Hospitals would face budget cuts if they continued to have junior doctors working shifts over 24 hours, under proposals aimed at settling the current IMO-HSE dispute over excessive doctor working hours.

Despite the bones of an agreement having been apparently been progressed on a number of issues, attempts to settle the dispute between junior doctors and the HSE reached a stalemate yesterday over the issue of sanctions on hospitals that breach the new limit of 24 hours on continuous shifts.

The IMO now wants the sanctions to include additional payments for junior doctors, while the HSE says there can only be non-pay sanctions.

Under the draft management proposals which emerged to date in the talks, the HSE could in some cases withhold full provision of a hospital's budgetary allocation for breaches of the 24-hour shift limit.

Other proposed sanctions include reassigning management authority to a different relevant staff member where breaches occur, formal recording of poor performance in implementing shift limits and 'formal consideration of the extent to which an individual manager/clinician should be held accountable in instances of non-compliance.'

The proposals state that a national group will be established to oversee verification and implementation of measures to reduce doctor hours, eliminate shifts in excess of 24 hours and achieve compliance with the European Working Time Directive (EWTD).

It was proposed that there should be formal links between junior doctors and hospital management.

Health service management would prioritise resource allocation to promote full EWTD compliance in 2014 and each hospital manager would formally establish a an EWTD implementation group.

The proposals provide for national discussion under the auspices of the LRC to ensure progress in achieving full EWTD compliance no later than  December 31 2014.

This would include consideration of any health and safety issues arising in the interim period.

It was also proposed that other issues relating to junior doctors' terms and conditions would be dealt with by the appropriate processes under the Haddington Road pay agreement.

This includes a planned conciliation conference under the LRC on the effects of the reduction in pay for new entrant consultants implemented last year.