HEALTH SERVICE management has sought “demonstrable” changes to work practices, attendance patterns and reporting relationships for hospital consultants.
It has also proposed a “significant reduction” in the amount of historic leave that can be taken by consultants. It said several hundred were entitled to up to a full year of historic rest days and in many cases, in the year before retirement, senior doctors were opting to act as their own locum, thereby receiving two salaries.
In a document drawn up late last week the HSE and the Department of Health said there should be a review of existing rosters and work schedules to ensure there was a greater presence from consultants in geriatric medicine, general surgery, paediatrics and others in emergency departments.
It said the review would also look at “the best use of consultants’ hours where access to operating or other facilities was restricted”.
Management said there should be a scheduled consultant presence in hospitals over an expanded working day running from 8am to 8pm. Consultants could be rostered on five out of any seven days.
The document suggested rosters could be realigned to ensure a consultant presence on site in hospitals on Saturdays and Sundays “in line with the volume or acuity of workload in acute services”.
Weekends and bank holidays would be considered part of the normal working week and no additional payments would apply.
The document said in some hospitals consultants in areas such as anaesthesia, obstetrics and paediatrics/neonatology could be rostered on duty to ensure a presence on site around the clock.
Consultants could also see their current work locations changed to support the implementation of the Government’s forthcoming smaller hospital framework, which is likely to see existing services moved around between larger and smaller centres.
The proposals form part of the bid by Minister for Health James Reilly to change consultants’ work practices as an alternative to pay cuts which are set out in the programme for government.
The document said consultants would also be obliged to co-operate with Department of Health proposals for a new grade of senior hospital doctor.
Under the proposals all consultants, regardless of existing contract type, would report to a clinical director. The document said consultants would recognise “the senior management role of the clinical director as superseding that of the medical board and other representative structures”.
They would also have to co-operate “with the introduction of annual leave policies, cross-cover in the absence of consultant colleagues and other measures associated with maintaining consultant cover”.
The document said measures would be implemented to ensure public patients waiting for elective care were seen within clinically appropriate timeframes.
It said contractual limits on private practice would have to be observed, and that where consultants could not avoid treating private patients in excess of their contractual limits, the patients should not be charged.
Consultants would also have to accept the existing methodology for determining compliance with private practice limits – which is strongly disputed by medical organisations.
Consultants would also have to sign off on insurance company forms within 14 days to allow payment to hospitals.
Management also said two hours per week were sufficient for personal professional competence requirements and routine clinical teaching for undergraduate and postgraduate students.
The document proposed individualised grants of €3,000 per year for continuing medical education should be replaced by a system under which the HSE would provide funding directly to postgraduate training bodies.
Management proposed reducing historic rest-day entitlements by 50 per cent.
