New national collective agreement signed for doctors

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In March 2000, one year after the adoption of a legislative decree on the reorganisation of the Italian national health service, a national collective agreement for doctors and veterinarians was signed. The most innovative aspects of the agreement concern the introduction of social dialogue and consultation in industrial relations, and of regulations on the exclusiveness of service within public hospitals. This is the first time that the work of a group of professionals has been regulated by an agreement signed with trade unions.

Legislative decree 299/1999 obliges doctors to choose whether or not to work, with their personal patients, solely in public sector facilities. According to the decree, only the doctors who take up this option will be given positions of responsibility in public hospitals. Those who, instead, opt for running their own private medical practices, outside public facilities, will not be able to become ""a top medical manager (primario), within the Italian national health system (Servizio sanitario nazionale) (IT9907342F).

On 8 March 2000, Aran– the public body which represents the state as employer in collective bargaining – signed an agreement with the Cgil, Cisl and Uil trade union confederations and autonomous doctors' trade unions, which addresses and regulates this new kind of relationship for doctors and veterinary surgeons. This is the first time that the work of a group of professionals has been regulated by a collective agreement signed with trade unions.

The agreement establishes that the doctors who decide to run their own private medical practices within public hospitals will be able to do so within the public facilities where they already work but outside the normal working hours. The doctors' fees, for their personal patients, will be decided by the public health facility and a portion of their proceeds will be kept by the facility as an allowance for the use of hospital equipment and rooms. The doctors will be able to use their private medical practices or other facilities, respecting the terms established, until public health facilities allocate some specific rooms to these professionals.

Working time for the services delivered within the national health system is set at 38 hours per week, of which four hours - which can be grouped together on an annual basis - can be used for professional up-dating. Doctors are allowed to work part time for family or social reasons.

The new agreement also provides for a very innovative industrial relations system which regulates doctors' employment relations. It introduces the possibility of decentralised bargaining for doctors at regional and facility level and defines the areas of social dialogue and consultation (concertation) between the national health service and the union organisations. Concertation procedures will be launched on the issues of managerial functions and technical expertise, remuneration scales, emergency procedures and mutual termination of the employment relationship. As regards regional bargaining, every health service facility will maintain its bargaining autonomy but the new industrial relations system provides for the establishment of a regional coordination centre, which will verify the effective application of some collectively agreed regulations, in particular those concerning managerial training and professional up-dating, the amount of funds allocated for remuneration scales, and the efficiency and efficacy of the services provided.

A "guarantee commission" will be established in each region in order to handle cases of dismissal of "medical managers" (primario) proposed by public hospitals.

Doctors' salaries will be increased by ITL 300,000 (EUR 155) per month. Moreover, the doctors who decide to run their own medical practices within the public service will receive a length of service-related allowance, ranging from a minimum of ITL 185,000 (EUR 96) per month to a maximum of ITL 1,354 million (EUR 699).

The agreement also provides for the establishment of a joint national committee composed of representatives of each region and of trade unions, which will create a national insurance fund to cover the tort liability of medical managers. Health service companies and doctors themselves will contribute to the fund, with an average per capita amount of ITL 50,000 (EUR 26) per month.

The posts with most responsibility will be filled according to merit and capability, states the accord. A technical board and an evaluation group, established within each hospital, will be responsible for the evaluation of doctors.

Giuseppe Garaffo, general secretary of the Cisl medici trade union, expressed satisfaction with the agreement and underlined that "the negative tendency, which saw the absence of negotiations for a while in this sector, has been finally interrupted".