Big overtime changes for doctors and healthcare workers in South Africa

The overtime budget for doctors and healthcare workers at public hospitals in Gauteng has been slashed by almost a quarter, with new approval rules now in effect.

According to DA provincial legislature member Jack Bloom, citing written responses from Gauteng Health and Wellness MEC Nomantu Nkomo-Ralehoko, the provincial overtime budget has been slashed from R3.45 billion to R2.65 billion.

This was done “to address inequalities and irregularities on the approval and management of Commuted Overtime,” the MEC told Bloom.

This will lead to a reduction in paid commuted overtime “where there are disparities on the payment of certain categories of clinicians.”

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.

Before 1 April 2024, the process was overseen by CEOs of hospitals and clinics. However, after April 1, a new policy was introduced, and approvals were now processed by the health department’s HoDs.

The change was made because hospitals and their managers were overspending on overtime, so the approvals needed to be reeled-in and better monitoring and oversight processes established.

According to Bloom, however, this amounts to the centralisation of overtime approvals, which will likely lead to delays and cuts in overtime payments. He also flagged concerns about deteriorating levels of healthcare service as a result.

“The Department claims the overtime budget cut in the new financial year starting from April is due to terminations, promotions and new appointees.

“This is a poor excuse which covers up the fact that patients in short-staffed hospitals will suffer as less overtime will be worked by essential doctors,” he said.

When the new overtime policy was announced earlier this year, unions expressed similar concerns, 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.

The budget cuts come directly from the 2024 budget, where Finance Minister Enoch Godongwana warned that provincial departments would have to manage their funds better – including overtime.

In the 2024 Budget, Godongwana increased the overall spending on wages, including healthcare services, as well as expanding budget allocations for health. However, this would grow at a slower rate than inflation.

Treasury specified that the wider budget for health (an allocation of R271.9 billion in 2024/25, rising to R295.2 billion by 2026/27) thus 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 warned. “(This) will prioritise greater efficiency, better management of commuted overtime and intensified promotion of preventative care.”

Read: Government coming after overtime for doctors and healthcare workers