New proposals to restrict private practice rights

Talks between health service management and consultants, which resume this morning, are expected to see new proposals for a revised contract for consultants.

The contract, proposed by management, would severely restrict private practice rights and pave the way for major changes to how medical services are delivered in public hospitals.

Last night the Irish Hospital Consultants Association (IHCA) warned health service employers against causing delay or "breakdown" of the talks in an attempt to gain "short-term political advantage in the forthcoming general election".

The IHCA claimed that "with goodwill on the part of the State", the talks could succeed within a reasonable timeframe.

Under the management proposals, consultants would either be appointed to salaried positions with no private practice rights or be allowed to see fee-paying patients on a limited basis in public hospitals or in the new co-located private facilities to be developed on State land.

There will be no entitlement to private practice in off-site private hospitals.

There would also be strict controls introduced to ensure that the level of private practice in public hospitals does not exceed the permitted levels and that all public contractual obligations are carried out.

The independent chairman of the talks, senior counsel Mark Connaughton, has been asked to provide an interim report to Cabinet next week on the talks' progress.

Under the management proposals, the salaried consultants would receive higher pay than those with private practice rights.

It has been suggested in recent weeks that the new salary scale on offer could be up to €240,000.

However, it is understood that proposed pay levels will not be set out in the management document to be tabled this week.

It is envisaged that this issue would be discussed later if and when there is agreement on the nature of any deal.

The management proposals would also include a bonus scheme for consultants who exceeded specific targets, most likely based on throughput of public patients.

It has been suggested that this bonus payment could be up to 20 per cent.

It is understood that the new management proposals would also envisage the introduction of a new hierarchical structure which would see consultants working as part of teams under a clinical director.

The clinical directors would be part of hospital management teams and would have a say in the allocation of budgets to specific departments.

The management proposals are expected to maintain that consultants should have both financial and clinical accountability.

However, the medical bodies have signalled that there could be difficulties if it is envisaged that the traditional clinical autonomy of consultants be watered down or if the clinical directors had a managerial role over the clinical activity of individual doctors.

The medical bodies are to examine closely the proposals in relation to the mechanism for appointing clinical directors - whether, for example, they would be elected by their peers or recruited directly by management - and the duration of their tenure.

It is expected that the new management proposals will recognise that consultants can have an advocacy role on behalf of their patients.

This was not contained in an earlier draft put forward by management in the failed talks before Christmas.

However, it is believed that a controversial confidentiality clause will remain.

This says consultants must keep confidential details regarding patients and also any information considered to be "hospital business".

This could prove to be a major flashpoint as consultants believe that it would prevent them from highlighting, for example, any cutbacks in services proposed or introduced by hospitals.