The new consultant contract – what constitutes success?

When approval of the new consultant contract was announced at the end of last year, the reaction from medical representative bodies was far from positive.

While Minister for Health Stephen Donnelly hailed the document as a “landmark” and “significant step forward” for the health service, statements from the IHCA and the IMO painted a different picture.

IHCA President Prof Rob Landers said despite progress in discussions, the Minister and Government had “moved on and ended talks with representative bodies”. Chair of the IMO consultant committee Prof Matthew Sadlier noted the Organisation had concerns “as to how some of these proposals can be implemented given the serious staffing issues at consultant level”.

Concerns were aired again when the public-only consultant contract (POCC23) was officially introduced in March. Separate surveys by the IMO and the IHCA highlighted reservations their members had with the document. In the IHCA’s survey, 73 per cent of respondents said they were not confident that the new con- tract would address the consultant recruitment and retention crisis.

So what is the situation six months on?

New figures revealed that 125 new consultants have been appointed under the POCC23 since March.

The IMO “cautiously welcomed” these appointments. However, Prof Sadlier said while the Organisation welcomes every consultant recruit- ed to the health service, the number appointed under the new contract is “a fraction” of what is required. Prof Sadlier pointed out there are 900 vacant consultant posts in the system.

“We are short a further 2,000 consultants based on population at the moment, so the scale of the challenge is clear,” he said.

“We remain very concerned at the growing waiting lists and the intolerable conditions for patients and staff within our services where resources are stretched and there are insufficient staff across all grades.”

It has also been revealed that 293 consultants already employed have moved to the new contract. Prof Sadlier stated it is a personal decision for consultants whether or not to move to the POCC23. He added that, in time, it will be helpful to understand which specialties and which locations are seeing higher or lower numbers switching to the new contract.

“Consultants continue to express concerns not about salary levels under the new contract, but on other key issues including uncertainty around working hours, location of work, their ability to do their jobs given the lack of resources and pressures within the working environment,” he said.

Our main feature in this edition of the Medical Independent explores the issue in more detail. As Prof Sadlier said, the apprehension of consultants is often not centred on remuneration. Is it, therefore, fair to judge the new contract on the number of vacancies that continue to exist? While the contract will play its part, reducing these vacancies will require wider health service reform. The new working arrangements specified in the document will need time to bed-in. It is still early days. What is clear is that the POCC23 is here to stay. Now it is up to Government, the HSE, and the representative bodies to make it work to the best ex- tent possible for the benefit of doctors, the health service at large, and ultimately, the patients.