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‘Unintended consequences’ of consultant contract discussed at Rotunda meeting

By Catherine Reilly - 24th Sep 2023


An update on the public-only consultant contract by the Rotunda Hospital’s Master to its board warned of “adverse outcomes” and financial losses to the hospital, according to meeting minutes.

A discussion document on the contract was tabled at the Rotunda’s board meeting on 4 May. “An update was provided by the Master [Prof Sean Daly] including major issues, challenges, adverse outcomes, unintended consequences, financial losses, and impact to the ancillary fund for the Rotunda as a voluntary hospital. There is no option for private obstetric care outside the publicly funded maternity hospitals,” according to meeting minutes.

The minutes noted that the contract was introduced on 8 March and was the only one available to new consultants. “Ultimately a decision will be required by the board as the employer on the provision of private and semi-private care.”

The hospital’s annual report for 2022 stated that it continued to recruit consultants in a number of specialties and was fortunate to have a “strong field” for all competitions during the year.

However, the report added: “The spectre of a new ‘Sláintecare’ consultant contract being implemented in 2023 may cause additional recruitment challenges for the Rotunda, as it may significantly restrain consultants from working to their maximal capacity. It remains unclear how this contract will be perceived by new consultant candidates, in particular given the internationally competitive environment in which the Rotunda must attempt to recruit the best consultants.”

This newspaper requested a comment from the Rotunda, but no response had been received by press time.

A Department of Health spokesperson commented: “The Government introduced the public-only consultant contract (POCC23) on 8 March 2023. The POCC23 is a key step in the move towards universal, single-tier healthcare with public hospitals exclusively used for the treatment of public patients, as envisaged in the Sláintecare Report…. One of its core principles, as noted in the Sláintecare Implementation Strategy and Action Plan 2021-2023, is to remove private practice from public hospitals to ensure that public patients can access public hospitals on the basis of clinical need rather than ability to pay. Introduction of this contract is a key deliverable of this principle.”

The 2023 contract contains a prohibition (subject to limited exceptions) on private work in public hospitals, but sets out freedom (subject to limited provisions) for consultants to do private work in off-site private practice outside of their contracted hours. Consultants can engage in external work if they are granted permission by their employer. External work is any work outside of the scope of the new contract.

Over time, as more consultants are recruited to or switch to the new contract, the level of private activity in the public system will decline, said the spokesperson.

However, they added that the immediate impact on private maternity care will be minimal, “reflecting the fact that most serving consultants who specialise in obstetrics and gynaecology hold contracts that allow them to engage in on-site private practice.”

“While maternity care is not currently available in private hospitals, all consultants who hold the contract, including those who specialise in obstetrics and gynaecology, will be entitled to treat private patients off-site in their own time, subject to their public contract and meeting their commitments under it.

“Patients can continue to attend their consultant as a private patient, as the measure does not involve current consultants giving up their private practice, unless they choose to switch to the POCC23.”

The spokesperson also referred to ongoing investment in maternity services. This included €16 million in new development funding in budgets 2021 and 2022 to support the ongoing roll-out of the new model of maternity care.

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