About ASMS

Annual Report 2006

• Renegotiation of the National DHB MECA
• Joint Consultation Committees (JCCs)
• National Processes in National DHB MECA
• The Non-DHB Sector
• Industrial Team’s Activities
• Job Sizing
• Delegate Development
• Surveying Full-Time DHB Senior Medical Staff Income
• Surveying DHB Senior Medical Staff Superannuation Entitlements
• Direction of Association and Relationship with Government
• Relationships with other Political Parties
• Health Professional Led Approach
• National Senior Medical Workforce Development Group
• Medical Council Elections
• Public Hospital Laboratories
• Protocols for Outsourcing (Privatising) DHB Services
• Employment Relations (Probationary Employment) Bill
• Review of Funding for Medicine and Dentistry at Universities
• Resident Medical Officers MECA Negotiations
• Pan Professional Medical Forum
• Establishment of a National Advisory Support Service for Doctors under Stress
• Meetings with Director-General of Health
• Council of Trade Unions
• Tripartite Process
• International Travel
• Association Publications
• Membership
• Medical Protection Society
• Medical Assurance Society
• Association Finances
• Administration
• Website
• Job Vacancies Online
• Other Matters

The National Executive has met on four occasions since the last Annual Conference with a fifth meeting immediately preceding this Conference.  One of these was the regular two day meeting (1-2 March) to allow for an informal strategic planning session on the first day, covering the year’s expected work including the forthcoming renegotiation of our national DHB collective agreement negotiations.  In addition, over the two days the Executive met the Minister of Health, the Hon Pete Hodgson, and the health spokespeople for the National Party (Hon Tony Ryall, Dr Jackie Blue, Dr Jonathan Coleman and Jo Goodhew).  David Meates (one of the two lead DHB chief executives responsible for medical workforce development) also joined the meeting to discuss workforce development and the establishment of a joint DHB-ASMS national group.  Other subjects discussed at the strategy session included our forthcoming national DHB MECA negotiations (including the development of our claim) and the Association’s health professional led approach.

After the 2005 Annual Conference Dr Andrew Munro (Region 2) advised of his resignation from the National Executive for personal reasons.  Subsequently, in February, Dr John Bonning was elected unopposed to fill the vacancy.  The Executive is appreciative of Dr Munro’s contribution to the leadership of the Association during his terms on the Executive.  The full National Executive is now Jeff Brown (President), David Jones (Vice President), Brian Craig (National Secretary), Judy Bent, John Bonning, Torben Iversen, Alastair Macdonald, John MacDonald, Gail Robinson and Paul Wilson.

The national office continues to be a busy place with a demanding workload.  This year its activities have centred on application of the national DHB collective agreement (MECA), Joint Consultation Committees in the 21 DHBS, renegotiation of the national DHB MECA, collective bargaining with non-DHB employers (including a hospices MECA), and individual employment-related cases and disputes.

In July Industrial Officer Kirsty Campbell resigned in order to return to Australia.  In recognition of the continual and increasing workload pressures of the national office, increasing membership numbers and the need to respond to membership enquiries and calls for advice and support more expeditiously, the National Executive has approved the creation of a second Industrial Officer position.  This is additional to filling the position vacated by Kirsty Campbell.  Appointments for both industrial officer positions have now been made.  Jeff Sissons, formerly with the NZ Nurses Organisation, commenced work in August while Sue Shone, who has extensive industrial and advocacy experience including with the Post Primary Teachers Association, commences with us in February 2007.

Consequently the national office now comprises seven full-time staff—Ian Powell (Executive Director), Angela Belich (Assistant Executive Director), Henry Stubbs (Senior Industrial Officer), Jeff Sissons (Industrial Officer), Yvonne Desmond (Executive Officer), Kathy Eaden (Membership Support Officer) and Barbara Narasy (Administration Officer).  This staffing complement will increase to eight in February with the filling of the second industrial officer position.  Bruce Corkill, barrister, continues to provide valuable counsel and support.  We also engage additional accounting support on a casual basis, usually to coincide with National Executive meetings, to assist with financial accounting and reports.

Renegotiation of the National DHB MECA

The current national DHB MECA expired on 30 June 2006 with negotiations for a new agreement commencing on 24-25 May.  The Association’s claim had been forwarded to the DHBs a fortnight earlier.  The National Executive determined to have an expanded negotiating team in order to provide broader representation and to spread the workload and time commitment.  Executive Director Ian Powell is the advocate supported by Assistant Executive Director Angela Belich.  In addition to the National Executive, the negotiating team also includes Drs Rod Harpin, Carolyn Fowler, David Grayson, Athol Steward, Stephen Purchas, Anthony Duncan, Derek Snelling, Geoff Lingard, Matthew Hills and Peter Christmas.

To date 11 days of negotiations have been held.  The Association’s approach is influenced by recent settlements in Australia, particularly New South Wales and Queensland.  In both cases these are in response to shortages and are intended to allow both states to aggressively recruit and retain in the same international market that New Zealand competes in.  Further, the Association is conscious of the aggressive recruiting efforts towards New Zealand doctors by both states.

There appears to be a significant shift towards the culture of managerialism in DHBs not seen since the early to mid-1990s which is affecting the nature of these negotiations.  To date the DHBs’ negotiating team has not only adopted a negative attitude towards our claim but also has proposed claw-backs (some of which have subsequently been withdrawn or revised) to the existing MECA including:

• Undermining the recognition of the professional standard for time for non-clinical duties.
• Eligibility for sabbatical (an earlier position, subsequently withdrawn, also involved a salary cut while on sabbatical).
• Disempowering the role of ASMS-DHB Joint Consultation Committees.
• Gutting the MECA’s consultation clause following the Association’s successful case for an interim injunction against the breach of this clause by two DHBs.
• Removal of ‘grandparented’ protections for new appointees for the enhanced collective entitlements to remuneration for average hours worked on rostered after-hours call duties in the Bay of Plenty and Waitemata DHBs.
• Requiring senior medical staff to adhere to DHB determined ‘DHB values’ (subsequently withdrawn).
• Increasing the accountability of senior medical staff in service management and clinical leadership roles.

In summary, the DHBs’ negotiating position involves endeavours to:

• Deny New Zealand’s recruitment and retention vulnerability in an internationally competitive medical and dental labour market.
• Disempower senior medical staff.
• Enhance managerial prerogative over senior medical staff.
• Devalue the importance of the professional and related non-clinical activities of senior medical staff.

The net result of the position of the DHBs’ negotiating team is to create an impasse in the negotiations.  There will be a special presentation at Annual Conference on developments to date and the challenges before us.  We expect that this will be the most critical issue to be considered by Conference as it will need to make decisions that will shape and determine our approach to these negotiations especially if, as appears likely, the impasse still remains unresolved after the scheduled negotiations on 25-26 October.

At the 2005 Annual Conference it was agreed to seek a bargaining fee in our collective agreements from non-union members pursuant to Part 6B of the Employment Relations Amendment Act 2004.  The bargaining fee is one of the Association’s claims in our national DHB MECA negotiations which has been accepted by the DHBs.  It will, however, require acceptance in a secret ballot covering all employees (members and non-members) who undertake the duties and responsibilities contained in the MECA’s coverage clause.  A majority of the employees eligible to vote must vote in favour (for the MECA this would be employer by employer).

Joint Consultation Committees (JCCs)

The DHB-ASMS Joint Consultation Committees are a creation of the national DHB MECA and are required to meet at least three times per annum.  They have been a major activity for the Association.  By the end of 2006 it is scheduled that all DHBs, except for Southland, would have had three JCCs.  To date, all JCCs this year have been attended by the Executive Director.  In most cases the DHB chief executive also attends.  In most cases the chief executive also gives a brief verbal report on the immediate issues and challenges facing the DHB.

In general, the JCCs have proved to be useful means of enhancing membership influence and empowerment, both reactively and proactively, but much of this potential has not been exercised.  Much of their success rests on the underlying culture and the quality of the relationships within each particular DHB.  These range from constructive engagement with senior medical staff (e.g. Taranaki) to their marginalisation and disempowerment (e.g. Otago).

The main issues discussed at the JCCs include:

• Job sizing—while some of this has been over the implementation of the time-and-a-half for average hours worked on rostered after-hours call duties, there has also been useful work done involving organisation-wide process agreements with some DHBs.  These have largely been about effective dates for any increased remuneration arising out of job sizing reviews.  They have also included, in a fewer number of DHBs, the formation of joint ASMS-DHB monitoring committees whose role is more facilitating although their relevance and effectiveness is more problematic.  The JCCs have also been a useful vehicle for resolving misunderstandings and misperceptions among some managers over time for non-clinical duties, including with particular reference to the 30% standard.
• Compensation for RMO unplanned absences—this has been particularly successful in extending the protected Auckland DHB rate (Schedule 1 of the MECA) to another seven DHBs (Northland, Waikato, Lakes, Taranaki, MidCentral, Capital & Coast and Canterbury).  This rate has become in effect the minimum ‘industry standard’ and has also helped ensure that this aspect of our MECA claim should not be seen as a cost of settlement.
• Workforce development taskforces (discussed further below).
• Evaluation of DHB provision of adequate workplace conditions, accommodation and resources (discussed further below).
• DHB District Annual Plans.
• Enhancing clinical leadership in DHBs.
• Provision of Broadband, laptops and other electronic aids.
• Various service review and reconfiguration processes.
• Hospital redevelopment projects.
• Medical (SMO/RMO) administration units.
• Staff shortages.
• Improving the performance of managerial processes in areas such as advertising for vacant positions and reimbursement of various entitlements.
• Outpatient clinic contact centres.
• Workforce morale and stress.
• Sabbaticals.
• Information on CME balances.
• DHB nominated travel agencies and CME leave.
• Credentialling processes and recommendations.
• Appointment processes.
• Increasing the level of the superannuation subsidy of those who are members of the Government Superannuation Fund or National Provident Fund to the level of the MECA entitlement for subsequent schemes.
• Clarifying various MECA entitlements and processes, including some implementation issues.
• Payroll performance.

Although much of practical benefit has been achieved there is still much room for improvement.  We hope that Association members on the JCCs will give further consideration to how this might be done over the coming year.  As part of improving the effectiveness of our work in the JCCs, and being proactive rather than simply reactive, our teams are increasingly encouraged to identify in advance of each meeting one to three issues that are tangible, achievable and would in some way improve the lot of our members or the services they are involved in.

The MECA provides for the establishment of a joint workforce development taskforce in each DHB.  These taskforces are charged with the responsibility of endeavouring to reach agreement over staffing plans, associated recruitment and retention strategies, and implementation plans for professional development and education, including sabbatical and secondment.  The potential to advance the collective interests and empowerment of our members is considerable but progress has been disappointingly slow.  In some cases this has been due to preoccupation with job sizing processes (an understandable consideration given the linkage between the two) while in others the level of dysfunction or negative managerial climate has been a contributing factor.  Although taskforces have been established (or agreed to be established) in several DHBs, progress remains disappointing.  Staffing, professional development and education, and recruitment and retention strategies ought to be a basis for proactive senior medical staff engagement and leadership but this has yet to emerge.

Another significant area of work required by the MECA is an agreed evaluation process between the Association and each DHB on the provision of suitable working conditions, resources and accommodation and for a process to address the remedying of any identified deficiencies.  Progress has been slow, in part due to the extent of hospital redevelopment initiatives in a number of DHBs which make the undertaking of this project premature in some cases.  The greatest advance is the construction of an agreed questionnaire at Waitemata which was then forwarded to clinical department heads and led to a most useful report.  The Waitemata survey is now being replicated or modified in some other DHBs.

National Processes in National DHB MECA

The MECA establishes several national processes focusing on implementation, enforcement and extension.  Although a national meeting with DHBs has not eventuated, varying degrees of progress have been made on the Association’s initiative:

1. Standardising the availability allowance for being on after-hours call rosters.  The National Executive came to the conclusion that owing to the quite differing circumstances between (and within) DHBs, the development of a national allowance was not achievable at least at the moment.  Consequently our approach in the MECA negotiations is to create a capacity for reviewing the appropriateness of the allowance in each DHB.
2. Standardised national system for pro rata calculation of remuneration for part-timers.  The proposed shift to an hourly system was adopted by the 2005 Annual Conference and forms part of our MECA claim.  To date the DHBs have not responded positively to this claim.
3. Arrangements (including remuneration) for unplanned absences of resident medical officers.  The National Executive has concluded that this was best pursued at an individual DHB level at this stage using the Auckland DHB minimum rate as a benchmark.  As discussed above this has proved to be a successful strategy and the issue is now also being pursued in the current MECA negotiations.
4. Arrangements (including remuneration) for working on evening, night and weekend shifts.  Again the National Executive concluded that this was best pursued at this stage at an individual DHB level although it now forms an important part of our MECA claim.
5. National guidelines for enhancing senior medical staff involvement in DHB decision-making to be followed by a national conference.  The National Executive is presently working on this from the standpoint of using the MECA provisions on empowerment and engagement as a checklist and also drawing upon a project jointly undertaken by the ASMS and management on clinical leadership at Waitemata.
6. Workforce development and education national conference.  This is on hold due to the lack of progress with the joint ASMS-DHB workforce development taskforces discussed above.
7. National guidelines for limiting hours of work including taking into account the European Working Time Directive.  No progress has been made in this area and, in response to membership reservations, this does not form part of the Association’s MECA claim.
8. National strategy for services and workplaces where registrars are not employed.  A draft policy paper developing a set of principles prepared by John MacDonald and Torben Iversen was adopted by the National Executive as the basis for a yet to be developed policy paper.  The objective of this paper is to promote debate and discussion and to provide the basis for further negotiation.
9. Ownership of intellectual property rights.  We are endeavouring to address this through our MECA claim.
10. Developing a standardised national system for the debiting and accrual of annual leave.  No progress has been made.

The Non-DHB Sector

It is in this area that the Association comes closest to a traditional union organising approach.  This year we have continued our approach of consolidating bargaining where it is desirable and expanding membership where requested.  There have been two important developments: the pending settlement of a hospice MECA and continuing expansion of the Association into the area of salaried general practice.  Our membership now covers the Porirua Union Health Service (previously covered by the Service Workers Union) and new groups of members in Pasifika West Auckland, Ngati Porou Hauora and Ngati Toa Hauora.

Our claims for any new collective agreement now are closer to the national DHB MECA (though job sizing and hours of work are generally very different from DHBs).  The most successful aspects of this approach have been in getting separate salary scales for vocational registrants (following the DHB model) which offer an incentive to gaining vocational registration.  Though the specialist scale in the DHB MECA offers a useful aim, the medical officers’ scale is substantially lower than the market rate in most areas for non-vocationally registered GPs.

Salaried General Practice

Hokianga Health Enterprise Trust

The Association has five members employed by the Trust.  The last two negotiations have been done by email.  On this occasion it was initially agreed by the doctors to put forward a claim for separate payment for the quite extensive after hours component at present incorporated in overall salary.  However, one section of our members didn’t wish to continue with this claim so we withdrew it.  Now the employer has picked up the idea and is pursuing it.  Negotiations are ongoing.

Auckland Union Health Centres: Otara and Waitakere

The Association has four members at West Auckland and two at Otara.  A claim was lodged in June but the employer has delayed negotiations and is talking about developing an incentive payment system apparently modelled on one in force at New Lynn Doctors where incentives are paid to individual doctors according to how many patients they process to meet the criteria (for instance, for cervical screening or immunisation) set by the PHO.

Ngati Whaatua Ki Orakei Hauora

The Association has two members employed by Ngati Whaatua Hauora.  A provisional settlement has been reached for this small collective agreement with only two members.  It features a salary increase of around 12% in the first year and 9% in the second year.  We have also achieved a $2000 allocation for CME (it is unusual to have specific allocation in GP collective agreements where funds tend to be available on an “if the budget allows for it” basis), and the use of CME leave for weekends and public holidays.

Pasifika West Auckland

Negotiations started recently at yet another small GP employer.  The Association has four members employed by Pasifika West Auckland.  A claim has been lodged with the employer and negotiations have begun.

Te Oranganui Hauora Wanganui

The Association has four members employed by Te Oranganui Hauora.  The collective agreement negotiated earlier this year provides salary scales slightly superior to those in the current national DHB MECA.  It also has an explicit allowance of $20,000 pa for the clinical leader.  Initially the Agreement was contingent on the employer getting the money to pay it from the DHB.  The employer has now acquired the money through the Iwi and the new collective is in force from 1 April 2006.  The previous collective agreement already had a scale similar to the DHB MECA medical officer scale.  It now has a vocational registrant’s scale of 10 steps starting at $125,000 per year and finishing at $163,500 per year and a medical practitioners (those without vocational registration) scale of nine steps starting at $110,015 and finishing at $144,800.

Ngati Porou Hauora (Gisborne)

There are seven Association members employed by Ngati Porou Hauora.  A claim has been developed and two negotiating sessions held so far.  This is another group where after hours work has historically been incorporated in the salary and we have put forward a claim to separate it out.

Ngati Toa Hauora (Wellington)

The Association has eight members employed by Ngati Toa Hauora who have recently joined.  We have developed a claim and are pursuing a collective agreement for them.

Wellington Primary Health Services

The Association has 16 members employed by four employers (Newtown (6), Porirua (5) and Hutt (2) Union Health Centres and Whaioranga (3) in Wainuiomata) covered by this collective agreement.

This multi-union, multi-employer collective agreement covers the single largest number of salaried GPs.  Some of the employers covered by this agreement do not employ doctors (though in some cases it is because doctors are retained as supposedly self-employed contractors).  The negotiations held in July this year weren’t as good for doctors as we had hoped particularly as a less than satisfactory process earlier in the year had led to the development of three separate salary scales.  The negotiations themselves saw hostility from some of the employers towards doctors’ claims on the grounds that they are paid more than other staff.  The settlement is for a two year term with an immediate cost of living increase of 4% for all staff, plus an increase equivalent to the movement in the consumer price index in the second year.  A vocational registrants’ scale was put into the collective agreement, fees for advanced vocational training were explicitly included as a work related expense that the employer pays, mileage rates were improved,  and an extra week’s annual leave and parental leave were agreed.  A working party on superannuation was agreed.  In addition we agreed to meet when extra funding for “super access” PHOs becomes available to look at recruitment measures and workforce strategies.

Union and Community Health Centre (Christchurch)

This collective agreement covering four doctors has been renegotiated.  The top rate in the new collective is $64.54 per hour.  The doctors also have an entitlement to five weeks leave each year (and two weeks long service leave after 10 years for the first time this year).

Hospices

There are 18 members who will be covered by the hospice MECA.  A further four members are employed by other hospices that are not presently party to the hospice MECA.

It has been a long-standing aim of the Association to get an employment agreement covering Association members employed by hospices.  A ballot of members working in the sector last year authorised the Association to begin bargaining and after some early hiccups negotiations started in March.  There were serious difficulties in the path of settlement.  Hospices had funding difficulties; there were different conditions and different circumstances, and we were dealing with a small number of doctors widely dispersed around the country.  The Nurses Organisation had reached agreement with many of the same employers on a potential settlement of a hospice nurses’ MECA but the agreement was dependent on the government making additional money available to hospices which has yet to, and may not, occur.

The last negotiating session for the hospice doctors MECA was held on 25 August and it appears possible that the Association has reached a provisional settlement with the employers potentially party to the agreement.  This is subject to agreement on the terms of settlement and ratification by employers and Association members.

The term is for one year as the collective agreement needs to remain synchronised with the DHB MECA presently under negotiation.  CME expenses, annual leave, sick leave, and redundancy payments are less than that in the DHB MECA.  Payments for call are at a flat rate.  Superannuation will be subject to a working party.

New Zealand Blood Service

The Association has five members in the NZ Blood Service.  The other six doctors employed by the service have not joined the Association.  NZ Blood Service members voted to join the DHB MECA so we have issued a notice joining the Blood Service as a party to those negotiations and an advocate from the Blood Service has attended one negotiating session.  The employer does not wish to be covered by the MECA and has undertaken to brief us on their reasons for not wishing to be party.

Family Planning Association

These doctors remain the lowest paid among our membership.  The Association has 24 members at FPA.  The recently negotiated agreement gave doctors on the FPA scale (non-vocationally registered doctors) a 5.5% increase and doctors on the vocational registrants scale will get a 6.5% increase.  This will mean some movement towards our aim of providing additional incentives for vocational registration by increasing the differential between the two scales.

The settlement proposal includes increasing the amount available for reimbursement of annual practicing certificates etc to $2,000 and decreasing the number of hours from 24 to 20 entitling doctors to reimbursement if they have no other medical practice.  For the first time doctors working less than 20 hours a week will get reimbursed up to $1000 if they have no other medical practice.  In each case doctors with other medical practice will have their entitlements pro rated.

Continuing medical education will now be available on the basis of 40 hours leave a year (pro rata for part-timers) plus agreed reasonable travel time.  Actual and reasonable expenses of $1,000 will be available for all doctors on a pro rata basis.  The mileage rate increases from 60 cents to 63 cents a kilometre.

Community Hospitals and Health Services

Many of the collective agreements which were negotiated in the aftermath of the first national DHB MECA are now expiring without a DHB settlement with which to claim relativity.  This includes collectives at Dunstan Hospital (eight members), the Wellington Independent Practice Association (three members), QE Hospital (two members) and Oamaru Hospital (two members).  We are in the process of lodging pro forma claims based on the claims made by the Association in the DHB MECA.

Industrial Team’s Activities

The appointment of a third member of the industrial team has provided much relief and support.  However the continued strong growth in membership and the increased workload associated with the introduction and application of the new MECA requires still more resources to enable us to keep up with membership enquiries and offer the level of support our members have come to expect.

With three (and soon to be four) industrial staff advising members we have introduced weekly industrial team meetings run by the Assistant Executive Director in the national office to assist us allocate work, discuss difficult issues and ensure consistency of advice.  We continue to discuss and investigate the best (or most suitable) way for the workload to be shared but are considering the allocation of specific employers to specific industrial officers and the Senior Industrial Officer also working on a referral basis from other members of the team.

Significant matters to note from the past year, many of which relate to the application of the national DHB MECA, include:

Advice to New & Prospective Members

This is an important service we provide to new and current members who are contemplating offers of employment.  We know from the comments of those we advise that this service is very much appreciated; it also ensures we are able to monitor changes and address “deviations from the norm” of appointments around the country.

We continue to emphasise the importance of members being willing to discuss with one another and their prospective new colleagues issues of job size, after-hours and acute roster details and resource problems within each service.  Individuals are seldom able to negotiate on their own the improvements that almost always come from collective and collegial activity within a service.

Appointments Procedures – DHB MECA cl.53

It remains a concern to us that the appointments procedures that have been agreed to by all DHBs are still not being honoured fully.  Perhaps this is a reflection of the fact that in many instances there are only one or two appointable applicants and the relief at securing someone to fill the vacancy is overwhelming and may cause members and employers alike to be less vigorous than would otherwise be the case in making new appointments.

Relocation Costs – DHB MECA cl.23

Some years ago most employers would offer generous relocation assistance, and in many cases the full costs were met.  Increasingly, except in the smaller and more remote DHBs, employers have imposed quite strict caps on the amount of assistance that they will offer a new employee who is taking up an appointment from overseas, and we are dismayed to regularly encounter offers of assistance within the $10,000 to $15,000 range.

Job Sizing – ASMS Standpoint

This issue has been covered elsewhere in the Annual Report but should be noted here as being perhaps the most important one we have been dealing with over the past year.  We have been very impressed with the way in which a number of services in a growing number of DHBs have embraced the process enthusiastically and produced very impressive and totally compelling spreadsheets of their activities and the time required to complete them.  In most cases, the DHB has responded positively and agreed to increase funding and staff numbers.  There have been three specially notable additional benefits from these job sizing exercises: members within a service have been brought closer together as they work collectively to analyse their service and workloads; managers have had their eyes opened as they have been forced to confront the detail of the work undertaken in their service and perhaps most importantly, a new group of members have become active and taken a lead in this process and been introduced to the work of the union.

Job Descriptions – DHB MECA cl.49

It is difficult to complete a job sizing exercise before a review and rewrite of the job description.  It is disappointing that more DHBs have not put the resources into updating job descriptions and more rigorously applied the recommended guidelines in the MECA.  But progress is being made, albeit slow and once again the review of job descriptions has been a very valuable tool for members to analyse and describe, in terms their managers can understand, the complex and comprehensive activities that must be undertaken in support of their clinical duties.

Auckland SMO Regional Alignment Project

This has been a difficult project, made all the more difficult because of the three Auckland DHBs inclination to take the hard way to do what could have been undertaken much more quickly and simply.  However, the benefit of the project has been to secure agreement and common understanding, at least at the level of first and second tier management, of the structure, terms and proper application of the MECA.  There still remain, however, concerns over ambiguous and misleading wording on some matters.

The underlying requirement of the MECA is consistency of application across the country and all DHBs of its various provisions.  No one who lives outside of Auckland should underestimate the difficulty in getting the three Auckland DHBs to sing in tune and from the same song sheet.

Consultation & Restructuring – DHB MECA cl.44

The MECA has a strong interlinked set of provisions relating to the DHBs’ obligations to consult both the Association and its members about changes in the delivery of services and workplace design, or restructuring.  It was this web of provisions that the Employment Court found irresistible when it issued its interim injunction in the case the Association brought against the Otago and Southland DHBs.

However the burden of the MECA’s consultation obligations can sometimes be heavy for both the DHBs and the Association to bear.  Sometimes the national office feels overwhelmed by the growing number of proposals for reviews and offers to consult us that 21 different DHBs are now regularly sending through to us.  It is difficult for us to keep up with them, understand all their implications and monitor their progress.  Ultimately the Association must rely on its local members to be vigilant and seek advice when they are concerned about reviews and possible changes in their workplaces.

Shift Work – ED staffing & 24 hour SMO services

This continues to be a vexing issue for the Association.  The national DHB MECA was not designed for “shift-workers” and most of our members do not work shifts, in the conventional way that RMOs work shifts.  Nevertheless a small but significant and growing number of our members do actually work shifts, particularly in emergency departments and small rural hospitals such as Thames, Taupo, Tokoroa, Taumarunui, Te Kuiti, Kaitaia, Queenstown, etc.  For these members (whether specialist FACEMS or medical officers) the burden of being on duty, in the hospital and working long days or nights over 1:3 weekends and of regularly working through the night on duty (in the sense that RMOs work on duty) cannot adequately be remunerated by the job sizing model of the national DHB MECA.  This highlights the importance of our claim in the current MECA negotiations to secure premium rates for working the so-called anti-social hours of a shift-worker.

Investigations of Clinical Practice – DHB MECA cl.43

This new clause is proving to be very important but most DHBs struggle to interpret and apply its provisions fairly.  With the assistance of the Medical Protection Society, their barristers and our own barrister (Bruce Corkill), the Association is becoming more confident and assertive in applying this clause.  The purpose of the clause was to ensure investigations of “concerns” and complaints about clinical practice were addressed quickly and fairly.  This means there must be proper, objective and agreed terms of reference, the appointment of agreed and appropriate investigators and a rigorous application of the rules of natural justice.  Each of these requirements has proved challenging for most employers, whose primary concern has been to manage their risk - if in doubt impose restrictions or suspend the doctor!  We intend to do much more work in this area in the next twelve months and will continue to work with DHBs to develop guidelines and rules for the application of this clause.

Employment Court – Mediation - “Involuntary” Resignations

In the past year the Association has referred a number of disputes to, or represented members before, the Employment Court (two) and mediation (five) and nine members have had their employment involuntarily terminated for a variety of reasons, notably for redundancy or on health grounds.

Job Sizing

Job sizing has been a major feature of Association activity both outside and on the JCCs.  The ASMS Standpoint on hours of work and job sizing has proven to be a helpful and well received tool for members.  It may be necessary to revise this publication taking into account what we have learnt over the past year, in order to more strongly emphasise the schedule or programme of activities approach and to provide practical advice for addressing impasses over the assessment of an appropriate job size.  We had hoped by now to have produced and circulated another publication covering ‘frequently asked questions’ about job sizing for members but unfortunately this has not yet been done.

We also published in The Specialist a DHB league table rating the performance of each DHB in terms of its commitment to recognition of the 30% minimum for non-clinical duties.  While some DHBs are demonstrating a negative attitude towards the importance of recognising sufficient time for non-clinical duties, it is encouraging that many DHBs are adopting a more positive approach.

It has become clear that some DHBs are using the excessive fiscal constraints imposed on them in order to rationalise the continued short-changing of an appropriate and fair job size for many Association members.  This unfortunate behaviour demonstrates a short-sighted devaluing of the contribution of senior medical staff to the publicly provided health system.

Delegate Development

Although a formal delegate system has yet to be implemented, the JCCs are in effect becoming a de facto delegate training ground and have the potential to develop further in this respect.  The National Executive is considering holding a national seminar or workshop (or alternatively regional seminars and workshops) in mid-2007.

Surveying Full-Time DHB Senior Medical Staff Income

The Association has completed its annual (12^th) survey of full-time equivalent salaries (FTE) for DHB employed senior medical staff based on our negotiated collective agreements.  The survey provides the most helpful comparative indicator of the salary gains that have been made since the commencement of local bargaining in 1993.  Advances are attributable to advancement through the salary scales.  This is the first survey undertaken since the implementation of the national DHB MECA.  The 13^th (1 July 2006) survey is currently underway.

On 30 June 1993 the mean FTE specialist base rate was $85,658.  By 1 July 2005 this increased to $140,583 (a raw increase of about 64.1%).  This represents a 6.7% increase on the 2004 mean.  The mean female salary is $136,160 compared with the mean male salary of $142,064.  This is the biggest increase over 10 years although the 2004 increase was the smallest.

For medical officers the equivalent salary movement on 1 July 2005 was from $67,457 to $111,088 (a raw increase of 64.7%).  This represents a 9.3% increase on the 2004 mean.  The mean female salary is $110.231 compared with the mean male salary of $111,650.

These are mean full-time equivalent base salaries and do not take into account hours worked in excess of 40 hours per week (i.e. recognised through job sizing), the availability allowance or any other special enhancements.  The results were published in The Specialist and are available on the Association’s website.

Surveying DHB Senior Medical Staff Superannuation Entitlements

We undertook our fifth survey of superannuation entitlements in DHBs, effective on 1 July 2005, which covers 2,214 senior medical staff receiving subsidised superannuation.  The largest group receiving subsidised superannuation are the 1,477 members whose schemes are based on the Association’s collective agreements.  The next largest group, 644, is the former government and legislation-based superannuation schemes (National Provident Fund and Government Superannuation Fund); to which access for new entrants was closed off by 1992.  The balance of members in super schemes, 93, is covered by other subsidised arrangements.  The results were published in The Specialist and are available on the Association’s website.

Direction of Association and Relationship with Government

At its 31 August meeting the National Executive considered its direction largely in relation to the direction of health policy primarily with regard to its impact on the effectiveness and viability of the public health system but also on the morale and confidence of Association members, and in response to their expressed concerns.  The performance and conduct of the Minister of Health on behalf of government over issues such as access to secondary services, laboratories, the politicisation of the Medical Council, and funding led the Executive to conclude that we had less in common with the government’s real objectives than we had anticipated.  There was also increasing concern over the performance of some DHBs in their handling of fiscal pressures and their increasing managerialism.

Consequently the Executive resolved that:

The Association should adopt a more consistent forthright position over concerns with government and district health board performance.

As a result of this decision the Association released a media statement outlining this position which attracted considerable media coverage including TV1 News and the front page of the Dominion Post and Christchurch Press.  The Executive would welcome discussion on this sharpening of our direction at Annual Conference.

Relationships with other Political Parties

Particularly through the Executive Director and our social functions, the Association has maintained and further developed contact and liaison with the other political parties, in particular, National.  The National Party health spokespersons met the National Executive at its informal meeting on 1 March.

Health Professional Led Approach

In the 2005 Annual Report we reported that the Association has prepared a paper which the Council of Trade Unions endorsed and enclosed with its briefing paper to the incoming government in October 2005.  The paper recommended a health professional led approach to the provision of secondary and tertiary services through a clinically led taskforce established to facilitate the formation and strengthening of national and regional clinical networks and make specific recommendations on resource utilisation, organisation and provision of elective, chronic and acute services in each of the DHBs.  This paper sought to promote the achievement of two ambitious objectives within the next three years:

1. Health professionals will have confidence that there are tangible improvements in access to and quality of health services.
2. The public perception of the health system is that it is improving rather than deteriorating.

While the Minister of Health has described repeatedly this proposal as a ‘gift’ and in May he met Association and CTU representatives to further discuss it, 12 months later he has yet to unwrap it.  More significantly, his modus operandi has been very much in the opposite direction.  His deeds and silence suggests that he is more comfortable with the culture of managerialism in decision-making processes rather than health professional leadership.  At this stage, at least, it appears unlikely that our CTU endorsed initiative will be adopted according to its tenor.

National Senior Medical Workforce Development Group

On the initiative of the DHBs and following an informal meeting with them on 20 November 2005, a joint national group has been formed to look at senior medical workforce development.  The Association representatives are National Executive members Judy Bent, Jeff Brown, David Jones, Brian Craig and John MacDonald along with the Executive Director and Assistant Executive Director.  The DHBs team is led by their ‘lead’ chief executives for medical workforce development Margot Mains (Capital & Coast) and David Meates (Wairarapa) and also includes Nigel Murray (interim Southland DHB chief executive), Mike Loftus (employment relations manager for the four northern DHBs), Sam Bartrum (human resources general manager for the Waitemata and Counties Manukau DHBs), Marilyn Rimmer (DHBNZ) and Dr Ian Brown (Northland DHB chief medical adviser).  A similar group with the Resident Doctors’ Association looking at RMO workforce development issues had previously been established but had collapsed due to the impasse in the RMO MECA negotiations.

Although the DHBs have unsuccessfully attempted to use this process to undermine employment conditions, mainly time for non-clinical duties, it remains a potentially useful process.  A second meeting on 20 February agreed to establish the national group and to develop terms of reference and principles which were further considered on 13 April and are close to completion.  A further scheduled meeting was taken over by the need to reach agreement on remuneration and other arrangements for members during the five day RMO national strike.

The potential for this group includes collecting reliable information in order to develop a profile of the senior medical workforce and the rationalisation of duplicated DHB processes such as consent forms.

However, the work of this group was disrupted by the SMO MECA negotiations which involved overlapping DHB teams.  As a result of the DHBs MECA negotiating team’s decision to cancel a scheduled negotiating date because they were not able to be prepared, at its 29 June meeting the National Executive resolved:

It was further agreed that given the DHBs’ inability to resource their teams for the RMO and SMO MECA negotiations, the scheduled meeting [on 20 July] for the joint ASMS-DHBs national workforce development group should be cancelled and further meetings not re-scheduled until the SMO MECA negotiations were completed or close to completion.

The DHBs ‘lead’ chief executives were upset by this decision and requested that we reconsider.  However, the National Executive reaffirmed its decision at its 31 August meeting noting that the circumstances remained unchanged.

Medical Council Elections

The Health Practitioners Competence Assurance Act 2003 removed the right of mandatory elections for four of the 11 members of the Medical Council, the statutory body responsible for the registration of medical practitioners (it also had a similar effect on the Dental Council).  This was despite the opposition of the Association and the wider medical profession which feared that this might lead to the politicisation of the Council and a consequential loss of confidence in it by the profession.  The Act did provide for the capacity for registration boards such as the Council to conduct elections but the Minister is not legally obliged to appoint the elected candidates.  The Act also gives the Minister the discretion to issue regulations providing for mandatory binding elections.

The Association, along with other medical organisations and the new Pan Professional Medical Forum, has persistently recommended to the Minister of Health that in the first instance he use his discretionary authority under the Act to allow the Medical Council to conduct elections and to accept the outcome by appointing the successful candidates to the new Council.  This became critical because the terms of the elected Council medical practitioners expired in 2006.  Second, as the next step for the future we recommended that he should use his authority under the Act to issue regulations providing for mandatory binding elections.

This issue became a priority for the Association largely working through the Pan Professional Medical Forum.  ASMS Direct was used as a means of promoting to members the importance of, first, considering standing for election or nominating a colleague and, second, using their vote in the elections conducted by the Medical Council.  The National Executive was encouraged by the statement of the Minister of Health at its 2 March meeting that while not obliged to, he would be foolish not to appoint the successful candidates.

Consequently we were disappointed and angry to learn that the Minister only appointed three of the four elected candidates and instead appointed an unsuccessful candidate.  The Association was publicly critical of the Minister’s decision and the Pan Professional Medical Forum sent an open letter to the medical profession outlining the fears of politicisation and loss of confidence in the Council.  This letter was sent to members in ASMS Direct and also published in The Specialist.

This controversy led to a meeting between the Minister and the Pan Professional Medical Forum on 13 September (the Association was represented by the National President and Assistant Executive Director).  Although it was a tense meeting by the end the Minister agreed to consider the option of issuing regulatory authority for mandatory binding elections.  Previously he had determined to appoint the fourth elected candidate to the Council.  While this measure is welcome the Minister’s handling of this matter has led the Pan Professional Medical Forum to be more determined to pursue the capacity for regulatory authority to avoid this controversy occurring in the future.

Public Hospital Laboratories

As a result of devolved funding from the Ministry of Health, DHBs assumed responsibility for funding community as well as hospital laboratories.  Historically most community testing is undertaken in private laboratories which are now largely a duopoly (although the recent Auckland community testing decision challenges this).  As these time-limited contracts come up for renegotiation DHBs have been concerned about the fiscal challenges of the uncapped demand driven nature of these contracts.  The private sector has made large profits out of community testing because of the uncapped and volume driven nature of these contracts which have also led to high levels of duplication of resources.  This situation led to DHBs facing increasing fiscal pressures and blow-outs leading them to move to capped funding contracts for community testing.  This involves shifting from a market in which profit maximisation is achieved by doing more work to one in which it is achieved by cost cutting and doing less.  It also creates a capacity for cost shifting of more expensive community testing to hospital laboratories.

Some DHBs have considered privatisation of their hospital laboratories in response to this challenge even though hospital laboratories were operating under stronger fiscal disciplines and were not responsible for the DHBs’ fiscal predicament.  This has caused much distress to Association members.  The Association has been actively endeavouring to persuade DHBs not to consider privatisation of their hospital laboratories.  During 2005-06, the Waitemata, Auckland, Counties Manukau (not to be confused with the current dispute over the controversial community testing decision), Waikato, Hawkes Bay (despite an eleventh hour bid by the board chair to override the previously agreed due process and privatise), Hutt Valley, Capital & Coast, and Canterbury all agreed to maintain rather than privatise their hospital laboratories.

However, Otago, Southland (as a combined operation), Nelson Marlborough and Whanganui (provisionally only) have resolved to privatise their hospital laboratories, despite the advice and opposition of their pathologists, while privatisation remains a possibility in Tairawhiti and Lakes.  Despite a successful application to the Employment Court for an interim injunction against the Otago and Southland DHBs (an important message to DHBs about compliance with the national DHB MECA consultation clause), we have not been able to turn around these decisions (Whanganui is still alive).

Decisions to privatise require the approval of the Minister of Health.  In the first instance they should be identified in the DHB’s District Annual Plan, which was not the case in the Otago-Southland case.  For this government to approve privatisation of a core public hospital service would have constituted a policy U-turn.  But this was precisely what happened.  Further, the government’s protocol on outsourcing was conveniently ignored by both the Minister and Ministry of Health.  The Minister also had the statutory authority under the Public Health and Disability Act to require DHBs not to privatise.  Public hospital laboratories have been subject to poor and opportunist leadership by the Minister.  In fact, the failure of the government to provide a national policy framework for decisions over laboratories has had a significant negative and destabilising effect, including on workforce.

The Association put a considerable amount of resource into the Otago-Southland case through the use of our barrister Bruce Corkill and the Senior Industrial Officer in the legal action (including its preparation) and the Executive Director in lobbying and publications.  The Association’s application for a full injunction, following the successful interim injunction, was to be held by the Employment Relations Authority in July.  However, the Minister’s unexpected decision to approve the privatisation within hours of the Court awarding its interim injunction (making the conditional contract signed between the DHBs and Southern Community Laboratories, a party not able to be covered by the injunction, unconditional) undermined our case, which may have been his intention.  This included our ability to overturn the DHBs’ decision to privatise and to obtain information such as the contract itself that would have assisted our ‘failure to consult’ argument before the Authority.  The DHBs hammered home the advantage provided by the Minister.

The Executive Director lobbied government MPs extensively and received positive support.  At one point it was reported to him that his efforts had been successful and that the privatisation would not proceed.  However, the Minister’s high cabinet rank and political influence was able to override this opposition.

The decisions by DHBs to privatise, most pronounced in Otago and Southland, have been characterised by factors such as:

• High levels of pre-determination over outcomes.
• Manipulation of selection and evaluation processes and the marginalisation of clinical input.
• Decisions largely driven by funding and planning divisions operating under the ideology of the funder-provider split of the 1990s.
• The determination of the private sector to do what was necessary to achieve their objectives influenced by the tight market it had to operate in whose risks included going out of business.
• The preparedness of some DHB managers and board members to run with outcomes whose risky consequences may not materialise during their ‘shelf life’.
• Marginalisation and disempowering of DHB employed pathologists.

It has been an important learning experience for the Association.  Owing to the unusual circumstances it took some time before we became fully aware of what we were up against including questionable managerial and political behaviour.  Further, it required a different response to the way in which the Association prefers to operate.  The Association’s approach since our formation has been to focus on negotiating a resolution leaving litigation as a rare and last resort.  However, laboratory privatisation processes lend themselves to litigation much earlier in the process, usually before a ‘Request for Proposals’ was issued.  This experience is not a justification for altering our preferred approach in general, but we have to be mindful of those few instances where it has limitations.

The practical effect of hospital laboratory privatisation is to concentrate as much of the community testing as possible in the hospital laboratory in order to reduce costs and maximise profits.  In other words, the outcome is to hand over a core public hospital health service.

Protocols for Outsourcing (Privatising) DHB Services

In 2005 the Association was involved in informal discussions with the Minister of Health, her advisers and the Ministry over the protocols for outsourcing DHB services.  The existing protocols were reasonable with an emphasis on continued public provision but would have benefited from more explicitness, removal of ambiguity and updating.  However, our representations were largely ignored.

Following the Minister of Health’s approval of privatisation of the hospital laboratories in the Otago and Southland DHBs, the Association working through the Council of Trade Unions made a new proposal to the Minister.  Although the proposal was not accepted in the form provided, it has lead to a new protocol that has a stronger emphasis on public provision in respect of decisions about longer term arrangements and steering private sector involvement in the provision of core secondary services more towards shorter term arrangements.  Further, there is now an express requirement for health professional engagement.  This is an improvement although the experience of public hospital laboratories is that government and DHBs are prepared to ignore their protocols if it suits them.

Employment Relations (Probationary Employment) Bill

The Association made a submission to Parliament’s Transport and Industrial Relations select committee critical of the Employment Relations (Probationary Employment) Bill also known as the Mapp bill after its proposer, National MP Wayne Mapp.

The Bill provides for a period of 90 days where no rights to personal grievances would exist.  In practice the major impact would be to take away any requirement for employers to give a reason for dismissal of employees in the first 90 days of their employment with an employer or any requirement to follow a procedurally fair process.  This 90 day period would apply each time any employee changes employer.  The Association’s submission focussed on the Bill’s basic unfairness and the implications for the health service including our dependence on international recruitment.

The Bill was referred to the select committee by a slender margin only made possible by the support of three of the four Maori Party MPs.  However, the Maori Party has now come out against the Bill and its future at this point in time looks bleak.

Review of Funding for Medicine and Dentistry at Universities

The Tertiary Education Commission is examining student-component funding for medicine and dentistry with a view to recommending adjustments to funding levels if they assess this as appropriate.  The Association of University Staff, in advocating for additional funding in order that the universities can ensure the long-term quality of their programmes, made an impressive submission which included a call for equality between university salaries for medical and dental academics and the salaries for senior medical staff employed by DHBs.  The submission highlighted the deteriorating recruitment and retention situation in the universities.  At its meeting on 29 June the National Executive resolved to support this submission by sending a letter of endorsement to the Tertiary Education Commission.

Resident Medical Officers MECA Negotiations

The Association was confronted with a considerable challenge with the five day RMO strike on 15-20 June.  In addition to the difficulties and pressures imposed on members by this strike, there was also a range of differing attitudes from members towards the dispute.  Some were concerned with the underpinning issue of RMO rosters while others were concerned with the behaviour of the DHBs, the controversial ‘Memorandum of Understanding, and the extent and nature of the strike action.  The Association endeavoured to maintain our own independent position and avoided commenting on the specifics of the dispute although there was concern over the implications of the ‘Memorandum of Understanding’.  Earlier in the year the National President had advised the RDA of the risk of loss of sympathy in the event of prolonged extensive strike action.

At its 4 May meeting the National Executive resolved that (a) the proposed ‘Memorandum of Understanding’ was inflammatory and provocative and therefore should be withdrawn and (b) recognising the loss of goodwill over the increasingly adversarial RMO MECA negotiations, a new recommendatory rather than deliberative process should be developed to address the concerns over RMOs rosters and related matters taking into account safe hours, training and flexibility.  Arising out of discussion at the National Executive’s 29 June meeting, a Presidential Letter was mailed to all members.  All the membership feedback over the Letter has been positive.

The Association in difficult circumstances also managed to negotiate an agreement covering enhanced rates and other arrangements for members who undertook additional duties and responsibilities as a result of the strike.  While the circumstances inhibited what could have been achieved and there are lessons for the future, it proved to be of considerable benefit to members.

At its 31 August meeting the National Executive was aware that the relations between the RDA and DHBs in these acrimonious negotiations continued to deteriorate and that further strike action appeared at that time to be likely.  Consequently it resolved that in the event of further RMO strike action arising out of the RMO MECA negotiations, the Association’s emphasis would be on supporting patients rather than DHBs.  The Executive also has serious concerns about the detrimental medical workforce effects of this acrimonious dispute in terms of the attractiveness of New Zealand as a place to train and retain doctors and dentists.  While it now appears that a settlement is likely, the level of conflict and acrimony in this dispute may mean that the damage it has caused will remain for sometime.

Pan Professional Medical Forum

In the 2005 Annual Report we reported on the formation of the Pan Professional Medical Forum comprising the Council of Medical Colleges, ASMS, Resident Doctors’ Association and NZMA in response to growing concerns within the medical profession.  Ably facilitated by CMC chair Associate Professor Phil Bagshaw, the PPMF has had three meetings to date this year with a fourth scheduled for late November (another meeting was also held late last year).

The main issue discussed by the PPMF has been the Medical Council elections and the risk of politicisation of the statutory body responsible for the registration of medical practitioners.  This included a meeting with the Minister of Health on 13 September which, although difficult and somewhat abrasive, appeared to make useful progress towards an agreement for the introduction of regulations to provide for mandatory and binding Medical Council elections.

While the basis of determining medical practitioners on the Medical Council will continue to be a pressing issue for the PPMF, another emerging issue is the medical workforce which is looking to develop a campaign around the theme of ‘train more, retain more’.

Other issues discussed included the impact of increasing student debt and a national support service for doctors although the drive in respect to the latter has been slowed due to the positive joint initiative of the Medical Protection Society and the Medical Assurance Society.

The PPMF is a positive development but it has its challenges.  There are differences in approach over a number of issues between the ASMS, RDA and NZMA while the colleges have decision-making processes that are not conducive to effective and immediate advocacy.  Furthermore, the PPMF lacks a realistic resource basis and is very much dependent on the goodwill and energy of Associate Professor Bagshaw.  While the PPMF is not sustainable in its present form its existence to date highlights the advantage of having a credible body that can advocate and articulate issues that unite rather than divide the profession.  If the PPMF is able to evolve into something more sustainable this will be a significant step forward for effective pan professional representation.

In recognition of this the National Executive has resolved to endeavour to raise the profile of the PPMF, including in The Specialist and on our website.

Establishment of a National Advisory Support Service for Doctors under Stress

In the 2005 Annual Report we reported that the National Executive had welcomed a draft proposal from Associate Professor Phil Bagshaw for the establishment of a national advisory support service for doctors under stress linking together legal, intellectual, emotional and rehabilitation support.  This was discussed at the 2005 Annual Conference leading to a resolution supporting the establishment of such a support service and authorising the National Executive to explore how to achieve this objective.

Particularly in light of the discussion and resolution at the 2005 Annual Conference, the National Executive welcomed the subsequent initiative of the Medical Protection Society and Medical Assurance Society to establish a support service for doctors and was pleased that the entry threshold was not linked to complaints.  At its 2 March meeting the Executive resolved:

That the Association support and actively promote the new national support service for medical practitioners established by the Medical Protection Society and Medical Assurance Society.

The Association promotes the new service through The Specialist and ASMS Direct.

Meetings with Director-General of Health

The Executive Director continued his regular informal meetings, usually monthly, with the Director-General of Health but only five have been held to date.  This is because of the gap between the resignation of Dr Karen Poutasi and the commencement of her successor Stephen McKernan.  Although the Association has over the years been critical of the performance of the Ministry of Health, we have always found Dr Poutasi a very conscientious, professional and ethical person to deal with.  We also positively received the appointment of Mr McKernan recognising his successful record as a chief executive in two DHBs.

These informal meetings are an opportunity to raise issues, perspectives and differences that might not otherwise be brought to the Director-General’s attention.  A common discussion point has been reporting back on the main themes and performance of the Joint Consultation Committees in each DHB created by the national DHB collective agreement.

Topics for discussion included:

• Our national DHB MECA negotiations.
• The joint ASMS-DHBs national workforce development group.
• Relevant issues in the RMO MECA negotiations.
• Denial of access to first specialist assessments.
• Public hospital laboratory privatisation.
• Medical Council elections.
• Specific internal DHB problems.

Council of Trade Unions

The Association continues to benefit from our affiliation with the Council of Trade Unions (CTU) at both a national office level and with the affiliates.  The Executive Director (or in his absence the Assistant Executive Director) usually attends the CTU’s quarterly National Affiliate Council  while either he or the Assistant Executive Director participates in the Health Committee along with the Nurses Organisation, Public Service Association and Service and Food Workers’ Union.  The CTU regularly meets with DHB chief executives which the Executive Director attends as part of the CTU team.  The CTU also provided the vehicle for the Association to pursue our health professional led approach and a new protocol for considering outsourcing (privatisation) of secondary services.

Issues considered by the National Affiliate Council included:

• The CTU workforce injury advocacy service which was run as an 11-month pilot funded by the ACC and provided independent support to union members who required assistance accessing ACC entitlements.  The service has been renewed and extended nation-wide.
• Improving the effectiveness and relevance of unions.
• Extending state sector provided superannuation coverage (still less than what is provided in the national DHB SMO MECA).
• An assessment of the ‘5% in 2005’ private sector campaign led by the Engineering, Printing and Manufacturing Union.
• A session with the Prime Minister.
• Increasing the affiliation fee by 15 cents per affiliated member (fte) to $4.75 in the 2006-07 financial year and by a further 15 cents in 2007-08.  [Affiliates were also invited to consider paying the second 15 cent increase 12 months early.  Recognising both the value of the CTU’s work and the minimal impact on the Association’s finances, the National Executive determined to accept this invitation.]
• The supermarket distribution dispute.

The CTU also established a fund for donations to assist unions seeking to represent more vulnerable and harder to organise employees, mainly in the private sector, to increase membership.  At its 4 May meeting the National Executive voted to make a donation of $500.

In September the Assistant Executive Director and new Industrial Officer Jeff Sissons attended the inaugural CTU employment law conference.

Tripartite Process

In its first term the Labour-led government set up a process known as the Tripartite process comprising the Ministers of Health and Labour on behalf of the government, DHBs and the Council of Trade Unions (health sector affiliates).  The intent was to provide a mechanism(s) for the implementation of a culture of constructive engagement throughout the health service.  The process includes a steering group of the three parties.  Meetings of the steering group have been infrequent often due to the difficulties of scheduling meetings with Ministers.  However, one successful outcome was the health sector code of good faith which now comprises a schedule to the Employment Relations Act.

In 2006 the Tripartite steering group was revived and held its first meeting on 11 July with a second held on 14 August.  The Executive Director has attended as part of the CTU team.  To date the meetings have lacked focus and purpose, with some tension between the Association on the one hand and DHB representatives and the Minister of Health on the other at the latter meeting.  However, they do have potential if a common purpose can be developed.  A third meeting is scheduled for 28 November.

International Travel

The following international travel was undertaken by national office staff since the previous Annual Conference:

• The Executive Director attended both of the twice yearly Industrial Coordination Meetings organised by the Australian Medical Association, in conjunction with the Australian Salaried Medical Officers Federation.  The first was in Sydney in April which provided an opportunity to be briefed on the significant Queensland and New South Wales settlements.  It also provided him with an opportunity to meet representatives of ASMOF and the Australian Council of Trade Unions to discuss the implications of the new federal industrial law and ASMOF.  The second was in Canberra in September which provided an opportunity to be updated on the new Victoria settlement.  He also gave a paper to the meeting on directions in New Zealand’s health system.  En route he also visited ASMOF in Sydney.
• The Executive Director made a two week trip to California, England and Holland in late September-early October.  In San Francisco he attended the triennial convention of the Union of American Physicians and Dentists.  In England he met officials of the British Medical Association on both their national employment contracts and health policy.  He also met with health policy academics from the London School of Hygiene and Tropical Medicine and the University of Greenwich Business School, the Medical Protection Society and the Trade Union Congress.  While in England he also visited the Royal Devon and Exeter NHS Trust because of its positive reputation in ‘clinical governance’.  In Holland he met the Landelijke Vereniging Van, a union similar to the Association, to discuss bargaining environments and terms and conditions of employment.  It also provided an opportunity to learn about their strike action over electives earlier in the year.

Association Publications

The Specialist, the Association quarterly newsletter (generously sponsored by the Medical Assurance Society) is a cornerstone of our advocacy work.  Feature articles included:

• Time for non-clinical duties.
• The Association’s health professional led approach.
• Dealing with registrar rosters.
• The DHBs approach to recruitment and retention in the national DHB MECA negotiations.
• Renegotiating the national DHB MECA.
• The MPS-MAS support service for doctors.
• Medical Council elections.
• New South Wales collective agreement settlement.
• KiwiSaver.

The ASMS DHB News both supplements The Specialist and plays an important role in local matters and supplying other relevant information.  The main theme in all DHB News has been the joint consultation committees.  This communication vehicle is also adapted for our members employed outside DHBs, largely in relation to collective bargaining.

The second occasional publication, ASMS Standpoint, covering employment related issues has been recently published and mailed to members in September (also available on the Association’s website).  It covers the national DHB MECA provisions for professional development and education, with particular reference to continuing medical leave, secondment and sabbatical.

We have also continued our email publication, ASMS Direct, which began in November 1999.  This is produced on an as-needed basis.  The circulation list is over 2,000.  To date 26 issues (twice as many as this time last year) have been produced this year.  Much of this has focussed on matters relevant to the implementation, and understanding, of the national DHB MECA and the ASMS-DHB joint consultation committees.

Other subjects covered included:

• The Association’s health professional led approach to the Minister of Health.
• Job sizing including time for non-clinical duties.
• National ASMS-DHBs senior medical workforce development group.
• RMO MECA negotiations and dispute.
• Hospital laboratory privatisation.
• ADHB chair’s comments on experienced older doctors.
• Pan Professional Medical Forum.
• Funding medical and dental degree programmes.
• Government funding boost and consequential new university salary settlement.
• Unemployment rates and implications for remuneration markets.
• MPS-MAS new support service for doctors.
• MPS administration change to MAS.
• CTU campaign for asbestos victims.
• Spending on health bureaucracy.
• World Medical Association statements on TB and organ transplants.
• Medical training pending crisis in Australia.
• Supermarket industrial dispute.

The national ASMS Direct is also supplemented by local ASMS Directs on Association activities and local issues.

The Executive Director has had for several years a monthly column in the fortnightly NZ Doctor.

Membership

Once again the Association has had another record membership year.  Membership, as of 31 March 2006, was 2,738 compared with 2,574 on 31 March 2005, representing an overall increase of 164 (6.4%).  It represents a 90% increase on our 1,440 members after our first year of existence (1989-90).

It is interesting to note the annual membership pattern increase since 1998-99 (the last year where we had a membership decrease) – 1999-2000 (105 – 6%), 2000-01 (118 – 6.4%), 2001-02 (98 – 5%), 2002-03 (146 – 7%), 2003-04 (117 – 5%),  2004-05 (239 – 10%) and 2005-06 (164 – 6.4%), an overall increase of 56% over this period.  Since our formation in 1989 there have been three years of membership losses – 26 (1.8%) in 1991-92, 47 (3%) in 1993-94, and 15 (0.8%) in 1998-99.

The annual average increase since our formation is 81 (5.6%).  Under the period of the Employment Contracts Act (1991-92 – 2000-01) the annual increase was 61 (4.3%).  Under the period of the Employment Relations Act, since 2000-01, to date the annual average increase has been 152 (7.7%).

Currently membership is over 2,760 although this may be affected by the subsequent resignation factors such as retirement that always occur at the end of our financial year and the slow trickle of new members between now and 31 March 2007.  The combination of recruiting new members and strong membership loyalty continues to be the key to our effective representation in both collective and individual matters.

Currently about 86% of our members pay their subscription by automatic salary deduction (about 83% of new members employed during the past year opted for fortnightly payments).

Again, despite incomplete information, it remains the case that few Association members are also members of the NZMA and these numbers appear to be declining.  Those who were NZMA members at the time of joining the Association presently represent an estimated 16% of our current members.  7% of members who joined the Association in 2006 were also members of the NZMA compared with 22% in 1996.

The Association received in February an enquiry about the possibility of joint ASMS-AUS membership for university employed specialists.  However, at its 2 March meeting, in line with our Constitution the National Executive reaffirmed that the Association was not able to represent them.

Medical Protection Society

The Association has continued our close working relationship with the Medical Protection Society, including working together on several cases where our respective roles overlap or intersect.  Much of this involves the Senior Industrial Officer working with the MPS representatives and lawyers on specific cases.

The Executive Director visited the MPS international office while in London in October and also met with them when they visited New Zealand later that same month.  Further, in October the Senior Industrial Officer attended the New Zealand panel meeting in Christchurch.  We are grateful for the generous decision of MPS to again sponsor the Conference dinner.

Medical Assurance Society

The Association’s collaborative ‘preferred provider’ relationship with the Medical Assurance Society has continued to strengthen.  This includes the Society’s generous sponsorship of The Specialist while the Association contributes to the Society’s quarterly publication, Hi Society.  The Society has also generously agreed to continue to sponsor the pre-Conference function.

The quarterly advisory consultancy meetings between the Executive Director (and Executive Officer) and Society Chief Executive Martin Stokes continue.  Discussions at these quarterly meetings have also included the new MPS-MAS support service for doctors, our national DHB MECA negotiations, other Association collective bargaining including the new provisional hospice MECA, the Minister of Health and Medical Council elections, MPS administration, Kiwi Saver, implications of the RDA-DHBs MECA dispute, and the Association’s job vacancy page.

Association Finances

The Association recorded another higher than anticipated surplus for the financial year ending 31 March 2006.

In summary the main factors for the healthy surplus were:

• Another much stronger than expected growth in membership.
• Interest on investments exceeding budget due to improved interest rates.
• Sundry income exceeded expectations largely due to the BMJ promotion of the online job service.

Administration

2006 has proven to be another challenging year largely attributable to the frequent membership correspondence generated by the MECA negotiations and JCC meetings.  Considerable importance is placed on getting this material to members in a timely and efficient manner and the administration team is constantly exploring timesaving methods of achieving this.

At the end of 2005 the office photocopier was upgraded to a late, colour capable model with scanning and other useful functions.  The use of email as an efficient method of communication continues to grow in popularity with 72% of the membership subscribing to ASMS Direct.

Strong focus continues on maintaining the professional standard of the Association’s publications; the most recent being the second ASMS Standpoint which has again received very positive feedback on its presentation and content.

Website

The website also continues to draw favourable comment from members who find it a valuable reference point.  Considerable emphasis remains on ensuring that the website is updated with topics of special interest listed on the home page.  Visitor numbers have steadily increased during the year to around 14,000 visits each month; an increase of 37% on last year’s traffic.

Job Vacancies Online

The ASMS Jobs Online service was introduced five years ago; it allows employers to advertise senior medical and dental vacancies on the ASMS website easily and economically.  Advertisements are linked to the employer’s website and all enquiries are directed to the employer or its agent.

The Association’s monthly advertising campaign with BMJ Careers, the United Kingdom’s principal medium for medical recruitment, concluded in September 2006.  Though difficult to gauge the success of the campaign in terms of placements, aspects that can be measured are very encouraging.  These are:

• positive feedback from employers and visitors to the employment sections;
• a significant increase in volume of monthly traffic to the site;
• an average of 200 visitors per month are directly referred from BMJ Careers to the ASMS website; and
• advertising has tripled to a monthly average of 46 listings since commencing the initiative; with 20 DHBs and several smaller employers utilising the service in the past year.

The National Executive has been pleased with the success of this venture and consequently at the 31 August meeting resolved to initiate a stronger advertising campaign in BMJ Careers including increasing the frequency to fortnightly.

Other Matters

Doctors-in-Training Roundtable

The Doctors-in-Training Roundtable established by the Minister of Health, on which the Association was represented by the National President, presented its report to the Minister in May.

Kiwi Saver

The Medical Assurance Society has been keeping the Association informed on the development and benefits of the Kiwi Saver scheme whose bill was recently adopted by Parliament.  The MAS also provided an article on the scheme for The Specialist.

Time Limit for Making a Complaint to the Health & Disability Commissioner

At the 2005 Annual Conference an enquiry was made during general business as to what the time limit was between the occurrence of an incident and a complaint to the Health & Disability Commissioner.  This has now been investigated and the answer is that there is no time limit although the elapse of time between the making of the complaint and an incident can be grounds for the Commissioner deciding to take no action on a complaint.

‘Well-Check’ Vouchers

During general business at the 2005 Annual Conference, it was requested that the National Executive investigate the importance of providing ‘well-check’ vouchers for senior medical staff to use in order to access general practitioners.  This was considered by the National Executive which resolved, at its 4 May meeting, not to proceed further with this matter.

Use of Expert Clinicians

During general business at the 2005 Annual Conference, it was requested that the National Executive investigate the use of expert witnesses being used in employer investigations of clinical practice.  The National Executive agreed that rather than investigate, we should be mindful of the importance of clinical experts being either college approved or acceptable to the affected doctor(s).

Safer Working Hours in Medicine Conference

On 9-11 November 2005 the Resident Medical Officers’ Association organised a conference in Auckland on safer working hours in medicine which was addressed by an impressive array of speakers including from overseas.  This was attended by the Executive Director.

Proposed ‘Health Summit’

The Association was invited to participate in a meeting set up to organise a ‘health summit’.  The invitation came from the Health Funds Association which represents private health insurers.  The National Executive was wary of being drawn into an activity which, if only indirectly, appeared geared towards creating an environment conducive to private health insurance. It therefore declined the invitation.

Bird Flu Pandemic Threat

The National Executive considered at its 2 March meeting how to respond to enquiries over the threat of a bird flu pandemic.  It was agreed to refer any enquiries to specified medical experts.

Brian Craig
ASSOCIATION NATIONAL SECRETARY
24 October 2006

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