Hundreds of public hospital consultants with rights to treat fee-paying patients in "off-site" private hospitals will be allowed to continue with these arrangements if they sign up to a new agreed contract, under new proposals put forward by health service management.
In a letter sent to medical organisations over the weekend, management said that existing consultants could hold on to their private practice rights as part of "transitional arrangements".
The clarification comes as the protracted talks on a new deal for consultants, which resume today, reach a critical phase. Minister for Health Mary Harney has said that she wants an agreement concluded by Christmas.
The proposed new contract is a key element of government healthcare reforms but the negotiating process has dragged on for years.
The aim of the Government in its negotiations on a new consultants' contract is to secure a greater commitment by senior doctors to treat patients in public hospitals.
Up to now it has proposed that there should be three new types of contract, a type-A under which doctors work exclusively in public hospitals, a type-B which would permit limited private practice rights in public or co-located hospitals and a type-C arrangement which would provide for off-site private practice in "exceptional circumstances".
It has been unclear what arrangements would be put in place to encourage many of the 600 or more existing consultants with unlimited rights to treat fee-paying patients in off-site private hospitals to sign up for the new deal, given that the maximum salary on offer to date was unlikely to compensate them for the loss of private earnings.
Following queries raised last week by the Irish Medical Organisation, one of the bodies representing consultants, management wrote back that consultants who opted for the proposed type-B contract would be allowed to retain their existing off-site private practice arrangements.
Management said that these arrangements would be "red circled" for existing doctors. It also said that the transitional arrangements would be conditional on the consultants concerned satisfying their employing authorities that they were fulfilling their contractual commitment to the public hospital.
"I must also emphasise that as these arrangements are of a transitional nature, they would not be made available to future appointees," the letter stated.
The new transitional arrangements would apply to the 600-700 doctors with the existing category II contract, who can treat patients in off-site private hospitals, and those with category I arrangements, who can see private out-patients in rooms outside their public hospital.
Given that category II consultants were being appointed up to last year, the proposed new transitional arrangements could mean that some consultants in public hospitals are likely to have rights to work in off-site private hospitals for the next 20 years or more.
Consultants opting for the new contract while retaining their existing private practice arrangements are also likely to be paid a higher salary.
However, they would have to work longer hours - a 39-hour week as against a 33-hour week at present - and accept new rosters which would see them working earlier in the morning, later in the evening and at weekends.
Consultants accepting the new contract would also have to work as part of teams under a clinical director.
Category II consultants currently receive between €146,000 and €162,000 per annum. Those doctors opting for the type-B contract and retaining existing private practice rights would earn between €156,000 and €171,000.
However, it remains to be seen how many existing consultants opt for the new contracts on offer.