Pay caps for doctors in specialist roles should be ended, report urges

The Government should introduce special derogations from official pay caps for senior medical consultants to facilitate the health service in filling highly specialised posts, a report to be published on Monday argues.

The report will also suggest that doctors with contractual rights to see private patients in public hospitals could be offered a once-off, non-pensionable payment to encourage them to opt out of these arrangements.

The report will also state that removing private practice from public hospitals – a key element of the overall Sláintecare health reform proposals – would cost €659.6 million per year but this could be offset by about €130 million if the State had to provide less in tax relief for health insurance.

A review group chaired by Donal de Buitléir, a former board member at AIB and the Health Service Executive, will say in its report that if the Sláintecare proposals are to be implemented, it will be imperative that new consultants are given contracts that allow only public activity in public hospitals.

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It says to ensure that such posts are attractive, “it will be necessary to review the remuneration package so that it is at a level sufficient to attract people with the appropriate skills and experience”.

Sláintecare contract

The report says that the Government should end the existing lower-pay arrangement for consultants appointed since October 2012 for those medical specialists to be recruited in the future under what would be known as a Sláintecare contract . It says the 2012 pay cuts should also be ended for those recruited in recent years on contracts which already only allow doctors to see public patients.

However, the report says “a more flexible approach to remuneration such as applies in the third-level education sector may be necessary to fill particular highly specialised posts”.

“If a similar scheme was to be introduced in the public health service, it could be used to attract the very highest qualified candidates for particular posts. However, we would caution that the implementation of any such scheme would have to be done under very tightly controlled circumstances and only used in exceptional circumstances.”

The report says that the vast majority of existing consultants – about 2,500 – have contractual rights to treat private patients in public hospitals. It says it will be necessary to enter into negotiations on the proposed “Sláintecare consultant contract”. It says some consultants with existing private practice rights in their contracts may opt to retain these for some time in the future.

‘Contract-change payment’

The review group also said that the Department of Health and the HSE should encourage consultants to move to this new contract through the introduction of a once-off "contract-change payment".

“The review group believes that it is appropriate to offer this incentive to existing contract-holders to encourage them to move to exclusively public contracts at the earliest opportunity.”

It says it would be a matter for the Department of Health and the Department of Public Expenditure to set the rate for such a contract-change payment to attract as many consultants as possible. It says such a payment would be in consideration of any loss of earnings.

The report states the Government should send a clear signal that, at some future date, private activity will no longer be permitted in public hospitals. It recommends that legislation should be introduced to ensure that public hospitals are exclusively used for the treatment of public patients from the conclusion of the 10-year Sláintecare implementation period.