New contracts for hospital consultants, which Minister for Health Mary Harney is planning to advertise, could dramatically reshape the way public hospital services are delivered. Martin Wallreports.
It could also ignite the most damaging industrial relations dispute in the health services since the nurses strike a decade ago.
The Irish Hospital Consultants Association, the largest body representing medical specialists, is to consider its response to the effective breakdown of talks on a new contract at a meeting today.
Unless it undertakes to enter fresh negotiations without pre-conditions, the Minister is planning to bring proposals to Cabinet on Wednesday week to allow her to begin recruiting the first tranche of up to 1,500 new consultants on revised terms.
Consultants have insisted in the past that they would boycott any such process and refuse to serve on interview panels.
The Minister's plan would involve advertising internationally for two or three hundred consultants, initially, in a number of specialty areas.
Health service management has not ruled out bringing in doctors from abroad to interview candidates, if necessary.
The Government would offer a single basic contract with two "manifestations".
The first type of contract would see the doctor employed exclusively in the public services. These consultants would be salaried employees and would not have the rights to treat private patients at all.
They would be paid a salary of up to €240,000. It is unclear whether this includes a potential 20 per cent performance bonus, which is also provided for in the new contract. This would be based on targets for treating specific numbers of patients.
The second type of contract would allow doctors to see fee-paying patients in the public hospital or in any co-located private hospitals established on the campus. However, there would be monitoring to ensure that public work was carried out first.
The Minister is to allow the development of co-located hospitals on eight sites around the country, although this could increase to 10 over time.
The consultant with private practice rights would have a lower salary. They would not be eligible for the bonus scheme.
The new contract would be offered to all 2,000 existing public hospital consultants in addition to the new employees.
The Government will not be able to force consultants who have an existing contract to opt for the new arrangements.
However it believes that the additional salary and pension entitlements - which are linked directly to pay - on offer could prove attractive, in particular for consultants close to retirement.
Opting for the new contract could see some existing consultants increase their pensions by €30,000 a year.
Under the new contract, consultants would be expected to provide services directly to patients rather than leading teams of non-consultant doctors as is the case generally at present.
They would be rostered over an extended working day. In some specialities, particularly emergency medicine and some types of surgery, a consultant would be required to be in the hospital at all times.
Talks on a new contract have been dogged by a row over the abolition of an arrangement which allowed private practice in public hospitals - the so-called category II contract.
Consultant organisations have insisted that this ban, which was imposed unilaterally a year ago, be lifted before they would engage in substantive talks.
Management has proposed that it could reclassify up to 40 posts established last year to category II status - about the same number as in previous years - in the context of a comprehensive deal.
The independent talks chairman Mark Connaughton has proposed that parties give a commitment to "unconditional negotiations" as a way forward.
However the definition of "unconditional" is likely to be the source of another dispute.