Some doctor grades, particularly in emergency medicine, are already resisting the directive by failing to present for shifts, albeit their gripe is linked to decreased pay rates.
Under the new directive, hospitals short of staff must give the designated “principal” locum agency in their area two hours to fill the position, regardless of how urgent the situation. A second agency can only be contacted if the first fails to meet the two-hour deadline. All agencies must be contacted electronically.
Liam Doran, general secretary of the Irish Nurses and Midwives Organisation (INMO), said they had formally requested last week that the HSE defer the directive’s “go-live” date (September 1) to allow a period of consultation, but the request was denied.
The INMO also sought confirmation that some specialist care areas, such as critical care, dialysis, and emergency department, be exempt from the two-hour wait time and that hospitals be allowed book staff who worked regularly in the hospital.
With no agreement forthcoming, the INMO instructed members to disregard the new directive where it interferes with patient safety.
“From a practical viewpoint, waiting two hours to fill a position is unworkable,” said Mr Doran.
He said the new booking system is “unnecessarily bureaucratic” and gives rise to situations where nurses providing specialist support services in the community to children who are acutely unwell would no longer be chosen to provide that care “because some of them are with an agency other than the principal supplier”.
He said the “sequential nature” of the new booking system means it is “not related to reality at all, it’s just about creating a paper trail”.
The Irish Association of Emergency Medicine said the row over the directive continues to affect staffing levels in emergency departments around the country, including Drogheda, Navan, Beaumont, Tallaght, Letterkenny, Naas, and Portlaoise — where some junior doctors had not presented for shifts.
Association spokesman Fergal Hickey said it was not a wildcat strike, that doctors’ had chosen not to turn up because the HSE had “not upheld its side of the [pay] bargain”.
He said emergency departments are disproportionately affected by the dispute because emergency medicine is more populated by registrar and senior house officer (SHO) grades than other specialties.
Mr Hickey said he expects the doctors’ action to escalate, with obstetrics possibly next in the firing line because it, too, has a high percentage of registrars and SHOs.
The directive cuts hourly pay rates for SHOs from €40 to €34. The HSE said the rate remains 36% higher than directly employed HSE doctors. The HSE said the new agency hiring framework would result in savings of €53m over four years.
Asked if the doctors’ no-show could cause emergency departments to close, Health Minister Simon Harris said all were open yesterday.
Asked if the HSE felt blackmailed by the locum doctors who know the health service relies on them, Mr Harris said: “I don’t think it is time for emotive language and, certainly, it would be irresponsible of me to inject any degree of emotive language into this discussion.”
Defending the HSE move, he said the pay difference between agency staff and people working directly for the HSE is “quite unfair”.
He called on doctors to “use the normal industrial relations mechanisms”, adding it is “vital that our patients do not become pawns in relation to a dispute over pay”.
Mr Hickey said he expects the dispute to “evolve” over the coming days.