Hospital consultants working in public hospitals would in future have no rights to treat private patients, under proposals to be tabled today by the Health Service Executive and the Department of Health, writes Martin Wall
A draft new contract for hospital consultants, presented to the Cabinet by Minister for Health Mary Harney yesterday, sets out that in future senior doctors should only work in public hospitals or community facilities and provide cover on a 24-hour, seven-day basis.
It proposes that hospitals should operate a consultant-provided service for patients. This would mean that consultants would have "a substantial and direct involvement in the diagnosis, delivery and overall management of patients".
At present consultants generally lead teams of non-consultant doctors in training.
The draft contract says consultants would be paid exclusively on a salary basis and they would receive no extra money for the treatment of patients with health insurance.
The draft does not set out any proposed salary scale. However, it proposes there would be a performance-related awards scheme "to incentivise" increased productivity.
The document suggests consultants should work a 39-hour week organised in a way to provide medical cover on a 24-hour, seven-day basis.
At present, consultants are contracted to work 33 hours a week.
It proposes that each consultant's commitment to their hospital would be set out in an annual work plan which would be supported by a series of performance indicators and review mechanisms.
The draft contract proposes that work plans for each consultant would set out specific duties such as emergency commitments, operating times, ward rounds, out-patient clinics and diagnostic work as well as regular on-call commitments and involvement in professional activities, audit and competence assurance.
It maintains that consultants would work as part of a multi-disciplinary team which would be led and managed by a clinical director.
"As a member of the team, consultants will make decisions regarding the care, treatment and discharge of patients during the absence of a consultant colleague who has lead responsibility for such patients," it states.
The primary role of clinical directors would be to manage and plan the delivery of services.
The draft contract will be presented today to medical organisations.
Ms Harney last night said the contract was a crucial element of health service reform. HSE sources said it was designed to promote equity of access to hospitals and equality of treatment.
It is envisaged that a new contract will be offered to the 2,000 existing hospital consultants. New appointments will only be on the basis of the new deal.
Last night the Irish Hospital Consultants Association said it would not consider the draft contract until the issue of how the deal would be "priced" was determined. It described the document as an "extended press release" and said it wanted to see a full draft contract.
The Irish Medical Organisation said that it would review the draft contract this morning in advance of the talks.