No doctor will be permitted to work for the Health Service Executive (HSE) on an agency or hourly basis for more than two months under new rules to be put in place by health service management from November.

Under a new instruction issued by HSE management, after two months doctors working on an agency or hourly basis will have to either accept a contract at the official salary rate or leave the public service.

The move is aimed at clamping down on the amount the HSE is spending on staff provided through employment agencies who cost more than those employed directly by the health authority itself.

By the end of July, the HSE’s agency bill had reached nearly €200 million – an increase of almost 50 per cent on the same period in 2013.

The instruction which was issued to hospital managers by the HSE last Friday says that “commencing from 3 November and taking full effect from 1 January 2015, no individual doctor can be employed on an agency/hourly rate for a period in excess of two months”.

It says that hospitals should proceed immediately to offer consultants working for them on an agency basis a fixed purpose contract of employment. It says the type of contract – whether, for example, it allows for private practice – should be determined by the employer.

Contract

The instruction says that hospitals should proceed immediately to offer non-consultant doctors, currently engaged through an agency, a fixed purpose contract in a service post for a two-year period.

The HSE has also told hospital managers that there should be strict adherence to existing rules which prohibit any non-consultant hospital doctors currently employed in the public health system from engaging in agency work.

The HSE has also urged managers to offer nurses employed on the nurse graduate programme – which pays less than the official staff nurse rate – two- year contracts to replace agency personnel.

The instruction says that the measures “must result in reduction of existing costs and there must be 100 per cent compliance from all HSE and HSE-funded service providers”.

“The full support of hospital management and in particular directors of nursing is fundamental to the success of this initiative in order to maximise the savings to be achieved.”

Challenges

Last month it emerged the HSE was paying private agencies €110,000 every 13 weeks to fill a single consultant post at Letterkenny General Hospital.

In total, five consultant posts at the hospital were being filled on hourly-rate contracts, with the cost for three months equivalent to the normal pay of a full-time consultant for a year.

The executive said it had encountered significant challenges in filling medical posts at the hospital. Seven out of 54 consultant posts are vacant and “in the recruitment process at various stages”.

Difficulties in filling posts at smaller regional hospitals have greatly increased since the Government cut starting salaries for consultants by 30 per cent two years ago. This is likely to be largely reversed soon.

The five vacant posts filled by hourly-rate consultants in Letterkenny are in the emergency department, radiology, general medicine and oncology.

Two paediatric posts are filled by locum consultants on payroll.