Dáil debates

Wednesday, 28 September 2011

Other Questions

General Medical Services Contracts

3:00 pm

Photo of Brian StanleyBrian Stanley (Laois-Offaly, Sinn Fein)
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Question 6: To ask the Minister for Health his plans to reform the consultants' contract and the general practitioner contract; and if he will make a statement on the matter. [26389/11]

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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The programme for Government provides for the introduction of a new GMS contract with general practitioners, with an increased emphasis on the management of chronic conditions, such as diabetes and cardiovascular conditions. I envisage that the new contract will also focus on prevention and will include a requirement for GPs to provide care as part of integrated multidisciplinary primary care teams. My colleague, Deputy Shortall, the Minister of State at my Department, is very much involved in this. She will answer a question on this subject later and will give the House greater detail.

The preparation of a revised contract will be advanced by my Department and Health Service Executive officials. There will be a full consultation process with relevant stakeholders.

New contractual arrangements for medical consultants were agreed with their representative organisations, the IHCA and the IMO, in 2008, following more than four years of protracted and detailed negotiations. Currently 2,087 consultants hold the 2008 contract, while approximately 396 consultants continue to work under the 1997 contract. The 2008 contract provides for consultants to work as part of a team over an extended working day of 8 a.m. to 8 p.m., an increase in the length of the working week and also structured weekend work. It also includes new private practice provisions ranging from a total prohibition on such practice to an upper limit of 20% for newly appointed consultants and up to 30% for consultants who previously held the 1997 contract.

The successful implementation of the consultant contract 2008 continues to be a priority for my Department and the HSE. The executive has been focusing, in particular, on provisions aimed at maximising consultant availability to public patients. In due course the contract will be subject to review in the context of reform of the health services as set out in the programme for Government and changes to the model for delivery of services.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister will be aware from his position as Opposition spokesperson and in his previous professional capacity that Sinn Féin and I have long advocated addressing the privileged position of consultants in the health services. This is not a response to the current economic difficulties post the Celtic tiger era; it long predates all of that.

Does the Minister accept, as I expect he will, that the basis of any reform in so far as consultants are concerned must be best outcomes for patients and equal access for all patients to best care? Steps must be taken to address what can only be described as the obscene level of remuneration which some consultants enjoy under the current contract and the aberrations that have recently come to light, namely, that consultants are entitled to take off, with full pay, their final year of service prior to retirement or, more bizarre, to appoint themselves as their own locum and be paid double for a year's work. These are absolute obscenities. What steps is the Minister taking to address those particular unacceptable anomalies with the current arrangement?

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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The HSE has been clear in respect of its pursuit of consultants who are in breach of their contracts in terms of the 80%-20% split. A number of consultants will be prevented from engaging in private practice, which means, not that they will not be able to see private patients but that they will not be able to charge them. I am given to understand this may be challenged in the courts by the HCA. So be it. Those in the next tranche who are found to be transgressing will also be pursued. It is not acceptable to me or the Government that a small number of our 2,500 consultants are behaving in an utterly unacceptable manner and are not alone being unfair to patients but are casting a slur on the remainder of their colleagues.

The Deputy can be assured that my Department and the HSE will not yield on this matter. We are going to pursue it.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I am aware of the Minister's intent in that regard, having received a written response to a parliamentary question from him in which it was stated that two consultants are currently being targeted and that 40 others will be pursued. It was also stated in the reply that the Minister is serious in this regard, for which I commend him. However, I specifically asked the Minister about the anomalies in respect of the entitlement of consultants to take off, with pay, the final year of service prior to retirement or to employ themselves as locums and be paid twice for the same year's work.

The Minister's reply to me on 14 September contained a tabular statement outlining the various levels to which consultants' pay could drop and the impact of this on the overall health budget. It would appear that if consultants' pay was capped at €150,000, the coffers of the Department and HSE would be significantly improved by tens of millions of euro. Is the Minister actively working towards a new contract for consultants and general practitioners? Will he indicate to the House today if engagement with the representative bodies is already under way and that progress has been made on such a new contract?

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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The Deputy, like me, is aware of the law of the land, the ability of legislation to be retrospective and the rights of people under contracts. The law is not the only road open to us in this regard. There can be negotiation and are broader matters that can be brought to the table that might help people see things in a different light.

On the Deputy's specific point, a number of consultants have extraordinary arrangements in place, with which I do not agree and will seek to change. The Deputy and I are law makers, not law breakers, and we must abide by the law. Within that framework, we will do everything we can to reduce the impact on our coffers.

I am interested in achieving from consultants, the vast bulk of whom are hardworking and give great public service, the flexibility around working hours and days that will provide us with the productivity that will deliver the service to our patients, reduce waiting times on trolleys in hospitals and reduce the duration of stay within hospitals. That is what I want to achieve. If I can achieve that, well and good. If consultants do not wish to co-operate, there will be a heavy price to pay.