Some consultants working fully in the private sector are coming under pressure from private hospitals to sign up to the Government’s proposed new contract, a leading medical specialist has said.
Consultant ophthalmologist Michael O’Keeffe said he had been informed about some private hospitals seeking to employ “strong-arm tactics” – including warnings about future rights to see patients – to encourage doctors to accept a proposed new State contract.
The Government several weeks ago agreed a deal to take over 19 private hospitals for a three-month period during the Covid-19 crisis.
While the deal covered 2,000 beds, other facilities and most staff, it did not, however, encompass up to 600 consultants who work exclusively in the private sector.
These doctors were offered a locum contract – known technically as an A-type contract – under which they could see only public patients and would be paid between €141,000 and €195,000 per year.
Last Sunday, Health Service Executive chief Paul Reid said some private consultants had signed up but the HSE has not released any details on the numbers involved.
The Irish Times has spoken to some doctors who have privately confirmed that they had accepted the new contract.
Mr O’Keeffe said on Tuesday that he would not sign the proposed new public-only contract. However, he said if there was a crisis he would be prepared to volunteer to work without a salary.
Laser eye clinic
He said he had a large volume of patients on his books who he would not be in a position to treat if he took up the contract.
Mr O’Keeffe also expressed concern that signing a HSE contract would restrict his ability to speak out on health service issues.
He said he had received no advance notification of the State’s deal to take over the private hospitals. He was told he could no longer treat private patients and they would be considered as public patients, and was also informed that his laser eye clinic would have to close, he said.
After he went public and warned that some of his patients could go blind, there was a change of heart to some degree, he added. Now he was allowed to treat urgent patients and see patients requiring follow-on care in his rooms but could not charge them, he said.
Dr Stephen Fröhlich, an intensive care consultant at Beacon Hospital said he also had not signed the contract.
He along with 14 consultant colleagues worked for a partnership in a corporate structure. He said it would have been illegal for him to step away from this partnership to sign a contract with the State as an individual, he said.
He said he had proposed to the HSE that it enter into an agreement with the partnership rather than individual doctors, adding this could be done at an equal cost to the proposed contract.
Operating costs
Dr Fröhlich said most consultant practices would be run at a huge loss if they were to take the proposed contract without a parallel agreement for the State to cover costs .
He suggested that fully private consultants’ operating costs were about €20,000-€30,000 per month.
“This amount includes professional indemnity insurance, staff and office and administrative costs. They are expected to provide normal service to existing patients for €6,000 per month (net after tax HSE salary). This is leaving private consultants with a monthly loss of €14,000-€24,000, or up to a €72,000 loss over the course of the deal.
“Few small businesses can withstand that, nor would they be expected to,” he said.
Dr Jonathan Lyne, consultant cardiologist and electrophysiologist, said it had not been possible for him to sign the contract "because basic issues are yet to have been properly addressed in its drafting".
“ For instance it doesn’t state basics such as the duration, or clarify continuity of care for our existing patients. The integration with current public hospitals for the ongoing care and responsibility for these patients once the Private Hospitals’ Association and employment contract finishes is undefined. Also one section in the contract even states it’s to be reviewed by the HSE in 2013.”
He said in the interim many private consultants were volunteering where they could and were working pro bono in the absence of a workable contract .
