About ASMS
ANNUAL REPORT 2004
- National DHB (Multi-Employer) Collective Agreement Negotiations: MECA
- Post-DHB MECA Implementation
- Membership Empowerment Strategy
- Membership Empowerment Seminars
- Collective Bargaining outside DHBs
- Industrial Officer’s Activities
- Industrial & Policy Adviser's Activities
- Surveying Full-Time DHB Senior Medical Staff Income
- Surveying DHB Senior Medical Staff Superannuation Entitlements
- Review of Rules: Draft New Constitution
- Health Practitioners Competence Assurance Act: Operation and Application
- Tertiary Intern Grant
- Health Sector Code of Faith
- Electronic Referral Letter and Hospital Discharge Summary Standard
- Relationship with Minister of Health
- Relationships with other Political Parties
- Meetings with Director-General of Health
- New Holidays Act
- Prioritisation
- Duty of Care Paper
- Employment Relations Law Reform Bill
- Public Finance (State Sector Management) Bill
- Medical Misadventure
- Productivity in Public Hospitals
- Complaint against Holmes programme
- Medical Council
- ‘Medical Roundtable’
- Relationships between Senior and Resident Medical Officers
- Resident Medical Officers National Strike
- DHBNZ
- Supervision and Recruitment of Overseas Trained Doctors
- Guidelines for Safe Working Hours and Punitive Remuneration
- Annual Conference Professionalism Resolution
- Association ‘Chat Room’
- Council of Trade Unions
- Wider Medical Representation
- Medical Protection Society
- High Court Ophthalmology Decision
- DHB Staff Shortage Surveys
- Australian Medical Association Industrial Coordination Meetings
- International Travel
- Association Publications
- Membership
- Medical Assurance Society
- Association Finances
- Administration
- Website
- Job Vacancies Online
The National Executive has met on four occasions (excluding the national DHB collective agreement negotiations) since the last Annual Conference with a fifth meeting immediately preceding this Conference. One of these was the regular two day meeting (4-5 February) to allow for an informal strategic planning session on the first day, covering the year’s expected work including our national DHB collective agreement negotiations, the membership empowerment strategy (including membership seminars and developing a delegate system), the draft new constitution, and guidelines for safe working hours and penalty-based remuneration. In addition, at this informal meeting the Executive met representatives of DHBNZ, TVNZ’s health correspondent Lorelei Mason, Ministry of Health officials on prioritisation, and Principal Medical Adviser Dr David Galler.
The National Executive comprises
The national office remains a busy place. This year its activities have centred on the national DHB collective agreement negotiations, as well as other collective bargaining (particularly with non-DHB employers), individual employment-related cases and disputes which involved both the Industrial Officer and the Industrial & Policy Adviser, and the new draft constitution. The crowning achievement, discussed more fully below, was the completion of the national DHB collective agreement negotiations and the subsequent ratification. This is an achievement that the National Executive believes should be celebrated given that the last such national agreement expired on 30 June 1992 (our right to re-negotiate was taken away by a combination of unfavourable industrial legislation and government policy at that time), given the gains and advances achieved in the new agreement, given the strong foundation it provides for our empowerment strategy, and given the boost we hope this will provide our members employed by the more dispersed non-DHB employers.
During this period the national office initially worked on the basis of five full-time staff including
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National DHB (Multi-Employer) Collective Agreement Negotiations: MECA
At the 2002 Annual Conference the following resolution was adopted:
That the Association initiate multi-district health board collective agreement negotiations in accordance with the provisions of the Employment Relations Act with the objective of achieving a national collective agreement covering all members employed by district health boards.
Subsequently the National Executive authorised the initiation of national negotiations in accordance with the provisions of the Employment Relations Act. This included the conducting of membership ballots over participation in the national negotiations held within six months of the expiry dates of each individual DHB collective agreement (ranging from
The 2003 Annual Report extensively covered developments up until November 2003 while the September 2004 issue of The Specialist outlines the provisional agreement for members when voting in the indicative ratification postal ballot. In summary the following points cover the key points concerning the negotiating process:
- The National Executive determined that it would have the ultimate responsibility for ratifying the final settlement and would base its decision on membership postal ballots. The desire would be that a majority of members in each DHB would vote in favour of any proposed settlement.
- The negotiating team initially comprised the Executive Director as advocate, National Executive members and the Industrial & Policy Adviser. During the negotiations the following members were added to our team—Drs Rod Harpin (Northland), Carolyn Fowler (Counties Manukau),
- Apart from the first three months the DHBs’ advocate was
- There were 29 formal days of negotiations which included, since October 2003, 18 in the presence of a mediator. In addition, there were several informal discussions including a meeting in Palmerston North in August involving the National President, Executive Director and key DHB representatives.
- Since the commencement of negotiations 12 issues of our national print publication, Bargaining Bulletin, were published which were also supplemented by our electronic communication, ASMS Direct.
- In August 2003 negotiations reached a crisis point when the DHBs tabled a proposal that would have included significant ‘claw-backs’ of existing conditions for many members. This lead to the informal ‘crisis’ meeting in Palmerston North discussed above and the involvement of mediation.
- In December 2003 the DHBs made a new proposal which was rejected by the ASMS negotiating team. However, we accepted their request to refer it back to members in a postal ballot which was conducted over January 2004. Although the Association recommended to members that they vote against this proposal, on the basis that it was inadequate and also potentially threatened some existing conditions, we also provided the DHBs with the opportunity to put their own position to members in the material accompanying the ballot. Based on a 51% response rate, members rejected the proposal by 84% to 16% (the extent of opposition ranged from 74% to 100%).
- Despite this rejection DHBs continued to advocate this proposal and insisted that the Association accept it. This ‘take-it-or-leave-it’ tactic led, in late March, to a threat to end the national negotiations and to return to 21 separate DHB negotiations which, no doubt, would have been centrally monitored and coordinated, and to make an aggressive media attack on the Association.
- Undeterred the National Executive, on 1 April, adopted two important resolutions in response to this crisis
1. That the Association continues to pursue the negotiation of a national DHB (multi-
employer) collective agreement.
2. That, due to the approach of the DHBs to the multi-employer collective
agreement negotiations, the National Executive notes that in some DHBs the
collective wish of members may be to initiate single DHB collective bargaining
and resolves that this will be supported. Further, the National Executive
considers that initiation of single DHB collective bargaining in this context would
be consistent with the Association’s objective of endeavouring to achieve a
national multi-DHB collective agreement. [Despite this second resolution being
reported to members, no individual or group of members sought to exercise this
facility.]
- Consequently the Association continued to make new proposals to DHBs which resulted in the DHBs remaining at the negotiating table. Eventually a provisional agreement between the two negotiating teams was reached in late June that, after some delay, reluctance and opposition, was ratified by the DHB chief executives. Although we strongly disagreed with his media statement in late March, we wish to acknowledge the constructive and energetic role of Stephen McKernan who, along with the DHBs’ advocate
- The Association has held 21 membership meetings in DHBs in which the Executive Director reported on the provisional agreement. Many of these were held before the DHBs confirmed their ratification. A 22nd meeting was attended by the Industrial Officer.
- The indicative postal ballot was conducted over a four week period during late September-early October. The vote for ratification was overwhelming. Based on a 57% response rate, 98% of members in the 20 affected DHBs voted for ratification. With one exception the ratification majorities ranged from 91% to 100% with the exception of Tairawhiti which had a 54% (two vote) margin from a small (38%) response rate.
- As a result of the ballot the National Executive ratified the provisionally agreed MECA and work is now well underway in preparing the new document for signing.
The Association’s approach to negotiations was described as ‘best of the best’. This is the same approach that we used for single employer bargaining under the former Employment Contracts Act in which we endeavoured to import into each new settlement the best provisions of existing settlements elsewhere. We would then assess the extent to which we had achieved this objective. However, it was the first time that we have used this description for our negotiations. In summary, much of the ‘best of the best’ was achieved although it required compromises on both the length of the agreement and the effective date of implementation of the fiscally-related entitlements.
The main features of the new national agreement are:
- An expiry date of
- New improved specialist and medical/dental officer salary scales for recruitment and retention purposes, including additional steps on the top of the scales and, for most members, widened margins between salary steps and the removal of existing performance criteria for advancement through the scales. The actual salary increases are a mix of (a) translations to the new scales (between $1,000 and $5,000; around $2,000-$3,000 for most), (b) widened margins between steps (between $500 and $1,500 per annum for most members), (c) the across-the-board $2,500 increase effective on
- An enhanced rate of 50% of the ordinary hourly rate (T1.5) for the average hours worked on rostered after-hours call duties and responsibilities (eg, call-back and telephone consultations). Current entitlements that exceed this level are protected.
- Strengthened wording on job sizing, hours of work and job descriptions (largely inclusive of the Association’s job description guidelines which now have a contractual rather than advisory status).
- The Association’s position on non-clinical time to support professional activities. Coupled with the strengthened wording on job sizing, hours of work and job descriptions, this represents the culmination, in an entitlement context, of the Association’s ‘time for quality’ campaign with the next phase being implementation and enforcement.
- Six weeks annual leave.
- $7,500 per annum reimbursement of
- Six weeks paid parental leave (two weeks for the partner not assuming the main responsibility for the child).
- Subsidised superannuation, specifically 6% of total gross salary, for those members not eligible for the former government schemes (members of the latter schemes may elect to change to the newer schemes).
- A new process for addressing and providing additional recruitment and retention benefits.
- Workforce development and education inclusive of identification and planning for staffing needs, recruitment and retention strategies, and support and pro-active planning for professional development and education such as sabbatical and secondment.
Other features include
- The status of the collective agreement as providing minimum terms and conditions of employment.
- Ensuring that all Association members will be covered by the new MECA.
- Protection for new appointees.
- Removal of the authority of management to determine who is a specialist for the purpose of the collective agreement entitlements (based instead on the designation of the Medical or Dental Council, as applicable).
- Bedding in, utilisation and extension of the legal concepts of mutual trust and confidence.
- Standard reimbursement of expenses.
- Open-ended sick leave.
- Attendance at professional meetings.
- Paid employee representatives’ education leave.
- Deduction of union fees.
- Stopwork meetings.
- Quality improvement environment.
- Research and publications.
- Public debate and dialogue.
- Professional and patient responsibility and accountability, including primacy of responsibility to patients where there is a conflict with one’s responsibility to the employer.
- A dispute resolution process for addressing patient safety concerns.
- Standard severance formula for redundancy.
- Termination of employment.
- Rights of private practice and conflict of interest.
- Strengthened consultation requirements including over establishment and evaluation of reviews.
- Full reimbursement of the cost of clinically relevant professional associations, in addition to the colleges (largely an extended entitlement).
- Sabbatical and secondment (enhanced in many cases).
- Subservience of DHB policies to collective agreement provisions (largely new matter).
- Appointment processes to vacant positions (largely new matter).
- Development of agreed guidelines over working hours, including reference to the European Working Time Directive (new matter).
- Development of agreed arrangements for senior medical staff working on shifts (new matter).
- Monitoring and resolving facilities, equipment and other resource needs (new matter).
- Enhanced involvement in DHB decision-making (new matter).
- Joint individual DHB-Association consultation committees (new matter).
- Fixed term appointments (new matter).
- Restrictions on clinical practice, as an alternative to suspension, when serious questions are raised about professional performance (new matter).
- Removal of several local DHB inequities and anomalies such as the basis for the calculation of reimbursement of entitlements and salary while on paid leave.
This outcome is a long way from original DHB claims to ‘claw-backs’ of existing conditions such as enhanced remuneration for average hours worked on after-hours call rosters, annual leave and wider margins between salary steps. It is also a long way from the DHBs’ positions of individually negotiating the effective implementation date of all fiscal elements with each DHB and increased managerial control, particularly over progression through salary scales and determination of specialist status.
As discussed above, for strategic reasons Association members employed by the Northland DHB voted not to participate in the national negotiations. Consequently this led to separate single DHB collective bargaining and to a new collective agreement which expires on
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Post-DHB MECA Implementation
The national DHB MECA establishes several national and local processes focusing on implementation, enforcement and extension. On a national level these are:
- Standardising the availability allowance for being on after-hours call rosters.
- Standardised national system for pro rata calculation of remuneration for part-timers.
- Arrangements (including remuneration) for unplanned absences of resident medical officers.
- Arrangements (including remuneration) for working on evening, night and weekend shifts.
- National guidelines for enhancing senior medical staff involvement in DHB decision-making.
- National guidelines for limiting hours of work including taking into account the European Working Time Directive.
- National strategy for services and workplaces where registrars are not employed.
- Ownership of intellectual property rights.
- Developing a standardised national system for the debiting and accrual of annual leave.
- Protection from vulnerability to infectious diseases.
At a DHB level the main vehicles are the DHB-ASMS consultation committees which should meet at least quarterly and, while ongoing rather than having an end point (ie, achievement of a collective agreement), are expected to resemble to a significant extent the negotiations that were previously conducted at each DHB (and predecessor) over collective agreements. However, in this new environment the focus will be on implementation and application of the various provisions of the MECA and on issues over and above these provisions (ie, above the core), which should also be seen in the context of the Association’s membership empowerment strategy discussed below. This focus is expected to include:
- Hours of work and job sizing.
- Implementing the job description guideline.
- 30% non-clinical time (linked to ‘time for quality’ as discussed above).
- Monitoring and provision of adequate facilities, equipment and resources.
- Workforce development and planning, including plans for staffing levels and professional development and education (eg, sabbatical and secondment).
- Locum arrangements.
- Additional benefits for recruitment and retention, both in services and departments and DHB-wide.
- Enhancing senior medical staff involvement in decision-making.
- Compliance with the appointment process requirement.
- Appropriate compensation for RMO shortages and unplanned absences.
- Appropriate arrangements, including remuneration, for shift work.
- Car parking arrangements.
It is clear from the above outline that the Association’s activities over the next 12 months are going to be intensive at both a national and local DHB level including the Executive Director, Industrial Officer and Industrial & Policy Adviser but also, more critically, closely linked to and dependent on membership empowerment, inclusive of an effective delegate system.
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Membership Empowerment Strategy
Membership empowerment was an important feature of the discussion at the Association’s 2002 Annual Conference where the following resolution was adopted:
That the Annual Conference authorises the National Executive to develop a strategy
of empowerment of members at their workplace based on the discussion at
Conference.
As reported in the 2003 Annual Report the National Executive subsequently determined that collective bargaining, inclusive of the achievement of the national DHB MECA, should provide an effective foundation and launching pad for empowerment. This led to the Executive authorising the development of a delegate system which would build upon some of the informal arrangements that we already use, and be complementary to the role of branches. It would involve an unlimited list of approved delegates originating from our own training programmes. The role of delegates might be variable and wide-ranging with some more focussed on being the ‘eyes and ears’ of the union at each workplace and others as advanced as health and safety representatives.
At its February meeting the National Executive confirmed, in order to facilitate the process of delegate selection and development, seven regional membership workshops. These workshops were conducted during August by the Industrial Officer and Industrial & Policy Adviser. Of the seven, three had disappointing attendances (one due to extreme weather conditions) while the other four were well-attended. In all cases, however, the quality of discussion was high. The National Executive will soon consider where to proceed next on the development of a delegate system to strengthen the empowerment strategy. Implementation of the national DHB MECA is expected to provide a strong supporting foundation. The National Executive anticipates that the gradual evolution of the delegate system will lead to a significant enhancement of the Association’s effectiveness.
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Membership Empowerment Seminars
In the Annual Report to the 2003 Conference, the
At its 28 August meeting the
regional membership seminars, perhaps half-day, should be organised in 2004,
commencing early in the year, and which may subsequently evolve into an annual
event. Issues discussed at these seminars might comprise a mix of national and
local topics. The
Conference over these proposed seminars including how they might be based (eg,
in each DHB, groupings of neighbouring DHBs, or in each Association branch).
A discussion paper was also produced for Conference delegates. To date the Association has held seven DHB-based membership empowerment seminars—MidCentral, Taranaki, Waitemata, Whanganui, Southland,
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Collective Bargaining outside DHBs
The non-DHB sector covers general practitioners working for union and community health centres and Iwi authorities; general registrants, GPs and specialists working for small community run hospitals; hospices; the Family Planning Association; the Blood Service and sexual health doctors working for the Wellington Independent Practice Association. Most funding for these employers comes directly or indirectly from the state.
Salaried General Practitioners
Hokianga Health
A variation was negotiated to this collective which incorporated ACC payments, made directly to doctors in the past, into the annual salary. This brings the top hourly rate to $53.85 increasing to $55.53 in November. There is an entitlement to six weeks annual leave. The Association has four members employed by the Trust.
Otara and Waitakere doctors are both sitting on expired collective agreements. The single member at the Mt Roskill centre is not covered by a collective. The Association has two members at
Ngati Whaatua Ki Orakei
A collective agreement has been negotiated which covers all doctors employed by Ngati Whaatua (an Iwi authority). As is the pattern with the establishment of an initial collective these negotiations were protracted. The agreement that resulted will apply to any doctors employed by Ngati Whaatua who become members at any of their three clinics. The top hourly rate is $49 an hour. There is six weeks annual leave after two years service. The new employer has established a good relationship with the doctors (who were formerly employed by the Otahuhu Union Health centre) after a bitterly fought personal case in the last days of the previous employer.
Te Oranganui Trust (Wanganui)
The employer is an Iwi authority. This collective agreement has been renegotiated for a two year term and is being prepared for signing. The scale is based on the erstwhile Wanganui MOSS scale. The top rate for a GP in the collective is $55.57 per hour going up to $60 per hour in December. The top rate for the clinical leader is $59.62 per hour, going up to $62 per hour in December. There is an annual leave entitlement of five weeks after three years. The members have an issue with a doctor who has refused to join the Association in the expectation that the collective will be passed on to him.
This multi-union, multi-employer collective agreement covers the single largest number of salaried GPs with 17 being Association members. The collective agreement has recently been renegotiated and is being readied for signing. The top hourly rate is $49.04 an hour. There is an entitlement to five weeks annual leave at the completion of the fourth or fifth year of service.
The Association is party to a multi union collective agreement (referred to as a MUCA). We have one member at the Centre who is the only doctor employed there. The employer has been increasingly problematic both because of a poor funding base and a poor infrastructure for the employment of medical staff.
This collective has recently been renegotiated. It covers three doctors. The top rate in the new collective (which has not as yet been signed) is $52.90 per hour. The doctors also have an entitlement to five weeks leave each year.
Community Hospitals
Even before ratification the provisional national DHB MECA settlement has had an effect on the community hospital employers in the sector. Two employers have already settled on the basis of the MECA salaries and a further employer believes that they have an undertaking from their DHB to meet the costs of passing on the MECA to their employees. Passing on other MECA conditions poses more of a challenge. However it is clear that the MECA will increasingly serve as the template for conditions for these employers and negotiations are likely to be conducted with considerably more dispatch.
This collective was renegotiated via phone and email incorporating the MECA salary rates. There are three members who are all specialist rheumatologists. The salaries incorporate 6% for superannuation. The top annual salary in the collective is $170,660 and there is an entitlement to 6 weeks annual leave.
Central Otago Health Services (
This collective is presently under negotiation. The members are insisting on the full and immediate implementation of the MECA scale. They point to the poor state of other rural hospitals in the region compared to the good retention and recruitment record of their own and are urging their employer to ensure it is maintained. There are six members employed at the hospital.
Bargaining has been initiated and a claim based on the MECA is in preparation. The Association has three members at
Rural hospitals
There has been discussion among rural hospital doctors on a pathway to registering a vocational scope of practice probably under the auspices of the Royal College of GPs. This would clearly be one way of addressing some of the issues for rural hospitals and rural medicine in general. We have a mix of members who fall into the broad category. Some are employed full-time at rural hospitals by DHBs, some are GPs employed part-time by DHBs and others are employed by community trusts. As well there are a number of doctors who are either employed on a fee for service basis in rural hospitals or have other financial arrangements in the area who are not (even potentially) Association members. So far our strategy in the area has been to support moves to establish a vocational scope of practice and to progressively establish the local DHB conditions in these hospitals. The MECA has already proved an effective standard and has enabled these employers to argue that the DHB as funder has implicitly agreed to the MECA as the rate for the job.
Hospices
A Hospice and Palliative Care working party has been set up to examine funding. Pay scales at most hospices bear a direct relationship to DHB scales though other conditions are much inferior. The Association has members in a number of hospices and it has always been a long-term aim to bring them under one multi-employer collective. Hospice employers have not expressed a difficulty with the principle of equality with wages and conditions at DHBs. The only barrier has been funding. The Arohanui Hospice (three members) is still the only collective agreement in place. A further claim is in draft for the Cranford Hospice,
New Zealand Blood Service
The Association has three members employed directly by the New Zealand Blood Service. These members have voted unanimously to become party to the MECA. DHB employers have agreed in principle to the Blood Service joining but the Blood Service has made clear in negotiation that it does not wish to be a party to the MECA where it has not participated in the negotiation and where it believes many of the clauses are not suited to a very small employer. Our bargaining position has been considerably weakened by the discovery that only three of nine doctors are members. Negotiations are continuing.
Family Planning Association
This longstanding collective agreement has pay rates for doctors that are an embarrassment to the employer, the Association and the profession. The employer makes a convincing case as to their inability to pay more which we have accepted in good faith. The collective was again settled with an inadequate scale though it was improved to some extent by a reduction from 10 steps to 8. Rates are still extremely low ranging from $34.25 per hour to $45.30. Most conditions are substantially inferior with only four weeks leave after five years. This year in addition we have set up a working party to:
- Canvass the possibility of a separate scale for staff vocationally registered in Family Planning and Reproductive Health, Sexual Health or Obstetrics & Gynaecology.
- Discuss the optimum number of “steps” for the scale.
- Discuss the method of progression through the scale, including the progression of part-timers in comparison to full time employees.
- Assess levels of remuneration in comparison with community sector organisations.
We have also suggested a joint approach by the employer and the Association to the Minister of Health and the Minister of Women’s Affairs to address the issue of continued under funding. There are 28 Association members working for FPA.
W
Bargaining has been initiated in this longstanding collective on the basis of coverage of all registered medical practitioners working for W
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Industrial Officer’s Activities
The Industrial Officer, supported by the Industrial & Policy Adviser, continues to carry a large caseload advising members on a wide range of matters related to their employment. Typically they include:
- individual routine enquiries from current and potential members;
- complex individual cases associated with issues such as concerns about aspects of the member’s clinical competence; concerns about their health and the members ability to continue to work; allegations of various forms of misconduct; job sizing and other money claims; poor relationships with colleagues or managers;
- requests from groups of members and specific services for assistance with respect to workloads, staffing levels and job sizing.
Some notable features of his activities in the course of the past year have been:
Mediation and Referrals to the Employment Relations Authority
The number of cases referred to mediation for assistance has more than doubled over the previous year, from three to eight matters. Five of these matters were satisfactorily resolved at or soon after mediation; three matters have since been referred to the Employment Relations Authority for what is referred to as an “investigation meeting” and a formal determination; ie, ruling.
In summary, these cases related to:
- Doctor A abandoned his employment and subsequently a substantial claim for reimbursement of a mix of professional and
- Doctor B had been on sick leave for nearly six months. The collective agreement allowed for reasonable leave “without loss of salary” on account of illness. In this particular case, the on-call payments formed a large part of his income (nearly 30%) but the employer paid only base rate and availability allowance during his sick leave. This matter has since been referred to and investigated by the Employment Relations Authority, whose formal determination is currently awaited.
- Doctor C’s agreed job size (ie, routine plus on-call hours) is more than 40 hours a week and he is therefore defined as “full-time” for the purposes of the collective agreement. However he has a private practice and his employer claims that because his “routine” weekly hours are only 8 tenths (ie, less than 40 hours a week) he is not entitled to claim 100% of his professional reimbursements or
- Doctor D had been employed under a strange individual employment agreement some years ago because the employer (erroneously) claimed he was not covered by the collective agreement. The employer eventually accepted he was covered by the agreement but a dispute arose about backdating and a claim for retrospective after-hours; ie, weekend payments. Resolved satisfactorily.
- Doctor E was dismissed for serious misconduct (no criticism of his clinical practice) and we initiated a personal grievance, requiring urgent mediation. The matter was resolved but the doctor was not reinstated.
- Doctor F was effectively suspended following management concerns about aspects of his clinical practice. In the course of urgent mediation and in the face of a vigorous challenge by the Association, in conjunction with
- The parental leave claim against Counties-Manukau DHB was resolved a few days before the Employment Relations Authority was due to hold its investigation meeting and determine the matter. The Association position, supported by our own legal advice, was that the employer had no realistic prospect of winning this case. For several years the DHB had allowed up to six weeks’ paid parental leave for the father of the new born baby but in a perverse decision changed its mind and declined to grant that payment to a steadily growing number of our male members. Counties-Manukau subsequently withdrew their opposition to our claim and agreed to pay all of our members who, as fathers, had been otherwise entitled to the payment but had been denied it. For the future, recognising that there was no entitlement in several DHBs, a national level the DHBs and Association reached agreement in the national DHB MECA for six weeks’ paid parental leave for the “primary caregiver” of the new born or adopted child while the other parent is entitled to two weeks’ paid leave.
- A formal legal claim has been brought against a DHB on behalf of a group of members whose job size and therefore remuneration is woefully inadequate. We have been unable to resolve this matter in negotiation or mediation; it has now been referred to the Employment Relations Authority for investigation and determination. We expect a two-day hearing in mid-November.
- A dispute arose over the meaning of “gross taxable salary” for the purposes of calculating and paying superannuation contributions. The DHB in question had quite deliberately not included any additional payments or the availability allowance in “gross taxable salary”. This matter has been partially resolved, following mediation but the parties have yet to decide on the next course of action.
Dismissals and Suspensions
In the course of the year, the Association advised and supported two members who had been suspended and three members who had been dismissed. In summary:
- Doctor E was dismissed - he is the same Doctor E referred to in the previous section;
- Doctor F was suspended - he is the same Doctor F referred to in the previous section.
- Doctor G was dismissed following a long illness from which he had not completely recovered and was unable to do call - the dismissal was not challenged;
- Doctor H was suspended and remains suspended (after six months) following concerns from other staff members (non-doctors) about his behaviour and practice - this matter remains unresolved pending a Medical Council competence review;
- Doctor I was dismissed, after being suspended on full pay for twelve months, because the DHB concluded that his clinical handling of a particular case “constituted serious misconduct”. The Association is in the process of bringing a personal grievance against the employer.
Job Size, Workload & Resource Issues
These matters continue to be a big part of the Industrial Officer’s work and in the past year he has worked with groups of members in a number of DHBs to address job size, workload and resource issues. These have included:
Complaints about Behaviour
This year has seen a small but noticeable increase in the number of members seeking advice following complaints from other staff members about their behaviour (ie, outbursts of anger; abuse; allegations of bullying; assault and inappropriate use of the internet).
Miscellaneous Cases
The Industrial Officer has advised and otherwise supported three members who experienced serious illness, including two cases where overwork, long hours and lack of support from management contributed to stress-related and psychological difficulties for the members concerned. In two of these cases, the members concerned resigned and left
The Industrial Officer attended the Australasian conference (in
The Industrial Officer continues to spend a lot of time travelling throughout
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Industrial & Policy Adviser's Activities
Policy
Policy work included preparation of the Associations input into the two rounds of consultation on changes to ACC’s medical misadventure provisions. This included meetings with several groups during the round of stakeholder consultations, preparation of the Association’s written response, preparation of the submission to the Health Select Committee and a further round of consultation on implementation which is continuing. Detail is elsewhere in the Annual Report.
Submissions to the Transport and Industrial Relations Committee on the Employment Relations Law Reform Bill and to the Finance and Expenditure Committee on the Public Finance (State Sector Management) Bill were prepared. Detail is elsewhere in the Annual Report.
There was also substantial policy support work for the MECA. The vacancy surveys are dealt with elsewhere in the Annual Report. The MidCentral survey sparked an additional investigation when the cost of locum cover for a single vacancy was discovered to be at least twice the cost of a permanent appointment. In order to obtain information on the level of DHB expenditure on medical staff in general and on locums in particular, Official Information Act requests were sent out. Most of the information was sent back in a form in which it was difficult to distinguish between expenditure on all temporary doctors and the negotiations got back on track without the need for this information. However, it is clear that the cost of locums to the DHBs compared to the cost of permanent senior medical staff remains an interesting area for investigation.
Health workforce issues remain on the agenda. There has been some liaison through the CTU with a consultant doing research for the Ministry of Health on the impact of an aging population and an aging work force. This work has also involved attendance at a workshop where the results of a Ministry of Health/Tertiary Education Commission stock-take of health related qualifications was revealed.
Some work has continued on issues to do with the implementation of the Health Practitioners Competence Assurance Act in particular the implementation of scopes of practice and the specification of restricted activities.
The Industrial and Policy Advisor has also attended
Industrial
Collective negotiations in the non-DHB sector and delivery of the membership workshops are dealt with elsewhere in the report. Dismissals and suspensions are generally referred to the Industrial Officer.
As with the Industrial Officer the common issues involve advice to members as they take up their first post as a specialist, their first employment in
The next most common issues are to do with issues of overwork and/or underpayment. These can either be long-term issues with job sizing or issues to do with the absence of colleagues or failures to recruit. These have ranged from groups or individuals who have had historic claims to do with totally absent or clearly inadequate provision for call in their job-size to groups of members working transparently unsafe hours of up to 144 hours a fortnight.
Issues to do with the interpretation of the provisions of the collective agreements have ranged from the parental leave clauses (where satisfactory resolution was reached on two Otago cases) through issues to do with the placement of vocationally registered GPs on the specialist scale. Some of these reflect the working through the system of “flexible” contractual arrangements reached during the 1990s where members were essentially tricked out of standard entitlements to salary increments or payment for call.
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Surveying Full-Time DHB Senior Medical Staff Income
The Association has completed its annual (10th) survey of full-time equivalent salaries (
On
For MOSSs the equivalent salary movement on
These are mean full-time equivalent base salaries and do not take into account hours worked in excess of 40 hours per week (ie, recognised through job sizing), the availability allowance or any other special enhancements.
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Surveying DHB Senior Medical Staff Superannuation Entitlements
We undertook our fourth survey of superannuation entitlements in DHBs, effective on
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Review of Rules: Draft New Constitution
As reported to the 2003 Annual Conference, including a conference discussion paper, the National Executive has initiated a review of the Association’s Rules with the intention of adopting a new constitution. Throughout the year this work was undertaken by the Industrial Officer supported by an Executive sub-group comprising Anthony Duncan,
The draft new constitution will be a key issue for consideration by Annual Conference and the National Executive recommends that consideration be given to its overall intent, direction and context. It has been forwarded to branches for consideration and members have been advised of its accessibility on our website.
It attempts to be simple and workable enabling the Association to undertake its daily work efficiently and effectively, while ensuring members (through the various governance structures) have opportunities and are encouraged to actively participate in setting policy and the industrial activities of the Association. The draft constitution also seeks to provide effective and fair processes for members to elect (or appoint), remove and supervise other Association members to leadership, representative or delegate roles.
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Health Practitioners Competence Assurance Act: Operation and Application
One of the main activities of the Association in 2003 was attempting, with limited success, to improve the highly unsatisfactory Health Practitioners Competence Assurance Bill. The new Act, overarching legislation covering the registration and competence of all health professionals including doctors, dentists, nurses and physiotherapists, has now replaced both the Medical Practitioners Act and the Dental Act.
Fortunately the sensible and pragmatic approach of the Medical Council towards scopes of practice, particularly the importance of them being broad rather than narrow or individualised, has alleviated our concerns for the moment although it is too early to assess whether our fears will be realised through possible legal challenges testing the new Act from individuals seeking narrow scopes of practice or a future fully politically appointed Medical or Dental Council. On the latter point, it is worth noting that the representative pan-professional Dental Association conducted its own elections and the successful candidates were then appointed to the Dental Council by the Minister of Health.
However, other developments unfortunately confirm the Association’s criticism of the new legislation. The major concern has been the development of nursing scopes of practice by the Nursing Council which, in summary, fail to differentiate between the roles of medical and nurse practitioners. Instead they suggest autonomous nurse practice contrary to the relationship with doctors’ roles and the prevalent practice of teamwork between nurses and other health professionals. The Association has liaised with the Medical Council which is also concerned. The Act provides for registration authorities (in this case the Medical and Nursing Councils) to mediate and resolve differences over conflicting scopes. In the absence of agreement the Minister of Health has the authority under the Act to make a determination. The Association has strongly recommended to the Minister that she insist that the two Councils achieve a satisfactory resolution and also noted that the scopes as proposed risked becoming an industrial issue if DHBs attempted to implement them. The Minister has advised that she agrees with this insistence and has expressed that advice to both Councils.
In the meantime the Association is working with the Society and
In addition to concerns over patient safety, the proposed nursing scopes of practice are likely to be unworkable due to limited, at best, labour market demand for such positions and protections against implementing such a move through the strengthened provisions in the national DHB MECA (eg, clauses covering consultation, patient safety and primacy of responsibility to patients).
Another relatively less important issue is the Ministry of Health’s approach to the requirement under the Act for the Governor-General, on the recommendation of the Minister of Health, to declare as ‘restricted activities’ those activities that put members of the public at risk of serious or permanent harm. The list prepared by the Ministry included invasive surgical procedures, ophthalmic devices and mental illness but excluded medical and anaesthetic procedures. While this risks sending confusing messages to the public the Medical Council reportedly believes that there may already be sufficient safeguards such as under the Medicines Act.
One of the major deficiencies of the Act is the failure to provide for elected representation on the Medical and Dental Councils, important for further enhancing patient safety and professional responsibility. It is pleasing nevertheless that the Minister accepted the outcome of the ballot conducted by the Dental Association for the Dental Council. The Association will be supporting the Medical Council’s intention to conduct a similar exercise for the Medical Council.
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Tertiary Intern Grant
At the June Medical Leaders Forum the Medical Students Association requested support for its advocacy of a significant increase ($10,000) to the Tertiary Intern Grant as a means of partially offsetting the impact of student debt arising out of the loan scheme. The National Executive considered this proposal and was pleased to advise the Medical Students Association of our support for it.
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Health Sector Code of Faith
The Association (through the Industrial Officer) continued to participate throughout the year in a bi-partite working party (made up of representatives of the
The Code has several purposes, which include: to promote productive employment relationships in the public health sector; to require the parties (ie, employers and employees) to engage constructively in all aspects of their employment relationships; and to recognise the importance of collective arrangements.
These are not mere empty phrases. Rather they will assist the Association and its members regain a proper degree of control and power in the workplace and their clinical practice.
The Code also prescribes procedures, including access to arbitration as a last resort, for determining and securing the level of staffing necessary during strikes (or other industrial action) to “provide for patient safety by ensuring that life preserving services are available to prevent a serious threat to life or permanent disability”.
The Code also considerably strengthens the rights of unions representing the lowest paid employees in the health sector, e.g. cleaners and orderlies etc. The Association was very pleased to work with the CTU and those unions to secure these important provisions.
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Electronic Referral Letter and Hospital Discharge Summary Standard
The Association, along with several other organisations, was approached by the Health Information Standards Organisation (established by the Ministry of Health in June 2003) which was seeking an indication of sector support or views over the development and production of health information standards in the areas of electronic referral letters and hospital discharge summary notifications. The Association responded that what was required was the ability share information electronically not further complex standard forms.
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Relationship with Minister of Health
The Association has continued to meet the Minister of Health, Hon. Annette King, on a two-monthly basis with both the National President and Executive Director attending. The main subjects for discussion were nursing scopes of practice and restricted activities under the Health Practitioners Competence Assurance Act; artificial and obstructive walls between funder and provider divisions of DHBs; the proposed ‘Medical Roundtable’; privatisation moves in pathology and radiology; our DHB MECA negotiations; the Association’s membership empowerment seminars; the DHBs’ approaches to compliance with regulatory and other requirements; national and supra-DHB service planning; primary care funding; health professional involvement through taskforce-type processes in reviewing service and resource needs (including the independent evaluation of the New South Wales Greater Metropolitan Transitional Taskforce); Employment Relations Law Reform Bill; and relationship problems in particular DHBs. In addition, the Executive Director has also maintained informal contact with the Minister’s office and has had a series of informal discussions.
It was pleasing that the Minister also willingly agreed to participate in our MidCentral and Northland membership seminars on the theme of the government’s health priorities and the role of senior doctors. This participation included both speaking and actively engaging with attendees including in sessions involving other speakers.
The Minister’s annual letter of expectations to DHBs for the 2004-05 year continued to be an improvement on the narrowly fiscally based letters of the 1990s. Particularly pleasing were the emphasis in the letter to shared decision-making with clinicians and ongoing quality improvement activities in DHBs.
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Relationships with other Political Parties
Largely through the Executive Director, the Association has maintained and further developed contact and liaison with the other political parties, in particular, National, ACT, United Future and NZ First (including meeting its new health spokesperson) along with Labour’s junior coalition party, Progressives. National’s then health spokesperson Dr
The Association’s relationship with Judith Collins got off to a difficult start over a sharp debate and differences over the new Holidays Act, with particular reference to the rate of remuneration for working on public holidays. Her reference to senior doctors being on the ‘pig’s back’ led to the Association writing to National Party leader Dr Don Brash seeking clarification whether Ms Collins’ statement reflected National’s position in reference to senior doctors. Dr Brash has advised the Association that it does not. The Executive Director has subsequently met Ms Collins and we hope that our future relationship will be on a more constructive basis accepting that there will be differences between us on issues from time to time.
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Meetings with Director-General of Health
The Executive Director continued his regular informal meetings, usually monthly, with the Director-General of Health, Dr
Topics for discussion included:
- The national DHB MECA negotiations.
- The application of the Health Practitioners Competence Assurance Act including nursing scopes of practice and the list of restricted activities.
- The proposed ‘medical roundtable’ looking at doctors-in-training issues.
- The new medical misadventure policy and the consequential parliamentary bill.
- The Treasury report on productivity in DHBs.
- The Employment Relations Law Reform Bill with particular reference to the inclusion of the health sector code of good faith and the controversial section 100D.
- The Association’s concerns over and complaint about the TVNZ Holmes programme.
- The Association’s membership empowerment seminars.
- The
- Privatisation proposals in pathology and radiology.
- The independent evaluation of the New South Wales Metropolitan Transition Taskforce, including the possible application of its taskforce approach to
- New South Wales' newly established Clinical Excellence Commission.
- The ophthalmology High Court decision.
- Specific internal DHB problems.
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New Holidays Act
The new Holidays Act 2004 came into force on
The main impact for our members is the ‘time and a half’ provision for working on public holidays. Strictly speaking of course the Act does not prescribe “time and a half”; it actually confers an entitlement to a 50% loading on ‘at least the portion of the employee’s relevant daily pay that relates to the time actually worked on the day’.
Unfortunately this provision leaves some room for debate however in anticipation of possible disputes over the application of this provision, the Association and DHBNZ have agreed on a process or method for calculating a “relevant hourly rate” on which to add the 50% loading. This agreement will be backdated and apply to all public holidays since the new Act came into force on
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Prioritisation
At its informal meeting in February the National Executive met representatives of the Ministry of Health to discuss its prioritisation project which focuses on priority setting within allocated funding and attempts to bridge the gap between high level goals and the reality of allocation at a DHB level. Although respecting the sincerity and earnestness of the Ministry officials, the National Executive was sceptical of the relevance of the exercise, particularly in the absence of effective engagement with health professionals. Nevertheless, following an informal meeting between the Executive Director, Principal Medical Officer (David Galler) and the Ministry official responsible for the project (Helen Wyn), we recommended Drs
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Duty of Care Paper
In the 2003 Annual Report the National Executive reported its concerns over early drafts of a paper prepared by Dr David Geddis (now Ministry of Health Chief Medical Adviser) on Aspects of Doctors’ Duty of Care. Some of these concerns have been resolved and some remain. Of greater concern, however, has been the confusion in some quarters, particularly in DHBs, over the status of the paper. After raising this with the Director-General of Health we received an assurance from her that the paper was for discussion purposes only and did not represent Ministry policy. Subsequently the Association wrote to all DHBs advising that the paper was part of the literature on the subject but was not an official Ministry policy.
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Employment Relations Law Reform Bill
The Employment Relations Law Reform Bill was introduced to Parliament in December 2003 and referred to the Transport and Industrial Relations Select Committee. It was the outcome of the review of the Employment Relations Act 2000, which was promised when the original legislation was passed. The
- promotion of collective bargaining;
- concrete and meaningful good faith provisions;
- an end to freeloading by non-union members; and
- protection of vulnerable employees in transfer situations.
The Bill showed a real attempt to address these concerns with its changes offering useful opportunities to the Association. Particularly interesting were:
- The extension of good faith so that it is clear that it means more than obligations of trust and confidence.
- The proposal that the duty of good faith requires the parties bargaining over a collective agreement to conclude a collective agreement unless there is genuine reason not to.
- The obligation on all parties to a MECA to attend at least one meeting in order to determine a bargaining process.
- A process where any party having serious difficulties in concluding a collective agreement can involve the Employment Relations Authority in a facilitating role. Among the grounds for the authority accepting such a request is that bargaining has been interrupted by an ‘acrimonious’ strike or lockout, or a strike or lockout has been proposed which ‘would be likely to affect the public interest substantially’.
- The introduction of the ability for the Employment Relations Authority to determine a collective agreement in the event of a breach of good faith ‘sufficiently serious and sustained as to significantly undermine collective bargaining’, that all other alternatives for reaching agreement have been exhausted and that making a determination is the only effective remedy.
- The specification of a test that requires objective consideration of whether an employer’s actions in dismissing an employee were fair and reasonable at the time the dismissal occurred. (This is to resolve the situation where the Court of Appeal held that the employer’s actions had to be fair and reasonable in the employers own view.)
- A further remedy in settling personal grievances where an employer has been found to be at fault, where the Authority or the Court can make a recommendation on the actions the employer should take to prevent similar instances occurring.
- Provision for ‘active’ mediation, mediation for people who are not in an employment relationship (ie, contractors) and provision for mediators to address parties to mediation directly (not through their representatives).
However, additional issues were raised which would have had an uncertain impact at best and at worst could have been detrimental. These included:
- Introduction of the general concept ‘codes of employment practice’ for the purposes of providing guidance on the application of the Act. These would be approved by the Minister of Labour following consultation with employer and employee interests but based on a low threshold. This new concept risks creating confusion about its relationship with codes of good faith, the latter being based on more stringent requirements for consultation while the former also increased the powers of the Minister of Health (refer (2) below).
- A requirement for the Minister of Health (by notice in the Gazette) to approve a ‘code of employment practice’ providing for the health and safety of patients employees and the public during strikes and lockouts. A breach of the code will be a breach of the good faith provisions in the Act and would incur penalties. In the Association’s assessment this gave the Minister excessive powers and was contrary to the code of good faith which was being developed by DHBNZ and
- The repeal of the Equal Pay Act 1972 and replacement with provisions in the Employment Relations Act. Some commentators had suggested that the provisions would be inferior and remove the ability to take any equal pay for work of equal value cases. Whatever the repeal’s impact it seemed premature with the Pay and Equity Employment Taskforce about to present its plan of action.
The Select Committee in its report back to Parliament has addressed these three concerns by removing references to ‘codes of employment practice’, the attachment of the code of good faith, now agreed between DHBNZ and CTU, as a schedule to the amended Act, and removal of the equal pay clause (and retention of the Equal Pay Act).
Much of the remainder of the Select Committee’s report remained intact. The requirement for all parties to a MECA negotiation to meet at least once was removed (as much on the advice of the
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Public Finance (State Sector Management) Bill
The National Executive considered the Public Finance (State Sector Management) Bill, a massive 348 page document which was introduced into Parliament in December 2003 and then referred to the Finance and Expenditure Select Committee. The impact of the Bill was difficult to assess. Schedule 8 contained 15 pages of amendments to the New Zealand Public Health and Disability Act 2000. It is envisaged that the Bill will eventually be divided into four major pieces of legislation: a new Crown Entities Bill, amendments to the Public Finance Act including integrating the Fiscal Responsibility Act 1994 into the Public Finance Act, amendments to the State Sector Act and to the State–Owned Enterprises Act. This is in addition to the many amendments to other legislation.
At least some of these provisions have implications for Association members. Under the Crown Entities Bill, DHBs will become crown agents (in contrast to the other categories, which are autonomous crown entities and independent crown entities). This will mean that the State Services Commissioner will have the power to set minimum standards of integrity and conduct in the same way he or she can presently for public servants. There was a lack of clarity over how this will mesh with professional codes of conduct, the provisions of the Health Practitioners Competence Assurance Act, and present rights set out in our collective agreements and subsequent national DHB MECA (for instance, the right to participate in public debate and dialogue).
There does not seem to have been a serious examination of the extent to which the public finance structures in the state sector set up state organisations to fail and serve as an encouragement to privatisation. There is even the possibility that the legislation extends the approach. Clause 205 and Clause 206 in Part 5 of the Bill extend the definition of surplus to include accumulated surplus and could allow asset stripping. It would not be necessary for any future government to have a public debate about the privatisation of a state entity; they could just make it impossible for the entity to function.
The
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Medical Misadventure
At the Association’s 2002 Annual Conference the Minister of Accident Compensation, Ruth Dyson, made a commitment to review medical misadventure. The Association and other organisations were extensively consulted and engaged with in the subsequent review, conducted by ACC and the Ministry of Health, which led to a new policy statement which involved changes of definitions for medical error and medical mishap, cover for preventable unintended medical injuries, and, most significantly, extension to unintended injury in the treatment process. The outcome of the review was almost identical to the position taken by the Association.
However, this still required legislation which is now occurring with the Injury, Prevention, Rehabilitation and Compensation Amendment Bill (No.3) which is currently before Parliament. The Bill is consistent with the preceding review. The Association has made a submission in support of the Bill but also recommending the establishing of an expert advisory panel to advise on how to best avoid unnecessary compliance requirements.
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Productivity in Public Hospitals
In December 2003 a Treasury report on DHB performance included the observation that public hospital total surgical and elective case weighted discharges had fallen despite increased health expenditure. As a result Minister of Finance, Michael Cullen, wrote to Health Minister, Annette King, advising that Treasury officials were undertaking an analysis of the ‘appearance of static productivity in the hospital sector’.
In light of Dr Cullen’s comment to the 2003 Annual Conference about the importance of clinical leadership in providing high quality cost-effective care, the Association wrote to him requesting the opportunity for the Association to participate in this exercise. Dr Cullen has replied positively to our request and this led to a constructive meeting of Association representatives (
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Complaint against Holmes programme
On 14 April TVNZ’s flagship Holmes programme featured an item that began as a report on an incident involving an Association member and general surgeon employed by the Southland DHB. That incident provided the background and apparent justification for the substance of the item, based on an interview with a health economist, which linked patient safety to the accountability, competence and standards of specialists in provincial hospitals and the integrity and professionalism of specialists in general. However, although the Association represented the member over the original incident and our role was well-known to TVNZ, we were not invited to participate in the programme. In summary, the programme was incompetent because it failed to undertake basic preparation and research leading Holmes to present an item that lacked balance, fairness and accuracy. This incompetence and failure to adhere to fundamental standards of balance, fairness and accuracy damaged the reputation of the member affected and the reputation of all specialists, particularly general surgeons who work in both provincial and metropolitan public hospitals.
Consequently the Association made a formal complaint to TVNZ on several grounds related to the points discussed above. TVNZ rejected all our specific complaints bar one—it upheld our complaint that Holmes had failed to disclose that the journalist responsible for the preparation of the item had been found against when working for another branch of the media in an earlier successful complaint to the Broadcasting Standards Authority by the member who was the original focus of the item. The National Executive considered TVNZ’s response to be grossly inadequate and resolved to proceed to the next stage of lodging a formal complaint to the Broadcasting Standards Authority, a statutory body. The Authority is presently considering the Association’s claim and has sought and received additional information from both TVNZ and the Association. This matter has been reported to members in both The Specialist and ASMS Direct.
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Medical Council
The Association has improved its networking with the Medical Council over the past 12 months. In January National President Jeff Brown, fellow National Executive members Anthony Duncan and Alastair Macdonald, and the Industrial & Policy Adviser met with Professor John Campbell, President of the Medical Council, largely to discuss matters relevant to the implementation of the Health Practitioners Competence Assurance Act. These included scopes of practice, codes of ethics, relationships between medical representative bodies and the Council (and the Council’s role in liaising with other authorities to advise on the implementation of the Act), Medical Council elections, and quality assurance.
The Executive Director and President of the Medical Council have also maintained informal contact on relevant strategic matters. Professor Campbell has also kindly provided an article for The Specialist, addressed the
In response to the Medical Council’s draft statement on disclosure of harm to patients the Association forwarded comments to the NZMA in order to form part of the latter’s submission.
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‘Medical Roundtable’
The Minister of Health has decided to establish a ‘medical roundtable’ to consider workforce and associated training needs prior to vocational registration. Unfortunately her considerations on its composition have been hampered by her narrow and inaccurate views on the role of unions and what constitutes ‘industrial’. The Association has advocated to her directly and through the Ministry of Health of the importance of the resident medical officer voice being represented through their organisation, the Resident Doctors Association, and also that the Association be included. The Council of Medical Colleges has supported the position taken by the Association.
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Relationships between Senior and Resident Medical Officers
At its June meeting the National Executive discussed concerns over relations between senior and resident medical officers and current pressures on senior medical staff. This was also the basis of the President’s Column in the June issue of The Specialist. It was agreed that the Association should discuss with the Resident Doctors Association ways in which we can have effective engagement over this matter. Branches have also been encouraged to consider organising local gatherings with
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Resident Medical Officers National Strike
Following difficult negotiations which commenced in May, on 18 October the Resident Doctors’ Association gave formal 14 days notice of a full national six day strike. This involved a total withdrawal of RMO labour, including emergency cover, and was based on the assumption that senior medical and dental officers would simply fill the gap. There was no prior consultation with the Association over the viability of such an unprecedented action in terms of contingency planning for patient safety. It subsequently became clear that the timing was chosen, at least in part, to avoid being bound by the code of good faith in regard to life-preserving services during strike action, which takes effect on 1 December.
The Association was placed in an invidious position. On the one hand, we have valued a working relationship with the
This led to a week of turmoil in which the Association made two media statements, had several media interviews and advised members through ASMS Direct. Members expressed wide ranging views, from unequivocal support of the
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DHBNZ
The Association has endeavoured to further its working relationship with DHBNZ as a new emerging influential organisation in the health sector. This has included the Executive Director participating in quarterly
At its informal meeting in February the National Executive had a positive exploratory session with DHBNZ representatives Syd Bradley (chair), Julian Inch (Chief Executive) and
In July the Executive Director attended a briefing by DHBNZ to
On the other hand, it is process-driven and runs the risk of being a ‘lines on paper’ exercise rather prone to jargon. There is a big gap between the various projects described and making a difference for the better at the workplace.
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Supervision and Recruitment of Overseas Trained Doctors
Following internal email discussion on the subject the National Executive resolved at its February meeting that the national office should develop a draft issues paper covering matters relevant to the supervision and recruitment of overseas trained doctors. However, workload pressures have prevented work on this from being further progressed.
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Guidelines for Safe Working Hours and Punitive Remuneration
The National Executive also resolved at its February meeting that the national office should develop draft guidelines for safe working hours and punitive remuneration. Again, however, workload pressures have prevented work on this from being further progressed.
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Annual Conference Professionalism Resolution
During general business at the 2003 Annual Conference the following resolution was adopted:
That the Annual Conference direct and empower the National Executive to consider
and implement all processes to promote and enhance professionalism in the
Zealand
The National Executive considered the application of this resolution at its February meeting and resolved that the importance of recognising and enhancing professionalism would continue to be advocated in all aspects of the Association’s work. This has already occurred in areas such as the new national DHB collective agreement and in the Association’s empowerment strategy both of which are strongly underpinned by professionalism.
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Association ‘Chat Room’
The National Executive considered a suggestion from a member that the Association develop a ‘chat room’ on our website. However, the Executive resolved not to proceed with this because of the resource (time) implications for national office staff.
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Council of Trade Unions
The Association is continuing its good relationship with the Council of Trade Unions (
Issues considered by the National Affiliate Council included:
- Training union health and safety representatives.
- Employment Relations Law Reform Bill.
- Implementation of the new Holidays Act.
- A new Rebuilding Unionism organising fund established by the
- Working with the Tertiary Education Commission on the implementation of the government’s tertiary education strategy including the adequacy of resourcing training initiatives such as the promotion of modern apprenticeships.
- ‘Work/life’ campaign.
- The affiliation fee which was increased by 10 cents per full-time member of each affiliate to $4.50 although this will only apply to the last three months of the 2004-05 financial year.
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Wider Medical Representation
The National Executive is concerned that policy-makers do not act as though there is a single pan-professional body representative of the medical workforce. This has led to frustrations and gaps in advice for both the policy makers and the profession. Examples include the relative ineffectiveness of the profession in addressing key concerns arising out of the Health Practitioners Competence Assurance Bill last year. As discussed in the 2003 Annual Report, the most effective representations were made by the joint health professionals groups which included the Association and the NZ Nurses Organisation (NZNO). The Association has had a generally collaborative relationship with the NZMA, which considers itself the single pan-professional medical body, since the Association’s formation, but there is an increasing majority of Association members who are not members of the NZMA. Also, the NZMA has taken positions from time to time that were in conflict with the interests of doctors whose form of employment was salaried, including Association members.
The National Executive was also concerned about the decision of the NZMA to withdraw from the MECA negotiations with the NZ NO on behalf of practice nurses employed by general practitioners. This dispute, which included the NZNO taking an action to the Employment Relations Authority, led to increasing Executive concern that the whole medical profession would be perceived as supporting the NZMA position. The position of the NZMA risked having a detrimental effect on the relationship between the medical and nursing professions. Consequently the Association considered it necessary to differentiate ourselves from the NZMA’s position. We wrote to the NZMA in August advising of our concerns, also advised other organisations and subsequently reported this to members in ASMS Direct. The NZMA was upset over and disagreed with the Association’s actions. The two organisations met to discuss the issues although the Association’s position remained unchanged. This has been a difficult matter and the Association is pleased that the NZMA has now agreed to return to negotiations with the NZNO.
The Association was also conscious that this dispute originally commenced at a time of considerable difficulty in our own national DHB MECA negotiations with the DHBs threatening to break down the negotiations and several individual DHBs more than happy to pull out if a pretext could have been found. Although we have remained silent on this aspect, opportunistic DHBs could have used the NZMA’s opposition to negotiate a MECA as part justification for breaking down our own MECA negotiations.
National Executive member Anthony Duncan has attended some of the meetings of the NZMA’s specialist council. The Association, through the National President and the Executive Director, have continued to attend the quarterly meetings of the NZMA convened Medical Leaders Forum which bring together some of the key medical organisations such as the NZMA, Medical Students Association, Council of Medical Colleges, the larger colleges (surgeons, physicians and GPs), and the Association itself. However, the Resident Doctors Association rarely attends. Subjects discussed have included ‘trials by media’ such as the TVNZ Holmes programme on general surgery and Southland; a project by the Tertiary Education Commission and the Ministry of Health on the health/education funding and training interface; workforce concerns; Tertiary Intern Grant; application of the Health Practitioners Competency Assurance Act, in particular, scopes of practice (medical and nursing) and elections to the Medical Council, the Aspects of Duty of Care paper; application of the Commerce Act to medicine and the implications of the Australian Competition Commerce Commission determination on the Royal College of Surgeons; and the Health Screening Amendment Bill. At the end of two of the four Forums held since the 2003 Annual Conference, the participants were joined by Director-General of Health, Dr
While the Medical Leaders Forum provides the opportunity for at least some of the key medical organisations to meet, its potential has yet to be sufficiently realised and it does not address the problem of a single effective voice for the wider profession inclusive of resident doctors and salaried medical specialists. On the positive side, however, newly elected chair of the Council of Medical Colleges, Associate Professor
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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. These cases usually arise from concerns about aspects of a doctor’s clinical practice or their health and the impact of those concerns on the doctor’s fitness to practice. They generally result in the doctor being “suspended”, taking extended sick or special leave, or having restrictions placed on their clinical practice pending the outcome of some external investigatory process.
The Executive Director visited the
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High Court Ophthalmology Decision
Since the Ministry of Health, on instruction from the then Minister of Health, referred the Southland ophthalmology dispute to the Commerce Act in late 1996, although not directly involved in their representation, the Association has endeavoured in the public arena to defend the integrity of the accused ophthalmologists and to criticise the use of the Commerce Act in this instance. Under the Act anti-competitive refers to both actions which are anti-competitive and have the effect of being anti-competitive. However, this year the High Court found against the ophthalmologists and the Ophthalmology Society. While arguably a harsh and unfair judgment, the National Executive considered that the lessons of this decision were based on distinct circumstances, not all of which are currently applicable, and there were no sufficiently wider policy and related issues to pursue.
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DHB Staff Shortage Surveys
These were undertaken firstly in MidCentral and subsequently in Wanganui and Tairawhiti in response to an ill-judged comment by lead DHB CEO for the MECA negotiations (Stephen McKernan) that there were no problems overall with the recruitment and retention of senior doctors.
The information collected for MidCentral suggested that the most conservative estimate was that MidCentral had 17 to 19 vacancies for specialists and a short fall of at least a further 21 to 24 in the view of the senior medical and dental staff. At least a further 2.7 FTEs on top of that would be required if college and other guidelines were met. With 101 specialists employed at MidCentral as at July 2003 (actual individuals and not FTE’s) and 19 medical officers (Moss) this suggested a ‘vacancy rate’ of at least 19%[1].
The survey elicited another interesting figure. Many of the senior medical staff canvassed, had from their colleges or other guidelines, a clear idea what the necessary numbers of specialists were for the population base they were covering. This elicited a ‘professional vacancy rate’ of at least 43%.
As is always the case the process of collecting the information elicited a number of interesting observations by informants. These were
- There are fewer young specialists. As specialists become older and families grow up there is less extramural incentive to stay. Increasing public and managerial expectations mean more time spent with each patient and each procedure.
- Fewer full-timers carry the departmental load of administration and audit while higher paid locums plug gaps but only the patient contact gaps.
- More time now had to be spent with patients and their families and this had an impact on the number of procedures that could be done per clinician.
- Vacancies (or an increase in numbers of specialists) have an impact through the system. An increased number of specialists in one area can place a burden on support services such as radiology. Failure to fully staff departments can cause blockages in the Emergency Department. Shortfalls in nursing (numbers and experience) create a need for additional specialist units such as a high dependency unit.
- Demand is continually being “ratcheted” up increasing the scope of services (breast screening), by signing up to projects (sexual abuse guidelines and training), by expecting existing staff to pick up from discontinued services (pain clinics), and by adding extra elements to procedures.
- Recruitment of
- Within the same hospital one department can be a "magnet" department and others can be almost impossible to recruit to. High levels of vacancies make it almost impossible to recruit to departments in crisis because rosters are more onerous and workloads higher.
- Private provision of services (privatisation), though it is more expensive in general to the public system, increases fragmentation, increases monitoring requirements and therefore transaction costs, may be the ultimate outcome when DHBs are not prepared to pay at a sufficient level to attract specialists as employees.
- The role of the medical officer (or MOSS) needs to be examined. Are they simply a “second best” alternative to vocationally registered specialists or should they have a long term role in areas such as emergency care and rural hospital staffing?
In the event the publication of the "MidCentral District Health Board Medical and Dental Specialist Recruitment and Vacancy Report" and the surrounding publicity (the report was released as an exclusive by TV1) played a part in getting the negotiations back on track. As a result preparation of the other two reports for publication was felt to be unnecessary.
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Australian Medical Association Industrial Coordination Meetings
Since 1991 the Executive Director has attended industrial coordination meetings convened by the Australian Medical Association (AMA). These twice yearly meetings are organised by the Australian Medical Association and involve industrial officers at both the federal and state level from both the AMA and the Australian Salaried Medical Officers Federation (ASMOF). They are also attended by the Resident Doctors Association. Since the 2003 Conference the Executive Director has attended two meetings in
These meetings enabled the Association to keep up-to-date with important developments in
The Executive Director also reported on developments in
While in Sydney and Melbourne he also:
- Met the chairperson of the Greater Metropolitan Transition Taskforce for
- Met the Deputy Director of the Australian Medical Workforce Advisory Committee in which the main subject was its resource-intensive project looking at all hospital doctors with an intended focus on numbers and quality (
- Met the Acting Chief Executive of the recently formed New South Wales Clinical Excellence Commission.
- Met the director of the
- Attended a formal session of the Special Commission of Enquiry into Campbelltown and
- Met the Assistant Secretary of the Australian Council of Trade Unions to further discuss our membership empowerment strategy in the context of the
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International Travel
The following international travel was undertaken by national office staff since the previous Annual Conference:
- The Executive Director attended two Industrial Coordination Meetings convened by the Australian Medical Association, in conjunction with the Australian Salaried Medical Officers Federation (discussed above).
- In recognition of the value of looking at the administration and organisation of bodies similar to the Association, the Executive Officer visited the ASMOF federal office in
- Executive Director was invited by the British Medical Association and Irish Medical Organisation to give an address to their jointly hosted second all-Ireland health conference in
In addition, the National Executive has approved a trip by the Executive Director to
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Association Publications
The Specialist, the Association quarterly newsletter (generously sponsored by the Medical Assurance Society), is a cornerstone of our advocacy work. In recognition of its importance the September issue was dedicated to the provisional national DHB MECA as background to the membership indication ratification ballot. Other feature articles have included:
- Background to and progress in the national DHB MECA negotiations.
- Membership empowerment strategy.
- Minister of Finance’s address and question and answer session at 2003 Annual Conference.
- Employment Relations Law Reform Bill.
- New Holidays Act including application to working on public holidays.
- Implementation of the Health Practitioners Competence Assurance Act and other matters (by the President of the Medical Council).
- The importance of doctors being prepared to say ‘no’.
- Risks associated with use of internet and email at work.
- New medical misadventure policy.
- Public Finance Bill.
- MidCentral DHB workforce shortage report.
- History of the Medical Assurance Society.
The ASMS DHB News (formerly Regional News) both supplements The Specialist and plays an important role in both local matters and supplying other relevant information. This communication vehicle is also adapted for our members employed outside DHBs, largely in relation to collective bargaining. The Bargaining Bulletin was also produced to keep members up-to-date with the national DHB MECA negotiations.
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 about 1400. The use of ASMS Direct has increased over the years with 25 issues produced in 2003 and, in the year to date, 26 issues. Much of this has focused on the DHB MECA negotiations.
Other subjects covered included:
- Medical misadventure policy.
- TVNZ Holmes programme.
- Ministry of Health prioritisation project.
- Criticisms of government and opposition party statements.
- World Medical Association statements.
- Consultation documents from Medical Council, Standards New Zealand and other organisations.
- Treasury on DHB productivity.
- Planned resident doctors’ national strike.
- Minister of Health’s letter of expectations to DHBs with particular reference to clinical leadership.
- Meetings with Minister of Health.
- Annual DHB senior medical officer salary survey.
- MidCentral DHB staff shortage survey.
- Holidays Act including public holidays.
- Nursing staff ratios.
- Funding for Doctors Health Advisory Society.
- Tertiary Intern Grant.
- Other collective agreement negotiations.
The national ASMS Direct is also supplemented by local ASMS Directs on Association activities and local issues.
In 2003 the National Executive initiated a new occasional publication, Parliamentary Briefing, targeted at members of Parliament over the Health Practitioners Competence Assurance Bill. The National Executive has resolved to continue with this publication on an as-needs basis. In the year to date one issue has been published—on the Employment Relations Law Reform Bill.
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Membership
At last year’s Annual Conference we anticipated another record membership year. This proved to be correct with membership, as of
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%) and 2003-04 (117 – 5%), an overall increase of 33% 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. In the remaining 11 years membership has increased with the highest being 162 (11.4%) in 1992-93, the first year of the full impact of the Employment Contracts Act.
The annual increase since our formation is 64 (4.4%). 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 increase over the two years has been 120 (6.1%).
Currently membership is over 2,410 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
Currently about 89% of our members pay their subscription by automatic salary deduction (about 98% of new members employed during the past year).
The Membership Support Officer is presently telephoning our potential members employed by DHBs encouraging them to join the Association in light of the settlement of the MECA. This exercise will also seek to verify their eligibility, size of appointment and interest in joining the Association.
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 20% of our current members. Of the Association members who joined in the calendar year 1996 the percentage was 22% compared with 9% in 2003.
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Medical Assurance Society
The Association’s collaborative relationship with the Medical Assurance Society continues to strengthen based on our ‘preferred provider’ relationship. This includes the Society’s generous sponsorship of The Specialist while the Association contributes to the Society’s publications. The Society has also generously agreed to continue to sponsor the pre-Conference function and to assist in its organisation.
The quarterly advisory consultancy meetings between the Executive Director and Society Chief Executive
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Association Finances
The Association recorded another healthier than anticipated surplus for the financial year ending
In summary the main factors for the increased surplus were due to:
- A higher than expected increase in membership;
- Interest on investments exceeding budget, and
- Higher than predicted sundry income (mainly from the online job service).
- A total of $11,100 was recovered from four DHBs (Northland, Nelson Marlborough,
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Administration
A busier than usual year meant resources were fully stretched. Strong focus continues to be placed on maintaining the professional standard of the Association’s publications. The use of email as an efficient method of communication is continuing to increase in popularity with 64% of the membership subscribing to ASMS Direct. A programme designed to enable members or groups of members to be emailed directly from the membership database has significantly improved efficiency in this area.
This year the national office computer network was brought into this millennium. The network server and four workstations were replaced and now run XP and Office 2003.
After a very lengthy process the negotiation of favourable terms and conditions for the Association’s lease renewal was finally concluded. The new lease expires in three years with the provision of a further three year right of renewal—final expiry date being
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Website
The long overdue and hugely underestimated task of redesigning the Association website was brought to conclusion in September 2004 with the launch of the Association fully revamped website. The new site is easier to navigate and consistent with the professional quality of the Association’s other publications. The content is managed and updated by the national office daily with topics of special interest listed on the home page.
The Association is one of the first points of contact for international doctors or dentists seeking medical employment in
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Job Vacancies Online
The online facility was introduced towards the end of 2001 in response to serious concern at the alarming number of unfilled specialist & MOSS positions within
Advertising jobs on line with the Association is fast, simple, user-friendly and therefore cost-effective. All advertisements are linked to the employer’s website and recent modifications allow the inclusion of the employer’s logo. Job seekers can also apply online directly to the advertiser.
Currently, the focus is on actively marketing ‘ASMS jobs online’ to employers and recruitment agencies.
Brian Craig
ASSOCIATION NATIONAL SECRETARY
[1] Specialists on ASMS’s database have part time hours ranging from 4-36 per week. The hours less than 40 were added up, divided by 40 giving a national FTE base of 87.5.
