Hospital Doctors Paid the Overtime Incentive for Ward Emergency Cover Must Now Help in A&E When It Is Overwhelmed
A despacho from the Minister of Health published on 22 October makes A&E the priority: doctors on internal emergency rosters who receive the special overtime incentive must support the emergency department when demand surges, staff are short or patients are seriously ill.
Hospital doctors on internal emergency rosters, who answer urgent problems among patients already admitted, must now go and help in the emergency department when it is overwhelmed, if they are being paid the Government's special incentive for overtime beyond the legal annual limit. Despacho n.º 12901/2026, signed on 15 October by the Minister of Health, Ana Paula Martins, and published in the Diário da República (official journal) on Thursday 22 October, sets the rules for how a hospital's urgência interna (internal emergency cover for patients already admitted) and urgência externa (the emergency department, or A&E) work together. It takes effect the day after publication.
Where the incentive comes from
Decreto-Lei n.º 119/2026 (decree-law) of 17 June created an exceptional payment for doctors in the Serviço Nacional de Saúde (SNS, the national health service) who work beyond the annual overtime ceiling, 150 hours in most cases and 250 hours for doctors under one particular working-time regime, to keep the emergency network running. It is paid per 48-hour block as a share of monthly base pay, starting at 45 percent and reaching 85.5 percent from the tenth block, and applies from 1 May 2026. In August, Decreto-Lei n.º 168/2026 extended it to work on internal emergency rosters and in VMER emergency medical cars, also from 1 May.
The new despacho says that extension was meant to reward the work, not to turn ward cover into a second, parallel emergency service. Being paid the incentive does not limit a doctor to the patients on their own ward, and it does not excuse them from supporting A&E.
What the despacho requires
- A&E comes first. Where doctors are needed in two places at once, the emergency department's needs prevail, while urgent problems on the wards must still be answered.
- When internal cover must help. The listed triggers include an exceptional influx of patients, an unexpected shortage of staff, a backlog of patients waiting to be seen or reassessed, a significant rise in waiting times, several seriously ill or unstable patients at once, blocked admissions or transfers, and a contingency plan being activated.
- Who decides. On each shift the emergency team leader (chefe de equipa) can call in the doctors on internal rosters and assign them tasks. Out of hours, that leader is the reference medical authority until a board member or the clinical director steps in.
- Limits. No doctor can be made to do work they are not qualified for, and internal cover cannot be used to replace A&E's own minimum staffing on a regular basis.
- Consequences. Failing a duty is dealt with under labour and disciplinary rules and, where the law allows, can cost the doctor the incentive.
Every hospital must pull its departments' internal rosters into one central operational map available to the emergency department's director and team leader, record each call-out and each time a doctor was unavailable, and track response times. Hospital boards have 60 days to adapt their internal procedures. The Direção Executiva do SNS (SNS Executive Board), which proposed the despacho, will monitor how it is applied.
What it means for you
The despacho does not change how patients reach A&E or how they are triaged. Its aim is to bring more doctors to the front door when queues build. For a problem that is not an emergency, such as fever, a cough or mild to moderate pain, SNS 24 advises calling 808 24 24 24 first: the line triages you and sends you to self-care, a health centre, an emergency department or INEM. For chest pain, signs of a stroke, severe breathing difficulty or heavy bleeding, call 112. See our guide to emergency numbers in Portugal.
