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.

But can it all be implemented by the beginning of next month as envisaged by the Minister?

The Irish Medical Organisation denied it had already endorsed the deal. It said its consultant committee would only meet in the days ahead to consider the issue before a ballot is undertaken.

The Irish Hospital Consultants Association did not return calls yesterday.

Even if the deal is backed, it is clear that additional consultants will need to be recruited for it to maximise its potential.

Reilly said yesterday the lower pay scales would allow for more consultants to be appointed. However at present the HSE is restricting virtually all recruitment on cost grounds.

The medical bodies did not agree to the lower pay scale for new consultants. It remains to be seen whether they will co-operate with this recruitment process.

THE DEAL

What's resolved

* New rostering arrangements for consultants

* 24/7 consultant service to be introduced in some specialities such as emergency medicine, intensive care and obstetrics

* Some consultants to be rostered on five out of any seven days

* Provision for consultants to be redeployed by their clinical director to work in other hospitals or locations to support the Government's new framework for smaller hospitals

* Clinical directors to be given new powers over rosters and work schedules of consultants

* Consultants to accept current controversial methodology for calculating private practice rates

* Consultants to co-operate with measures to support the collection of income from insurance companies in a timely manner

* Consultants no longer to receive an individual €3,000 annual grant for continuing medical education. Instead additional money to go to postgraduate training bodies to provide supports to doctors

What's unresolved

* Government decision to cut pay by 30 per cent for senior doctors appointed in future to any of the existing categories of consultant position. This is being implemented unilaterally by the Government

* Management proposals to reduce rest-day arrangements.

* This is to go to the Labour Court for a binding recommendation under the Croke Park agreement

* Management proposals to introduce reforms in the areas of community and mental health services.

This is to go to the Labour Court for a binding recommendation under the provisions of the Croke Park agreement

* Management proposals to reduce existing arrangements for providing compensation to consultants for historical leave which they were unable to take in the past.

Management believes this could cost up to €103 million up to 2027.

This is to go to the Labour Court for non-binding recommendation outside of the provisions of the Croke Park agreement