New restrictions on rest days for hundreds of consultants working in public hospitals will come into effect from tomorrow as part of a binding Labour Court recommendation under the Croke Park agreement.
Up until now, the level of compensatory rest days provided to consultants called out after hours was set at a fixed rate depending on the type of on-call roster they worked.
However, on foot of the Labour Court decision this system is to be replaced by an arrangement under which compensatory rest periods will be allowed only after an incident in which consultants are actually called out after hours.
The reforms to rest day entitlements will affect consultants working 1:3 and 1:4 rosters – the vast bulk of senior doctors working in public hospitals.
Up until now, consultants on a 1:3 roster received two rest days every four weeks. Those on a 1:4 roster received one rest day every four weeks.
Doctors working 1:1 and 1:2 rosters will see no change in their current entitlements.
The Irish Hospital Consultants Association said yesterday the Health Service Executive’s move was “unworkable” and would lead to inefficiencies in hospitals. It said the changes, if implemented, would prevent consultants treating patients on any morning after a night-time call. “This will severely disrupt patient care, urgent surgery and outpatient clinics and lead to cancellations at short notice and increased waiting times,” it said.
Labour Court
In its decision in November the Labour Court found the on-call and call-out arrangements in place for hospital consultants were out of line with standard arrangements in the public health services. The court recommended the replacement of the current arrangement with a system in which compensatory rest was allowed after an actual call-out incident.
The court said it had been informed by management and representative bodies that the 1:1 and 1:2 rosters were undesirable and ought to be eliminated as part of the current talks on restructuring and reconfiguration. It said the number of consultants on such rosters was small and declining. It recommended that existing rest-day arrangements should continue to apply to consultants working those rosters until they were phased out.
B factor
The provision of compensatory rest days for consultants was in addition to the payment of additional fees for being on-call – known as B factor – and for being called out after hours, which was known as C factor.
In reform proposals drawn up earlier this year, HSE management said: “B factor is paid for being on-call and is at a rate of €3,857 per annum with further payments for more onerous rosters. C Factor is paid in respect of call-outs and ranges from €78.59 – €209.65 per call-out dependant on time of call out and the overall number of call-outs per annum.
“Further payments per hour or part-hour in excess of the first call-out range from €52.31 to €104.84. A consultant may earn a maximum of 22,203 per annum under C Factor payments.”
HSE management has also told regional directors and hospital chief executives that they should be proceeding to give effect to any of the work practice reforms for consultants agreed last September considered relevant to their service needs.
Among the key provisions of this agreement were that consultants would be available for rostering for any five days out of seven as opposed to weekdays as at present; that consultants could be rostered on an 8am to midnight or 24/7 basis in services where this was required; and that clinical directors would have a much strengthened management role in respect of consultants.
