Minister Harney accepts proposals from consultant contract talks chairman and urges consultants to accept new proposals
The Minister for Health and Children Ms Mary Harney TD today (Friday, 5th October) accepted the final report on a newconsultant contract by the independent chairman, Mr Mark Connaughton SC.
“I believe that Mr Connaughton’s proposals represent an even-handed approach to the resolution of outstanding issues between health service employers and the consultants’ representative organisations.
“As a package, they represent a significant advance for the public interest.
“They are acceptable to me, and I sincerely hope that both the IHCA and IMO will also find them acceptable so that we can get on with the task of implementing the new contractual arrangements for the benefit of public hospital patients.
“Our objective for the country is to be able to attract the best medical experts to work in our health services, in the best possible working arrangements together for the best possible outcomes for patients. These proposals will help us to achieve that.
The Minister said that the need for new contractual arrangements has been the subject of an emerging consensus among all stakeholders in the healthcare system over the last decade, and that it is a key element of the health reform programme.
The Minister said
“All the issues involved have been the subject of extensive and exhaustive discussion.
“While I know that there has been compromise by all sides, I would like to emphasise that the proposals represent a considerable advance on the existing way in which consultants deliver services, particularly in our acute hospitals.
The overall package on offer offers tremendous potential from which patients will benefit. This includes flexibility on extended working hours and development of local flexible working initiatives, new management structures involving Clinical Directors, team working and new disciplinary procedures:
- The proposals provide for an extended working day – 8am to 8pm – which will include a defined commitment to on-site presence at weekends. This means that patients should be seen faster, admitted faster and discharged home as soon as medically ready, seven days a week.
- New practice plans and locum cover arrangements will allow for planned measurable commitments by consultants for patient services.
- We will now have stronger team working arrangements among consultants and direct reporting relationships by them to Clinical Directors.
- There is a strong theme in these proposals of facilitating local arrangements to provide more responsive patient services.
- There will be greater clarity around private practice and significant advances for equity for public patients.
- The basis for localised arrangements to facilitate the co-location initiative is also here.
- It is most important that public patient access would not be disadvantaged by private practice. Access to Emergency Medicine Departments and public hospital diagnostic facilities will be on the basis of medical need. The patients’ public or private status should be irrelevant regarding diagnosis of, for example, cancer conditions and these proposals will deliver that.”
- An agreement on a new contract will allow us to move forward to recruit much needed additional consultants. 68 posts of an estimated requirement of an additional 1500 consultant posts have already been advertised and we need to accelerate the recruitment programme.”
The Minister also said
“New working arrangements, complemented by new management structures with clear reporting lines, and underpinned by the provisions of the Medical Practitioners Act 2007, will provide assurance of high quality services to patients and a framework for developing an enhanced professional working environment for highly qualified doctors.
I am confident that, with the combined efforts of management and the medical organisations, we can implement a new contract that will meet the ever increasing complexity of health service delivery.
The Minister thanked Mr Connaughton and participants in the lengthy negotiations for the development of proposals which she commended for acceptance by the medical representative organisations and their members.
Consultants’ Common Contract
The contractual arrangements applying to consultants in the public health service have remained largely unchanged since the early 1980’s. While the contract has been renegotiated twice – in 1991 and 1997 – the contract remains difficult to manage effectively, does not adequately provide for the organisation of the consultant resource in response to service need and contains an incentive and reward structure that does not prioritise the care of public patients.
The terms of the Consultant Contract and the implementation and management of the contract have been the subject of sustained critical analysis for the past two decades. The Tierney (1993) and Forum (2001) reports emphasised the need for changed consultant work patterns, clinical teamwork, consultant participation in management, new rostering arrangements and clinical audit. The Commission on Health Funding (1989), the NESC (1990), the Government White Paper on Private Health Insurance (1999) and NESF (2002) all noted the relationship between the contract and the extent to which there was equitable access for public patients to public hospitals.
Renegotiation of the consultant contract in 1991 and 1997 had not resolved these issues. As a result, the contract was subjected to detailed review during the drafting of the three reports at the centre of the Government’s health service reform programme – the Report of the Commission on Financial Management and Control Systems in the Health Service (Brennan); the Audit of Structures and Functions in the Health System (Prospectus); and the Report of the National Task Force on Medical Staffing (Hanly).
The implementation of the contract has also been the subject of a recent report by the Comptroller and Auditor General.
Negotiations on a new consultant contract have been ongoing since November 2005 but have been stalled on a number of occasions. On 26 June 2006 the independent chairman of the talks Mr Mark Connaughton SC provided management and the medical organisations with proposals to resume talks.
Bi-lateral talks took place over the summer and full plenary talks resumed on 4th September 2007 which have continued over recent weeks.
Main Features of Proposed New Contract Arrangements for Medical Consultants
The contract proposals provide for two types of consultants
- Consultants holding a Type A contract will be fulltime to the public service and will not engage in privately remunerated professional medical practice.
- Consultants holding Type B contracts may engage in privately remunerated professional medical practice only in hospitals or facilities operated by the Employer, as part of such activities that arise as part of the employment contract, or in co-located private hospitals on public hospital campuses. The volume of private practice shall not exceed 20% of the Consultant’s total clinical workload. A monitoring mechanism will apply.
Type B Consultants will not be entitled to charge fees in respect of the following:
- Patients attending Emergency Departments in public hospitals;
- Patients attending Public Outpatient Services in public hospitals;
The development of private hospitals on the sites of public hospitals and the transfer of private activity to the private hospitals will free up 1,000 additional beds for public patients.
This policy will help to:
- maximise the potential use of public hospital sites;
- promote efficiency among public and private acute service providers;
- promote greater competition in the supply of hospital services; and
- offer improved quality and choice to all patients.
Equity of Access to Diagnostic Services
A new “one-for-all” equity of access arrangement for all out-patient diagnostic services will be introduced. This arrangement will be structured in such a way as to ensure that no prioritisation takes place based on ability/willingness to pay or source of referral. The public hospital will have total control over the management of this arrangement, which will include validation of clinical priority.
The new consultants’ contract will provide for revised working hours/patterns for Consultants:
- Standard working hours for individual Consultants will be 37 hours per week (net).
- As a senior professional employee the Consultant will be expected to work beyond his/her rostered period without additional remuneration as required by the exigencies of the service.
- Consultants will be required to provide a scheduled on-duty on-site presence during an extended span of the working day and the working week as determined by the Clinical Director having regard to clinical and service need:
- Schedules will provide for an 8am-8pm Monday-Friday (including public holidays) on-duty on–site commitment as part of the 37hour week.
- In many circumstances a requirement will arise at weekends for a scheduled Consultant on-site presence. The new contract will provide for a Consultant to be on site on both Saturdays and Sundays for 5 hours each day.
- Flexibility will be provided for locally determined team working arrangements
- In addition to commitments set out at b. and e., the Consultant’s liability for on-call outside scheduled hours will continue to apply.
- As new consultants are appointed, there will be an incremental build up of arrangements which will allow for the 5 day working week over the 7 day period, as required.
The new contractual arrangements will cover, among others,
- The introduction of Clinical Directors;
- Greater levels of Team Working;
- The introduction of Practice Plans for individual Consultants;
- Extended working hours;
- Consultant involvement on an advisory basis in the structuring of posts;
- Locum cover arrangements
- Revisions to the Grievance and Disciplinary Procedures.
New contractual arrangements will have the following effects:
- Expand the level of access for patients/ clients to Consultant provided services;
- Enhance the level of on-site access to senior clinical decision-makers, thereby improving the:
- quality and safety of clinical care and service to patients/ clients,
- timeliness of senior decision-making,
- efficiency and effectiveness in the functioning of the hospital/ facility,
- level of supervision for non-consultant hospital doctors.
New Pay Proposals
Health service employers have offered Consultants an annual salary of up to €216,000 to sign up to the new Type A contract, and up to €190,000 for the new Type B contract. This is an interim offer. The final determination of the salaries applicable to the new contracts will be made by the Review Body on Higher Remuneration in the Public Sector.
This offer relates to basic salary only. The potential annual earnings of a Type A contract holder would be in the region of €275,000 when weekend working and on-call, call out payments are included.
(The current basic salaries of Consultants range from €164,000 to €182,000 for a Category I Consultant, and from € 147,000 to € 162,000 for a Category 2 Consultant.)
Total Average Annual Salaries of Consultants in Hospitals
- There are 2,203 medical consultants with an average annual pay bill of €400m. This includes €33m for on-call payments which averages €15,000 per consultant.