Dear Member
We welcome any feedback on the contents of the 21st issue of ASMS Direct for 2009.
This copy of ASMS Direct focuses on:
1. ASMS Annual Conference shapes strategic direction for national DHB MECA negotiations
2. Encouraging shift of emphasis on government policy over devolution of secondary care services
3. Minister of Health’s Address to ASMS Annual Conference.
4. ASMS Annual Report.
1. ASMS Annual Conference shapes strategic direction for national DHB MECA negotiations
The ASMS’s 21st Annual Conference on 3-4 December was a great success with a record attendance of delegates. One of the features was the development of our strategic direction for our forthcoming MECA negotiations with the 21 DHBs next year (the current MECA expires on 30 April 2010). The following resolution was adopted overwhelmingly by delegates:
That the Association’s strategic direction for the forthcoming national DHB MECA negotiations be based on the following statement:
That the Association promotes the right of equal access for all New Zealanders to high quality public health services. Both access and quality are threatened by the medical workforce crisis in our district health boards. Critical to resolving this crisis are:
(a) a clear pathway to competitive terms and conditions of employment for senior doctors and dentists;
(b) recognition that district health boards are competing in an Australian medical labour market; and
(c) recognition that the Government is responsible for resolving the crisis.
On 6 December the ASMS issued a media statement which included the above resolution. It also commented:
Senior doctors voted overwhelmingly last Friday to focus on achieving a pathway to competitive terms and conditions of employment in our national collective agreement negotiations with district health boards next year in order to help overcome the detrimental effects of our medical workforce crisis.
The senior doctor workforce in New Zealand is vulnerable and brittle. We train high quality young doctors who then move to greener fields in Australia; we lose too many of our existing specialists to Australia; and we offer greatly inferior salaries when competing against Australia to recruit doctors internationally. As a result many patient services are being held together by a seriously short-staffed and overworked senior medical workforce.
This crisis is unsustainable. It threatens the accessibility and quality of patient services. Patients need doctors but patients are being short-changed. They deserve better.
While our negotiations are with district health boards, we expect that government will also need to be involved as it has ultimate responsibility. The government is responsible for funding DHBs. But it also has highly commendable objectives which will require increasing the number of senior doctors if they are to be achieved. These include introducing comprehensive clinical leadership and increasing the role of senior doctors in the training of resident (junior) doctors.
These negotiations will be challenging. Our Annual Conference increased the membership subscription to better resource us for this campaign. But with goodwill and if we, the DHBs and government adopt a ‘can do’ approach we can get there.
The ASMS’s strategic direction is more fully outlined in the front page article of the forthcoming December issue of The Specialist which is currently with the printers.
2. Encouraging shift of emphasis on government policy over devolution of secondary care services
In his annual Letter of Expectations to DHBs earlier this year the Minister of Health, Tony Ryall, announced a rather arbitrary policy of transferring secondary services to primary care organisations (subsequently ‘transfer’ has been replaced with the term ‘devolution’; unfortunately the replacement is of little benefit and we hope it will change again to capture the integrative nature of the primary-secondary interface). He then called for ‘expressions of interest’ from the primary care sector for proposals. DHBs in the main were marginalised from the process even though it might be the services they currently provide and their funding that might be affected.
From over 70 ‘expressions of interest’, nine were accepted. They are now required to develop a detailed business case, including costings, and a development pathway by 15 February 2010 (extended by the Minister of Health in response to concerns raised at the ASMS Annual Conference until the end of February). Evaluation of these business cases by the Ministry is to be completed two weeks later. For the first time affected DHBs are to be directly involved with the business cases to be forwarded to the Ministry of Health requiring their agreement. Those business cases that meet the standard will move into contract negotiations. The whole process, including approval of business cases and signing of contracts is required by government to be completed in May 2010. Little is known of the details of the nine proposals although one from Pinnacle Independent Practitioners Association has created alarm bells because it seeks to take-over around $66m of secondary care funding from the Waikato, Lakes, Taranaki and Tairawhiti DHBs.
Both the time frame and the time of the year make a mockery of the government’s commitment to clinician engagement and leadership. It is inconsistent with both the Time for Quality agreement between the ASMS and the 21 DHBs and In Good Hands which forms part of government policy on clinical leadership.
However, in part due to concerns raised by the ASMS, the Minister of Health last week advised DHBs that the nine approved proposals should not involve devolution of services from secondary care to primary care (unless there is agreement with secondary care clinicians arising out of genuine clinical engagement which is inconceivable given the time frame and circumstances). Instead the Minister is keen for the business cases to focus on:
• After-hours primary care cover.
• Primary care access to diagnostic services.
• Integrated family health services.
This is a welcome shift in direction and pleasing to see that Mr Ryall is listening and taking note of pragmatism rather than ideology. The ASMS is advising DHBs not to agree to anything in the business plans which are not based on genuine clinical engagement and consensus.
3. Minister of Health’s Address to ASMS Annual Conference
There were a number of exceptional addresses to Annual Conference including Professor Don Matheson (published in the forthcoming December issue of The Specialist), Dr Andrew Hamer (Chair of the National Cardiac Network) and Professor Des Gorman. Also well received was an address from Hon Tony Ryall, Minister of Health. It can be downloaded from the ASMS’s website www.asms.org.nz or the Minister’s website with the following link:
http://www.beehive.govt.nz/speech/health+minister039s+speech+asms+annual+conference+3+dec+09
4. ASMS Annual Report
The ASMS Annual Report, which was adopted by the Annual Conference, is an invaluable and extensive record of the ASMS’s work and challenges over the past year, including ongoing activity. You are encouraged to read it either by downloading from www.asms.org.nz or requesting by email at asms@asms.org.nz.
Best wishes
Ian Powell
EXECUTIVE DIRECTOR
