Government coming after overtime for doctors and healthcare workers

The Gauteng Department of Health says it will be clamping down on commuted overtime at hospitals in the province from 1 April 2024, as it tries to “maximise efficiencies” while it struggles with limited resources.

In a follow-up statement to a circular that was distributed earlier this month, the department said that it has taken a decision to withdraw the delegation to approve commuted overtime by CEOs of hospitals in the coming 2024/25 financial year.

While this does not mean that overtime is removed entirely, the department said it will be reviewing and developing new overtime guidelines – and that the health department’s HoDs will have to approve all applications for commuted overtime.

The department said it has been overspending on overtime and needs to reel it in.

“This decision is necessitated by the challenges over the years related to the management and monitoring of the performance of overtime and consequence management, which has resulted in an over-expenditure in the commuted overtime budget,” it said.

It added that it will also be looking at its processes to try and “enhance accountability” and “prevent the misuse” of the overtime system.

In the initial circular that was distributed to hospitals on 15 February, the department said it would be reviewing the system and revising overtime guidelines, which will be communicated to Accounting Officers.

The Democratic Alliance said that the end result would be a “drastic cut” to overtime from 1 April, which would severely impact doctors, nurses and other healthcare workers who put in the hours after work.

Commuted overtime refers specifically to hours of work on top of the total number of normal hours of work required by the employer to render a health service within a health facility in terms of operational needs. The process is overseen by CEOs of hospitals and clinics.

From 1 April, this will no longer be the case.

The DA said this new policy will cause short-staffing at night, on weekends, and on public holidays, and appears to be the department’s attempt at saving money at the expense of healthcare workers and patients.

The department said it would engage with all affected employees to ensure that patient care is not compromised while the new “uniform and consistent” guidelines are developed.

Some unions have expressed concerns over the policy shift, noting that healthcare professionals are often contracted on 40 hours of work a week, and that after 16h00, overtime hours kick in.

Realistically, however, many casualties and emergencies happen outside of these “work hours”, and the policy shift may impact service delivery and result in patient deaths. The policy may also impact admin, worker shifts, rosters and other work, resulting in a chaotic environment.

Doctor salaries

The policy change comes just a few weeks after health minister Joe Phaahla said that health departments are facing budgetary constraints and were struggling to place new doctors and health professionals – with high salaries and increases being part of the problem.

However, the minister soon backtracked on this position, saying later that he was working with the Minister of Finance, and found a solution to address the current challenge of doctors.

In the 2024 Budget Speech, finance minister Enoch Godongwana did not make specific mention of money for new doctors and healthcare workers but did increase the overall spending on wages, including healthcare services, as well as expanding budget allocations for health.

Part of this was reversing “a substantial portion” of the spending reductions initially proposed at the time of the 2023 Medium Term Budget Policy Statement (MTBPS).

Over the medium‐term expenditure framework (MTEF) period, after providing for debt‐service costs, the contingency reserve and provisional allocations, 48% of nationally raised funds are allocated to the national government, 42.2% to the provincial government and 9.8% to local government.

“Provinces will be able to fund the wages of teachers, nurses, doctors and other critical skills that are essential for service delivery,” Treasury said – adding that other fiscal consolidation conditions remain in place.

Notably, Treasury specified that a wider budget for health (an allocation of R271.9 billion in 2024/25, rising to R295.2 billion by 2026/27) comes with the requirement that health departments operate with greater efficiency – including commuted overtime.

“The health budget is anticipated to grow more slowly than inflation over the MTEF period,” it said.

“(This) will prioritise greater efficiency, better management of commuted overtime and intensified promotion of preventative care.”

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