EC doctors in overtime row

Fears patients will be left in lurch amid clash over new overtime policy, which medics say will slash pay by a third

Doctors at public hospitals in the Eastern Cape fear they will lose about a third of their salaries amid a raging dispute with the health department over a new overtime policy.

The move will affect patients because the angry doctors have vowed to stop working after hours, pledging to work strictly from 8am to 4pm, Mondays to Fridays.

The doctors said starting from May 1 they would no longer work overtime or agree to be on call — a move which could result in the province’s hospitals being unable to handle emergency cases such as car accidents that occur after hours.

The department says it wants doctors to claim for actual overtime worked instead of being paid a standing overtime amount, known as commuted overtime.

According to the department, commuted overtime refers to the hours worked in addition to the total number of normal hours of work required by the employer to render a health service within a facility in terms of operational needs.

But the doctors are up in arms over the move, saying the new rules mean a change in conditions of employment without proper consultation.

The decision was communicated via a circular, seen by the Dispatch, written by provincial health department acting head Sindiswa Gede.

It says the auditor-general had noted with concern the challenge with the department’s implementation and management of commuted overtime.

The change in implementing commuted overtime took effect from the beginning of April.

The circular reads: “With effect from April 1 2024, commuted overtime will no longer be captured as recurring on the Persal system.

“It will be captured by the institutions on a month-tomonth basis on the Persal system. The Persal system will be amended to accommodate these changes.

“Section (7.2) of the national policy on commuted overtime states that it is necessary for all participants in the commuted overtime remuneration system to complete a commuted overtime contract in the beginning of each financial year.

“Commuted overtime is optional and not compulsory for the employees to work.

“It is based on a needs analysis done annually by the institution during the last quarter of the financial year by determining the institution’s capacity to ensure the coverage.

“By the seventh of each month, clinical managers need to confirm using the attached template that the employee did meet their commuted overtime commitments and submit to HR ...”

The doctors decided at a meeting on April 30 that, should the department not withdraw the circular before May 1, they would not sign a commuted overtime contract, would only work contracted hours from 8am to 4pm on weekdays, and no doctor would be available to be on call.

SA Medical Association Trade Union Eastern Cape chair Dr Mpumelelo Melamane said all doctors signed two contracts when they were employed — a normal eight-hour contract and the commuted overtime contract.

Melamane said they had not been consulted about the latest decision.

In February, department officials reportedly promised to scrap the circular but did not do so and had been dodging meeting the doctors ever since.

“When one is employed, the Labour Relations Act and the Basic Conditions of Employment Act govern us,” Melamane said.

“Nobody should unilaterally change conditions of employment. That is unfair. All doctors are in support of this decision.

“The department is breaking the Basic Conditions of Employment Act. They have been refusing to come to the table.”

He said commuted overtime was usually between 64 and 80 hours a month and each doctor was paid according to his or her expertise.

Scrapping the overtime would take about a “third of their salaries”.

“It’s unfortunate that this is happening. As doctors we took an oath to serve our communities.

“The only thing we wanted is for the department to come to the table and for it not to do this unilaterally.

“We sympathise with our people [patients]. It’s the arrogant stance of the department that has led us here.”

SA Medical Association CEO Dr Mzulungile Nodikida confirmed the department’s decision had been taken without consultation.

“We know that the department has no capacity to manage the proposed changes. These will be disastrous for the patients.

“These changes have the potential to adversely affect clinical services and academic programmes ... and will ultimately affect the livelihoods of doctors and their ability to deliver patient care.

“Many of our doctors rely on overtime, which constitutes at

least a third of their basic salaries.

“Removing this income stream leads to financial instability and strain and may further drive a brain drain into the private sector in search of greener pastures.

“Sama’s stance is that we are ready to approach the courts should the rights of our members be infringed.”

Democratic Nursing Association of SA (Denosa) provincial secretary Veli Sinqana said if the new regime was implemented, the promised action by the doctors would put further strain on nurses, worsening the nursing shortage.

Rural Health Advocacy Project director Russell Rensburg said it was important to have doctors on call.

“We want to make sure health services are maintained and patients aren’t compromised.

“We call on the doctors and the department to find a way to ensure this transaction doesn ’ t affect patients negatively.”

DA provincial health spokesperson Jane Cowley said it was sad that doctors “felt abused by the department”, which had led to their decision.

“The department has been irresponsible in the extreme when it comes to management of its finances, and there are absolutely no consequences to those who are responsible for irregular, fruitless expenditure.”

Provincial health spokesperson Mkhululi Ndamase said: “The department is not stopping overtime, and performance of overtime does not have anything to do with Persal — this is only a salary payment system.

“The department, supported by the national department of health, previously met doctors’ representatives and it was

We are ready to approach the courts should the rights of our members be infringed

made clear that overtime needed to be managed.

“The department has not introduced any changes to the policy.

“It has introduced a system to ensure that overtime is needsbased and is also accounted for before it is paid.

“This is to ensure that it is not abused.”

Ndamase said it was “unfortunate that the basis for performance of overtime is based on the contract”.

“Those who have [been] contracted will be paid after they have performed overtime and submitted proof.

“As stated above, this is to ensure that overtime is managed. This will also assist in curbing any abuse.

“It is also important to state that overtime is not a condition of service.

“We urge doctors to perform their overtime and submit proof so that the more than 90% of uninsured people in the Eastern Cape who depend on the public sector for their health needs will continue to receive improved services.

“We are confident that the patriotic doctors who continue to go above and beyond the call will continue to serve the people of the Eastern Cape with care and professionalism.”

Melamane, however, said the department was not acting in good faith and was “playing with words”.

“Why are they [not] coming to us? All the doctors are affected. We reject what they are saying.”