Executive Direct - Issue 2011-3

28 June 2011

Dear Member

This is the 3rd 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 23 June. The next Executive meeting is scheduled for 1 September.

• 1. NATIONAL DHB MECA NEGOTIATIONS
• 2. BRANCH ELECTIONS: PRESIDENT AND VICE PRESIDENT
• 3. DISTRIBUTIVE CLINICAL LEADERSHIP
• 4. EMPLOYMENT RELATIONS AUTHORITY DECISION ON THE APPLICATION OF THE HEALTH SECTOR CODE OF GOOD FAITH
• 5. MEDICAL COUNCIL’S PROPOSED INCREASE IN FEES CHARGED TO INTERNATIONAL MEDICAL GRADUATES
• 6. CHANGES TO THE GENERAL PRACTICE EDUCATION PROGRAMME
• 7. OTHER MATTERS
• 8. NATIONAL EXECUTIVE: REGIONAL REPRESENTATIVES

1. NATIONAL DHB MECA NEGOTIATIONS

The national DHB multi-employer collective agreement (MECA) negotiations dominated much of the meeting. The background to the difficulties these negotiations got into particularly since late April has been reported in The Specialist and ASMS Direct. The Executive’s deliberations were also shaped by tentative signs of progress in the informal meeting the ASMS had on 16 June with Gregor Coster (Counties Manukau and Chair of the 20 DHBs national chairs group) and Kevin Snee (Hawke’s Bay and Chair of the 20 DHBs national chief executives group)

The National Executive considered three broad options for the ASMS’s future direction in negotiations.

i. Accept the DHBs’ offer to us or some minor variation to it. In summary this is a 1.7% salary increase plus further new working groups. In effect, this would mean the abandonment of the Business Case and, even more seriously, the high likelihood that joint collaboration between the ASMS and DHBs at least at a national level would be inconceivable for several years because of the circumstances that led to this abandonment. Having further working groups would have been untenable given that we had already done this through the joint workshops held mid-last year and the joint work undertaken to develop the Business Case.

ii. Escalating to industrial action reasonably soon (August-September) commencing with national stopwork meetings. This was considered to be premature partly because of the tentative moves by the DHBs to engage again, partly because of the general anxiety and trauma associated with the Christchurch earthquakes, partly because of the need to continue to promote the importance and benefits of the Business Case to the health system, and partly because of the need to address the effects misleading and erroneous statements by the DHBs over the cost of the Business Case and the effect of the earthquakes on health funding.

iii. Engaging with members over the importance of the jointly agreed Securing a Sustainable Senior Medical and Dental Workforce in New Zealand: the Business Case being the blueprint for the future and why DHBs need to invest in their senior medical and dental workforce, through the MECA, as the necessary prerequisite to make it happen. If a settlement was not achieved by the time of the ASMS Annual Conference in November, this event would be an opportunity to reassess our direction including consideration of forms of industrial action.

The National Executive resolved unanimously to adopt the third option discussed above. The Executive has also received external public relations advice about pursuing it. It will include a series of electronic ‘Blueprint Alerts’ focussing on the risks and costs to the health system and patients of not using the Business Case as the blueprint and the benefits to the health system and patients (including financial) of investing in the senior medical workforce in order to deliver on this blueprint. It was also agreed to hold a special national meeting of the newly elected branch Presidents and Vice Presidents (see below).

There is a high level of anger and annoyance among the National Executive over the conduct of the DHBs in late April and May but we are also aware that anger is not a sound basis for determining strategy and tactics. We are continuing to explore the opportunity of further engagement with the DHBs in these negotiations while at the same time preparing for another negative turn of events should this unfortunate circumstance occur.

2. BRANCH ELECTIONS: PRESIDENT AND VICE PRESIDENT

The National Executive considered the outcome of the recently concluded branch elections. The following were elected unopposed:

Nominations will soon be called for the vacant Vice President positions in the Tauranga and South Canterbury branches.

It was also agreed to hold a special meeting in Wellington on Wednesday 31 August for Branch Presidents and Vice Presidents. This would include the state of the national DHB MECA negotiations discussed above. Other issues have yet to be worked through and would depend on the state of the negotiations at the time.

3. DISTRIBUTIVE CLINICAL LEADERSHIP

Aside from the MECA negotiations the other main issue discussed was stimulated by the National President’s attendance at the Ko Awatere conference (Counties Manukau DHB) held earlier in the week. This led to extensive discussion, including on the importance of ‘distributive clinical leadership’ which is also what the Business Case is based on. The Executive is looking at providing discussion on this theme at the Annual Conference in November.

4. EMPLOYMENT RELATIONS AUTHORITY DECISION ON THE APPLICATION OF THE HEALTH SECTOR CODE OF GOOD FAITH

The National Executive considered a recent Employment Relations Authority Determination in the 20 DHBs’ case against APEX relating to the role of “gatekeepers” under the Life Preserving Services agreements (under the Code of Good Faith; a schedule to the Employment Relations Act) between DHBs and those unions who have given notice of strike action.
The Authority ruled in favour of the DHBs and against APEX. The effect of the Authority’s decision is that DHBs are not required to agree with the striking employees’ union:
• that a particular patient’s clinical condition requires life preserving services; or
• that a particular person (i.e. a gatekeeper) should make that decision; or
• that a particular person (i.e. a conduit) should communicate the decision that is ultimately made to the striking employee.
This is an important decision and is consistent with the ASMS’s advice to members and DHBs that the decision as to whether a particular test, treatment or procedure was required in a given situation was for the treating specialist to make, without having to justify their decision or have it challenged by the union through a gatekeeper.
The roles of gatekeeper and conduit are not requirements of the Code of Good Faith or Life Preserving Services agreements (there is a common misunderstanding that they are). APEX has filed notice of appeal.

5. MEDICAL COUNCIL’S PROPOSED INCREASE IN FEES CHARGED TO INTERNATIONAL MEDICAL GRADUATES

The National Executive was advised on the Medical Council’s proposal to increase the fees charged to international medical graduates (IMGs) seeking provisional vocational registration for the assessment of documents and interviews. The Council passes on these fees in their entirety to the Colleges it uses to assess the IMGs. These fees have not been changed for seven years and there is a strong argument made that this has been unfair on the Colleges.

The Council proposes to increase them from $177.78 to $653 for the assessment of documents and from $1511.11 to $2365.00 for an interview and to introduce two new charges of $508 for a revaluation fee and $75.00 for advice on a supervisor or employment.

The national DHB MECA provides for DHBs to reimburse vocational registration fees relevant to duties and responsibilities with the employing DHB. As long as the IMG has had an offer and acceptance and has terms and conditions set by the MECA at least part (and often all) of this fee will normally be paid by a DHB with respect to their employees. The MECA wording before the 2010 variation was for vocational registration fee (once only).
The Medical Council appears unaware that the cost is likely to fall substantially on DHBs.

6. CHANGES TO THE GENERAL PRACTICE EDUCATION PROGRAMME

The National Executive considered and agreed to make a response on a discussion paper from the Royal New Zealand College of General Practitioners, Medical Council, and Health Workforce New Zealand which makes proposals thought to be necessary in order to bring GP training in line with the vision set out in the National Health Board’s paper ‘Trends in Service Design and New Models of Care’ which envisages much more of a cross over between care delivered in hospitals and care delivered in primary care settings. The expectation is that GPs will need to be better equipped to work in hospitals as specialists do more work in the community. The initial modules being developed for GP training are in mental health & addiction and care of the elderly (both are being developed in conjunction with the appropriate specialist college).
The main changes are:
• a new division between year one and the advanced training for years two and three;
• eight months of hospital based training over the 36 months;
• availability of new competency modules for trainees and fellows;
• the introduction of a compulsory academic programme;
• changed assessments including practice based assessments and a change in the way the written PRIMEX is assessed but no change to the clinical component; and
• enhancement of the GP bursary to bring it closer to the conditions of other registrars.
There are clear implications for the ASMS with new demands for training GP registrars on already overburdened SMOs. There are also longer term implications with an increasing part of the hospital based workforce being made up of GPs. This is already occurring in a minor way with the longstanding GP liaison positions being joined by GPs employed in part-time positions and clinical leadership positions at DHBs such as Hawke’s Bay and Nelson Marlborough.
As long as these positions and those of specialists working in the community are as employees of the DHBs, the national DHB MECA will tend to protect their terms and conditions of employment (as long as MECA conditions remain attractive to GPs).

7. OTHER MATTERS

Other matters considered by the National Executive included:
• The National Executive noted that ASMS membership continues to reach record highs and we were now only four short of 3.600 members.
• The Executive was advised of collective agreement settlements for ASMS members employed in the Hokianga Health Service, Wellington Primary Health Care and Dunstan Hospital. Negotiations are commencing for the hospice MECA and will soon with the NZ Blood Service.
• Health Workforce New Zealand has called for feed-back on its draft investment plan for post-graduate training. It was a document that was obscurely written and also provided barely a week, including a public holiday, for responses. The National Executive was consequently not able to consider it. Our annoyance has been conveyed to HWNZ.
• The National Executive considered a report on the second joint ASMS-DHB enhancing SMO engagement workshop held in Waitemata where the focus was on issues, challenges and directions in different clinical services and led on to a rich discussion on quality systems and information technology.
• The Executive Director attended the National Bipartite Action Group meeting on 13 June as an observer. What is unfortunately known as the National BAG comprises the 20 DHBs and the other CTU health unions. The day’s programme included sessions with representatives of the Quality & Safety Commission, Health Benefits NZ (part of the National Health Board and responsible for ‘back office procurement’ and related matters) and Health Workforce NZ; the unfolding of national services (genetics, paediatric & congenital; paediatric & adult metabolic; and paediatric & perinatal pathology); and the ‘managed bargaining’ process of the other CTU health unions and the DHBs currently being developed.
• The National Executive received the paper from the Medical Council, Pre-Vocational Training Requirements for Doctors in New Zealand: a discussion paper on options for an enhanced training framework. Notice of regional meetings to be held by the Council has been advertised to members through the ASMS Direct. The Council is also seeking a meeting to discuss the issue with us and this is currently being organised.
• The government’s budget (2011-12) was discussed by the National Executive. This was discussed in the June issue of The Specialist.
• Through the Executive Director the ASMS is represented on the Health Sector Relationship Agreement Steering Group comprising the Ministry of Health on behalf of government, the 20 DHBs and health unions affiliated to the Council of Trade Unions. His report on the last meeting (May) was considered by the National Executive. Features of the meeting included reports from Professor Des Gorman, Chair of Health Workforce New Zealand, and Chai Chuah, National Director of the National Health Board (Ministry of Health).

8. NATIONAL EXECUTIVE: REGIONAL REPRESENTATIVES

In addition to the 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