Executive Direct - Issue 2011-5

Dear Member

This is the 5^th issue for 2011 of our electronic publication, Executive Direct, to report to members on National Executive news. The intention is to forward it to members after each Executive meeting (at least). It reports on the last Executive meeting on 16 November. This publication will also be kept on the ASMS website www.asms.org.nz. The next Executive meeting is scheduled for 9 February 2012.

Much of the meeting was devoted to the national DHB MECA negotiations and the organisation of the ASMS Annual Conference the following two days. These are being reported separately. This Executive Direct discusses some of the other matters discussed.

1. Health Benefits Ltd

Health Benefits Ltd (HBL) is the national shared services agency (a crown entity) which the government established to handle the rationalisation of so-called ‘back office’ functions of DHBs including procurement. This includes acting more like Pharmac over, for example, the purchase of medical devices. Rationalisation might include regional consolidation, national consolidation and outsourcing (privatisation). Further background was outlined in an article in the last issue of The Specialist.

HBL has its own board which reports directly to the Ministers of Health and Finance. It is required by their Ministers to make savings in DHBs of $700m (cumulative) over five years (over one of which has already passed) from 2010-11.

HBL has released two business cases to the DHBs. The first was on procurement, finance and supply chains. This would include a new single shared services agency (possibly with hubs) to run a single financial system for the whole country. Part of its work would be procurement through bulk purchasing to reduce some of the variation (this may be the area of greatest interest for SMOs).

The second business case covers other common services such as laundry, food, waste systems and building maintenance. This is less defined (compared with the first business case) and more difficult because, for example, some services such as food are presently outsourced in many DHBs.

There are two other areas of HBL’s work although they have yet to get to the level of a business case – human resources and related matters, such as health and safety (it could include work on payroll), and information services.

The Association’s expectation, as has been expressed to DHBs through the Joint Consultation Committees, is that in so far as the recommendations in the two business cases (and any more that might eventuate) affect SMOs, directly or indirectly, the consultation responsibilities of the MECA will be adhered to according to their tenor.

Arising out of these recent JCC discussions the ASMS has attempted to obtain copies of these two business cases from some DHBs under the consultation obligations under the MECA and the Official Information Act. Unfortunately, after seeking advice, they have been advised that this would be in conflict with their ‘confidentiality agreement’ with HBL. This is unsatisfactory and in response the National Executive adopted the following resolution:

That the Association calls on Health Benefits Ltd to release its two business cases and calls on the district health boards to release and review their confidentiality agreement with Health Benefits Ltd.

We have subsequently requested from HBL both the two business cases and the confidentiality agreement. We will also raise the latter with the DHBs.

2. Health Workforce New Zealand Proposal: Prioritisation Criteria for Funding Training for Medical Specialties

Health Workforce New Zealand has sought feedback on a paper outlining the process they are considering for prioritisation of medical disciplines for funding by HWNZ. A prior effort was sent out with a time frame that did not allow for discussion by the National Executive.

The ASMS has put the HWNZ paper has been put on the agenda for Joint Consultation Committee’s that have occurred over the last few weeks and we have sought to gain DHBs views on the paper. Overwhelmingly, with one exception (Hutt Valley; their chief executive at least) DHBs have been critical.

There has been an overriding concern from members (and DHBs) over the linking of funding prioritisation for training, which requires a long-term approach, to shorter term government target objectives which are largely shaped by the circumstances of the time, the policy of the government of the day, and the inclinations of the health minister of the moment. There is also concern over the use of data and the methodology used to draw its conclusions. It appears that the Medical Council also has similar concerns.

The Association has written to HWNZ outlining our concerns but unfortunately received an unsatisfactory response that ignored the issues raised.

The National Executive was concerned by the lack of robustness of the HWNZ paper (and the risks to postgraduate training that it generated) and that it appeared that HWNZ had a pre-determined position. Consequently it was agreed that the Association should write to the Minister of Health advising of these concerns.

3. Annual Specialist and Medical Officer Salary Survey, 2011

Since 1993 the Association has been undertaking salary surveys based on data provided to us by the DHBs. The survey is based on the number of people on each of the steps on the specialist and medical/dental officers. The comparison incorporates advancement through the salary scales plus changes to the scales. It enables us to work out the average 40-hour base salary. This survey is the 18^th we have undertaken. DHBs were asked for data on SMO’s salary step as at 1 July 2011

Below is a summary of the main points:

· The annual increase between 2010 and 2011 was 2.7% for specialists and 3.5% for medical officers. Last year the increase was only 0.8 % for specialists and 0.4% for medical officers so we are seeing the effects of the 2% increase in January this year.

• The average base rate has increased for specialists by 2.7% to $176,705 ($168,965 for women and $180,185 for men) between 1 July 2010 and 1 July 2011. The average base rate for medical officers has increased by 3.5% to $137,495 ($138,453 for men and $136,330 for women).
• Specialists in Wairarapa DHB on average have the highest base pay and those in Waitemata the lowest. Medical officers have the highest average base pay in South Canterbury (albeit with only six in total) while those in Auckland have the lowest average base pay.
• The top step of both scales has the greatest number of senior medical/dental officers on it of any step with 1,145 specialists on the top step (out of 3,685) and 201 (out of 565) medical officers. Last year 885 specialists were on the top step as were 164 medical officers.

These are mean full-time equivalent base salaries and do not take into account hours worked in excess of 40 hours per week (which are recognised through job sizing), the availability allowance or other special enhancements. The survey is available on the ASMS website www.asms.org.nz.

4. Collective Bargaining with Non-DHB Employers

The ASMS has over 180 non-DHB members spread across 45 workplaces of which over 160 are covered by collective agreements. The remaining members work in small practices or organisations where collective agreements are judged to be impractical or unnecessary at this point. At each meeting the National Executive receives an update on progress and developments in this area.

By the end of this year we expect all 2011 expired or expiring collective agreements to be settled or well on the way to settlement. Early next year will be busy for non-DHB bargaining due to the roll-over of most 2011 documents in order that we might incorporate gains from the eventual settlement of the national DHB MECA settlement.

The national hospices MECA expired on 30 June 2011 and negotiations were held in October. Terms of settlement were agreed and sent to employers and members for ratification. ASMS members agreed on an increase of 2% as an interim measure until the DHB MECA settlement is known plus an increase of CME to DHB levels and some lesser changes.

5. Medical Council Proposed Revision of Standards on Doctors and Financial Conflicts of Interest

The Medical Council is reviewing its standards relating to doctors and financial conflicts of interest. To facilitate this it has prepared a discussion paper with response to be made by 12 December. This paper may be relevant to a small but significant group of ASMS members who are doing clinical research at DHBs and thus possibly can have a relationship with what the Council calls a ‘Health Related Commercial Organisation’ (HRCO).

After considering the implications the National Executive agreed to raise them with the DHBs’ chief medical officers group and also relevant experts in this area.

6. Medical Council Proposals for Clinical Audit

The Medical Council has sought the Association’s views on a proposed definition and criteria for clinical audit. The proposed definition would be used in its resources, when assessing College recertification programmes for accreditation and when they audit recertification for doctors registered under a general scope. Initially, therefore, discussions would be with Colleges seeking accreditation for their recertification programmes.

At present each doctor must do at least one clinical audit per year to be recertified. The Medical Council says the criteria it proposes are congruent with that used by the Royal Australasian College of Surgeons. However, the proposal has caused some concern that the requirement will require more non-clinical time than they presently have and that this will impact on the time available for patient care.

The Association has provided feed-back to the Medical Council.

7. Other Matters

Other matters considered by the National Executive included:

• The National Executive has been concerned about the embellished interpretations Health Workforce New Zealand has been taking out of the now concluded physician assistant pilot/demonstration at Counties Manukau’s general surgery department. Consequently we have written to HWNZ but unfortunately received a disappointing reply that glossed over the points we raised. This will continue to be an issue of debate it appears.
• The Executive Director reported on a visit to Hobart in September to attend the twice yearly Industrial Coordination Meeting convened by the Australian Medical Association. The subjects reported on were the Commonwealth, State and Territory Agreement on health and hospital network reform; the implementation of the ‘four hour rule’ for emergency departments in Australia; industrial relations changes in New South Wales; physician assistants; industrial coverage of GP registrars; and the national rural generalist pathway.
• Consideration was given to a recommendation to recommend to the Annual Conference a $20 increase to the ASMS membership subscription for the 1 April 2012 – 31 March 2013 financial year. However, such is the healthy state of the Association’s finances (due to membership growth, strong reserves and prudent management) that the National Executive instead recommended a $10 increase to $750 (GST inclusive). This lower recommendation was subsequently adopted by Annual Conference the following day.
• Earlier this month the Executive Director attended a meeting with the new Southern DHB (merger of the former Otago and Southland DHBs) in Balclutha. Attendees included the DHB’s Acting Chief Executive, the two chief medical officers, and the ASMS Otago and Southland branch presidents and vice presidents. The meeting arose out of the report of the National Health Board’s assessment of systemic issues at Dunedin Hospital. That report was highly critical of the DHB leadership and identified an environment of disempowerment. In the background sat the merger of the former Otago and Southland DHBs into Southern. It was generally accepted that despite this it was in effect functioning as two separate DHBs sharing the same letterhead. The meeting itself was positive but struggled for focus. The outcome included a service development approach. To begin with services in both base hospitals should be encouraged to meet in order to discuss opportunities for service development across the Southern district and accepting that the opportunities and challenges will vary from service to service due to factors such as critical mass and volumes. There are likely to be further meetings between ASMS and SDHB.
• Association membership currently stands at 3,587 (15 above last year’s record high after a little over eight months of the current year). Of this total, 3,483 are employed by DHBs and 185 in the non-DHB sector.
• The total number of visitors to the Association’s website ranged between 2,300-3,100 ‘unique visitors’ per month for the six month period to the end of October. The homepage has drawn between 900-1,600 visitors per month over that period while the job vacancy page attracted between 900-1,400 visits per month. Of these, between 550-680 each month were new visitors. There are 96 positions currently advertised on the ASMS website.

National Executive: Regional Representatives

In addition to National President Jeff Brown (MidCentral) and Vice President Julian Fuller (Waitemata), the Executive comprises eight regional representatives. They are:

Members are welcome to raise issues and comments with their regional representatives above by clicking on the relevant hyperlink. This includes non-DHB employed members who work in the geographic area of these regions.

Ian Powell
Executive Director

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