Slovenian doctors have been on strike over pay for almost seven weeks but now some of them will stop working overtime, which is expected to disrupt the public health service further. To help care providers ensure uninterrupted services and protect patients, the government has adopted a set of measures.

Fides, the union of doctors and dentists, has been on strike since 15 January, demanding a separate pay pillar for healthcare, a reformed system of promotions and an immediate pay increase for senior doctors to tackle disparities that emerged after junior doctors' wages rose more substantially last year.

As the government has been insisting on reforming the public sector pay system as a whole despite reaching separate deals with some groups such as doctors earlier, Fides started collecting statements whereby doctors revoke their consent to work overtime. Most of these revocations will come into effect on 1 March.

Uncertain how many will no longer do overtime

The union says more than half of Slovenian doctors have revoked consent to work overtime, while the Health Ministry estimates there are around 30% of such doctors at hospitals and around 20% at community health centres.

Some care providers have reported that doctors changed their minds after their bosses withdrew their consent for them to work for another healthcare provider in their spare time.

Once the revocations come into effect, doctors will work up to 48 hours a week, which means up to 8 hours of overtime. They will no longer work more than 16 hours continuously. "This is fully in line with the European Working Time Directive," Fides head Damjan Polh says.

Due to staff shortages, the public health system relies heavily on overtime, which is why the revocations are expected to cause considerable problems to institutions in how they organise their work.

Work to be reorganised

To help them, the government has taken several measures, including allowing emergency care providers to pool resources to set up joint emergency centres.

They will be able to change their work regimes for doctors, possibly going from the current system of regular working hours topped off with on-call work to shift work. Save for doctors other healthcare staff already work in shifts.

There is also the possibility of stand-by when a doctor's workload is estimated not to top 25% of regular workload.

Some hospitals do not expect any major disruption, while others say they will organise work in shifts and many expect to cancel elective or non-urgent services.

The country's largest medical centre, UKC Ljubljana, has said they will still manage to provide emergency medical care and uninterrupted healthcare in all organisational units.

Under existing strike rules, doctors are obliged to treat urgent cases and provide services to patients over 65 or under 18, pregnant women and cancer patients.

More services made mandatory during strike

However, the government has extended that list to include treatment of patients referred under a "very quick" level of urgency, and the issuance of medical certificates and sick notes.

They will also be required to refer patients for further treatment and provide information on the health status of the elderly in care homes or patients in other special social care institutions.

Medical services will have to be provided for all vulnerable groups, including people with disabilities or special needs, palliative patients, war veterans, victims of war and psychiatric patients with restricted freedom of movement.

Doctors will also have to perform medical assessment services requested by patients to meet requirements of other institutions, such as insurers or courts. They will also have to issue medical certificates for drivers and perform services related to health and safety at work.

The extension, which will take effect on 1 March, addresses issues that patients or their advocates have been reporting since the strike started such as inability to obtain sick notes, or people with disabilities having difficulties getting medical exams to extend their driver's licence.

Health Minister Valentina Prevolnik Rupel said she was aware of the importance of the right to strike, but that it must be proportionate and in no way outweigh other constitutionally guaranteed rights.

She said the measures had been green-lit by the government's legal experts. "Constitutional judges would surely recognise our concern for people with disabilities and other vulnerable groups."

Union says measures unlawful

Fides finds determining the medical services to be performed during a strike by means of a government decree is unlawful, and in breach of the right to strike.

The Medical Chamber said there "seems to be no legal basis" for the decree and that no decree can replace the 1,200 doctors Slovenia is short of compared to the EU average.

Fides also argues that measures such as introducing shift work would worsen instead of improve accessibility of health services and some measures are based on rules that are no longer valid.

Because the negotiations have been deadlocked, the Patients' Association has offered to act as a mediator between the government and the doctors' union in a bid to try to end the country's longest-running strike.

Negotiations between the government and Fides are due to resume next week, while Fides has been refusing to take part in talks on public sector pay reform involving all other unions representing public employees.