NEARLY TWO dozen hospital consultants have been warned by health service management in recent days that they have been treating too many private patients in public hospitals.
This is the first time such letters had been issued to consultants since the introduction of a new contract for the sector, according to medical sources.
The new consultant contract, introduced last year, sets strict limits on the numbers of private patients permitted to be treated by consultants working in public hospitals.
The contract stipulates that the ratio of public to private patients treated by doctors in public hospitals should range between 70:30 and 80:20.
The Irish Timesunderstands that last Friday the Health Service Executive (HSE) and local hospital management sent out letters to 22 consultants around the country, pointing out that they had been treating too many private patients in the first three months of the year.
The HSE yesterday did not provide full details of the private practice activity levels that led to the letters being sent out.
However, informed sources said that in some of these cases the public-private practice ratio was running at about 60:40 but that in some isolated incidents the majority of patients treated were private.
The consultants concerned will now be invited to follow-up meetings with the clinical directors or with hospital managers.
Under the terms of the contract, if private practice rates persist at levels above the official thresholds, there is provision for consultants to face financial penalties.
However, how this would work in practice remains vague at present.
While the number of doctors who have received letters is relatively small, Minister for Health Mary Harney has signalled on a number of occasions over the past year that the new limits would be enforced.
About 85 per cent of the 1,800 permanent public hospital consultants in the country have now signed the new contract and come within the scope of the new restrictions on private practice.
A spokesman for the HSE said yesterday that measuring and monitoring of private practice was one of the key elements of the implementation of the new contract.
He said that details of activity levels for the first quarter of the year were now becoming available to hospitals and hospital management.
The HSE spokesman said that there were a number of reasons why the private practice levels of individual doctors could be above the official thresholds.
He said that these included the number of patients presenting through emergency departments for admission, the absence of private hospitals in particular areas and the particular level of private health insurance coverage in individual geographical areas.
Full details of the private practice activity levels in public hospitals may emerge next week when the Dáil Public Accounts Committee is scheduled to hold a hearing into the implementation of the new consultant contract.
Last November, a Public Accounts Committee report found that hospital consultants were routinely breaching rules that limit the extent to which they can engage in their private practices while working in public hospitals.
Speaking at the time, the committee chairman, Fine Gael TD Bernard Allen, said the 80:20 split for public-private practice in public hospitals as set out in consultants’ contracts was being ignored extensively across the board.
“When we looked for information on the private-public mix, we were told it could not be made available to us because of contractual arrangements,” said Mr Allen.
“We find that hard to take. It’s quite horrifying in an area where taxpayers’ money is involved,” he said.
The new hospital consultant contract, which was agreed after more than four years of negotiations, provides for higher salaries of up to €240,000 in return for changed working practices, longer hours, weekend rostering and restrictions on private practice.