in public hospitals with no private practice - would receive €198,000-€216,000 on a four-point scale.
Consultants opting for the type B contract - under which they would have limited rights to see fee-paying patients in public and co-located private hospitals - would receive €175,000-€190,000.
Management has also proposed a new arrangement for existing category II consultants who have rights to treat fee-paying patients in off-site private hospitals.
Category II consultants who sign up to the new elements of the type B contract such as team working, more flexible day, etc, while retaining their existing
private practice arrangements would receive €156,000- €171,000.
At present category II consultants receive €146,000-€162,000 per annum.