‘Up to 15 years’ before private practice will cease at Rotunda

Private obstetrics practice at the Rotunda Hospital in Dublin will take 12-to-15 years to “disappear”, heard a hospital board meeting.

Last September, the Master Prof Sean Daly advised the Rotunda’s board of a meeting held between the Masters/Clinical Director of the maternity hospitals in Dublin and Cork and Minister for Health Stephen Donnelly.

“The discussion concerned the new public-only consultant contract [POCC] and the impact on obstetrics where there is no private inpatient option. Prof Daly has drafted a letter post-meeting with input from the other Masters.”

The board discussion, which followed presentation of the Master’s report, noted that consultants on the type B contract can “still deliver private practice as their contract remains unchanged”.

The Chair Prof Tom Matthews queried timeframes and the minutes noted a response that private practice “will disappear within five-seven years; obstetrics will take longer, estimated at 12-15 years. The Rotunda should be future-planning with this timeframe in mind.”

According to meeting minutes from November 2023, a hospital working group would “consider future options with regard to private practice and services”.

In relation to the projections on the cessation of private practice, a Rotunda spokesperson told the Medical Independent: “These are local estimates and are subjective based on age profile and demographic.”

Some 30 per cent of whole-time equivalent consultants at the hospital now held the POCC, but this figure is “lower” for obstetrics/gynaecology.

The spokesperson said the loss of statutory income that accrues from private/semi-private patients (accommodation charges) is a concern for the hospital.

“This has not happened yet and will need to be addressed in funding envelopes as budgets are currently net of this income – this is a national issue.”

The hospital declined to comment on the meeting with Minister Donnelly.

In April, Minister Donnelly told the IMO AGM that just under half of consultants held the POCC.

The Government introduced the POCC on 8 March 2023. As of April this year, there are 68 consultants in obstetrics and gynaecology with the POCC (in December 2023, there were 204 consultants in obstetrics and gynaecology in the public health service and 19 per cent held the POCC, according to data from HSE National Doctors Training and Planning).

“Introduction of this contract is a key deliverable of the Sláintecare report that proposed the phased elimination of private care from the public system,” said a Department of Health spokesperson. “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.”

The Department’s spokesperson said 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.”