Taskers will have to work during critical periods

Currently, the ULS establish short-term contracts with service providers (which can be for days, weeks or a few months), indicating the hourly rate to be paid and the weekly workload to which the doctor/s in question are obliged. However, these same contracts contain clauses that allow professionals not to work during critical periods , which affects the functioning of emergency services.

When doctors on duty are unavailable to work an emergency shift on a holiday, for example, the ULS return to the market — and with little room for manoeuvre to avoid closing the emergency room — they have difficulty in securing a doctor to fill the shift(s), finding themselves forced to pay hourly rates much higher than the contract they had established, which can go up to 150 euros.

Currently, the order signed in May 2024 by the Minister of Health remains in force, authorizing the ULS to pay an hourly rate 40% higher to doctors on a temporary basis than to doctors on staff (around 46 euros). Above this amount, the ULS must request authorization from the Executive Board of the SNS and that is when the amounts escalate. In the latter case, a source familiar with the process told Observador, a ceiling on the hourly rate is not being considered.

Expenditure on medical service providers has, moreover, been increasing consistently over the last few years, reaching a record last year. In 2024, expenditure exceeded the 200 million euro barrier for the first time — it reached 213.3 million euros , according to data from the Central Administration of the Health System (ACSS). This is an increase of 11% compared to the 191.8 million spent on contract doctors in 2023. The increase in expenditure under this heading has, in fact, been galloping. In 2022, expenditure on medical service providers was 160.5 million euros.

NHS spending on temporary doctors rises by 11% and now exceeds 200 million euros

One of the Government's objectives in regulating the provision of services is also to halt the rise in spending on this item.

On the other hand, the Ministry of Health also intends to make work under the service provision regime, which many doctors already dedicate themselves to exclusively, less attractive. “A new specialist (even with full dedication) receives a maximum of 24 euros/hour. Then there are hospitals paying service providers 46 to 150 euros/hour. It is at least double and of course it becomes very attractive to young doctors ”, says the president of the Portuguese Association of Hospital Administrators (APAH), Xavier Barreto, who sees the Government's intention to regulate the provision of services in the NHS as a “positive” measure.

Although it is not yet clear what the minimum duration of medium-term contracts signed by hospitals should be, for Xavier Barreto these should have a duration of at least six months.