Executive Direct - Issue 2012-4

4 October 2012

Dear Member

This is the 4^th issue for 2012 of our electronic publication, Executive Direct, to report to members on National Executive news. It is forwarded to members after each Executive meeting. This issue reports on the last Executive meeting on 27 September. This publication will also be kept on the ASMS website www.asms.org.nz. The next Executive meeting is scheduled for 28 November.

The main features of the meeting were:

• Preparation for the forthcoming national DHB MECA negotiations (see below).
• The review of the Health Practitioners Competence Assurance Act (see below).
• A constructive session, to which ‘Chatham House rules’ applied, with the Hon Maryan Street MP, Labour health spokesperson. This continues the practice of the National Executive of meeting the official Opposition health spokesperson as we did, for example, with the Hon Tony Ryall when he was previously in this role.
• Planning for the ASMS Annual Conference on 29-30 November.

This issue of the Executive Direct reports on the following:

• 1. Preparation for National DHB MECA Negotations
• 2. Members stories on clinical leadership experiences requested
• 3. Review of Health Practitioners Competence Assurance Act
• 4. Salary Survey
• 5. Collective Bargaining with Non-DHB Employers
• 6. National Joint Consultation Committee
• 7. ASMS engages health researcher
• 8. Other Matters
• ASMS branch representatives: next executive meeting
• National Executive: Regional Representatives

1. Preparation for National DHB MECA Negotations

Preparing for the forthcoming DHB MECA negotiations continued to take up a large part of the meeting. It was greatly assisted by a productive branch officers’ workshop the previous day that included presentations from Executive Director Ian Powell and ASMS researcher Lyndon Keene. The consensus at the Executive meeting was to focus on the competitiveness and attractiveness of the salary scales, particularly the upper end, with the objective of improving retention (thereby also improving recruitment).

Meanwhile, as a precursor to formal negotiations scheduled to commence in February, informal ‘technical’ discussions between the ASMS and the DHBs commence next week and continue through until 6 November when progress will be assessed.

The National Executive will be considering the draft claim at its next meeting on 28 November as well as our ratification process and composition of our negotiating team. The forthcoming negotiations will also feature at the ASMS Annual Conference the following two days.

2. Members stories on clinical leadership experiences requested

At each Executive meeting the National President gives a verbal report on relevant matters and themes that have attracted his interest. On this occasion Dr Jeff Brown spoke on his recent experience in southern England of witnessing poor quality patient treatment which had arisen out of seriously flawed systems. This led to some thoughtful discussion on the importance of promoting clinical leadership in New Zealand’s health system.

Arising out of this discussion it was agreed to request ASMS members to provide stories of their experiences of clinical leadership in order to better inform the National Executive of what is really happening at the ‘clinical frontline’. It is possible that this may lead to the establishment of an online ‘post box’ where some reported experiences may be placed (but only with the consent of the members providing this material of course). We will be following up on this in due course.

3. Review of Health Practitioners Competence Assurance Act

The prime legislation governing the regulation and registration of medical and dental practitioners is the Health Practitioners Competence Assurance Act. This Act also covers a range of other health practitioners, including nurses and pharmacists. One aspect of the Act is the requirement for regular operational reviews, something which the ASMS and other organisations successfully lobbied for when the Act was first adopted by Parliament.

The latest review is now underway. Government has delegated responsibility for the conduct of the review to Health Workforce New Zealand (HWNZ) based in the Ministry of Health. HWNZ has issued a public discussion paper as part of the review. The time allowed for public discussion is very limited with the discussion paper released on 31 August and submissions closing on 26 October. The discussion paper is available at http://www.healthworkforce.govt.nz/HPCA-Discussion-Document.

The review findings and recommendations will be released for discussion between March and April 2013 and the final report will be released at the end of July. The process after that may include legislative changes which would be sent to Parliament.

The ASMS is aware that HWNZ has issues with the Act, including:

• The cost to DHBs of the responsible authorities through the reimbursement of practicing certificates. The government has required the authorities to amalgamate their secretariats by June 2013 to increase efficiencies.
• The purpose of the Act is to protect the health and safety of the public and the feeling is that this had led to insufficient attention to heath workforce needs.
• The Act is regarded in some quarters as a barrier to workforce innovations such as physician assistants.
• Many international medical graduates have had very poor experiences with the Medical Council (and this may be replicated in other professions).
• The tensions intrinsic in the Act are beginning to be felt with a number of practitioner groups wanting to be brought under its auspices and discussion about a two tier system.
• The provision of workforce data has not been a core function of the responsible authorities and HWNZ wants data more attuned to its needs.

This review will also look at common standards for professions and workforce flexibility. It is also clear that the Minister and Ministry of Health were not happy about the fact that the current legislation did not allow them to easily force the amalgamation of the responsible authorities and the review may lead to the increase in the power of the Minister/Ministry under the Act.

Concerned about a possible politicalisation of the regulatory authorities, the National Executive agreed that a submission should be made. In addition, however, this will become an important part of the ASMS’s work for the rest of the above time frame. It is also likely to be an important issue for discussion at the ASMS Annual Conference in November.

4. Salary Survey

The ASMS conducts an annual salary survey of average base salaries of DHB employed senior medical and dental officers for a 40-hour week effective 1 July. This is based on information provided by DHBs on the numbers on each of the steps of the specialist and medical/dental officer salary scales.

The National Executive considered the just completed analysis of the 2012 salary survey. Average base salary for specialists as at July 2012 was $184,271 (excluding allowances and job sized hours above 40 per week). The equivalent figure for medical and dental Officers was $144,488.

This represents an increase of 4.3% over the previous year for specialists and an increase of 5.1% for medical/dental officers. The increase in the previous twelve months (to 1 July 2011) was 2.7% for specialists and 3.5% for medical/dental officers.

Average base salary for women specialists was $176,918 whereas the average for men was $187,661. Male medical/dental officers average base salary was $145,137 with females having an average base salary of $143,729.

For the first time we included two tables and two figures setting out the headcount of senior medical and dental officers deriving from the salary surveys. This has consistently proved to be the most accurate workforce information available.

The full report is available in the In Depth section on the ASMS homepage www.asms.org.nz.

5. Collective Bargaining with Non-DHB Employers

Over 160 ASMS members are covered by collective agreements outside DHBs that we negotiate. We have 16collective agreements in the non-DHB sector including one MECA (hospices). At each meeting the National Executive receives progress reports.

Settlements subject to ratification have been achieved in Ngati Porou Hauora (East Coast), and the Hospices MECA.

Currently negotiations are underway or about to commence for Hokianga Health Trust (Rawene Hospital), Waitakere & Otara union health centres, Compass Health Wellington (sexual health service in Wellington), and a GP MECA applying to four employers in the lower North Island.

6. National Joint Consultation Committee

The National Joint Consultation Committee (NJCC) is a joint DHBs-ASMS body set up under the MECA. The National Executive discussed the report of its last meeting on 24 September (the third for the year) where the ASMS was represented by Executive members Brian Craig, Judy Bent, Carolyn Fowler, Paul Wilson, Hein Stander, Tim Frendin and John MacDonald, along with Ian Powell and Angela Belich. The DHBs team was led by Whanganui DHB Chief Executive, Julie Patterson along with Pat Hartung (Northland HR General Manager), Viv Rawlings (Auckland General Manager HR), Warrick Frater (Hawke’s Bay Chief Operating Officer), and Laurie Biesiek (DHB Shared Services).

The main feature of the meeting was the attendance of two senior officials from Health Benefits Ltd - Rachel Walle (Change Manager) and Mark Reynolds (Communication Manager). They updated the meeting on progress on the programmes.

The ASMS has been working with HBL on the establishment of a Clinical Council to advise its decision-making. HBL advised that the appointment of the Chair of the Clinical Council was on the verge of being announced though nominations for the rest of the Council had not yet been sought. HBL added that they are also taking care to align the new Council with Pharmac.

The major piece of work by HBL is the business case for procurement, finance and supply chain. It expects to forward its proposed business cases to each of the 20 DHBs for consideration by next March. This is when the consultation processes the DHBs are required to undertake with their workforce and the health unions assume a more tangible focus. Other HBL activities include facilities management (the present focus is on food and laundry), information technology and human resources.

In advance of the meeting the ASMS had written to the DHBs advising of our concern that the sheer volume of HBL’s work and possible political constraints risked undermining the proper level of engagement required with us and ASMS members under the MECA. We have received a response assuring us that the tenor of the MECA’s responsibilities and obligations would be respected.

Discussion at the JNCC also included the following other matters:

• Delays in processing the reimbursement of CME expenses. Fortunately this is not a widespread problem and it was agreed that where applicable the ASMS would raise it at local Joint Consultation Committees.
• The ASMS raised concerns that some SMOs had been refused permission to go to the Pacific Islands as part of college accredited CME because this was viewed as aid rather than CME. The DHB representatives (General Managers HR) undertook to follow up this issue up with the CMOs.
• The ASMS enquired about moves by Ministry of Business Innovation and Employment to promote a ‘whole of government, travel policy. However, DHB representatives were not aware of any such proposal.

The next NJCC is on 7 December.

7. ASMS engages health researcher

The National Executive accepted a recommendation to engage Lyndon Keene, a researcher with a journalist background (also a former cabinet minister senior adviser) as a researcher. In recent years we have engaged his services on a casual basis. Overwhelmingly this has been on workforce analysis, including the ‘Leaking Bucket’ publication for the SMO Commission in 2008 and the background papers for the joint workshops with the DHBs in 2010 as part of the national DHB MECA negotiations. He also researched and wrote the Health Dialogue on Lakes District Hospital at Wakitipu. This proved to be influential in helping to shape the outcome of the independent review’s recommendations to the Ministry of Health and Southern DHB which were subsequently adopted.

The Executive is looking at using this position to extend and enhance our policy work with the main focus expected to be workforce related but could also extend into related professional issues such as the operation and review of the Health Practitioners Competence Assurance Act and ‘public private partnerships’ in health. The position is half-time and fixed term for up to 18 months at which time the future of this new role will be reviewed.

8. Other Matters

Other matters considered by the National Executive included:

• The ASMS has been involved in ‘below the radar’ informal discussions with Waitemata DHB representatives over employment arrangements and remuneration for the North Shore elective surgical centre due to open in July next year. The National Executive received a report on progress to date which regrettably has been little to date due to some fixed inflexible positions within the DHB.
• As previously reported the ASMS has been in dispute with the three Auckland DHBs over their unilateral decision to change the approach to placement on the specialist scale in the MECA. This applies to the placement of new appointees with four years or less relevant experience from 2013 onwards. The Executive received an update on discussions we are having with the human resource general managers of Waitemata, Auckland and Counties Manukau. These discussions are at a sensitive stage but ongoing. At some point, if progress fails to be achieved the ASMS may need to escalate the dispute to chief executive level.
• Previously we reported the National Executive’s disappointment that the DHBs had done a U-turn and decided not to develop agreed guidelines on the employment of senior medical staff in regional service collaboration. At the September meeting it was agreed that the ASMS should further develop the work done to date, expand its scope (including working in primary-secondary collaboration and integration), and to publish this as an authoritative ASMS Standpoint.
• The New Zealand Medical Association has sent the ASMS the draft principles for workforce redesign. This is part of the NZMA’s ‘building block’ policies, specifically the role of the doctor and health equity position statements. The National Executive was supportive of the draft’s broad principles.
• The main points considered at the Council of Trade Unions’ National Affiliates Council in September, including the anticipated proposed amendments to the Employment Relations Act, Lobbying Disclosure Bill, Trans Pacific Partnership Agreement, and union leadership development.
• The total number of unique visitors to the ASMS website has ranged between 2,500-2,800 per month over the past three months to August 2012. This is within the range of the past year. The homepage has drawn over 900 unique visitors per month over that period, which continues the improvement this year from the first three months of the year when we consistently saw around 750 visitors per month. Members are encouraged to regularly assess the homepage www.asms.org.nz for up-to-date news items.
• The job vacancy pages attracted around 1400 total visits per month over the past three months, sustaining the levels seen over the past 15 months. Of those around 670 each month were new visitors. There are 74 positions currently advertised on the website, overwhelmingly from 14 DHBs. Members are recommended to encourage their DHB to make greater use of our job vacancy page as it attracts a high number of hits.
• Four particularly successful recently held joint ASMS-DHB SMO engagement workshops were reported. One was particularly novel – jointly involving MidCentral and Whanganui (held at the latter DHB). The others were at Northland, Capital & Coast and Canterbury (around 250 attendees).
• The Executive Director reported on his attendance at the Industrial Coordination Meeting organised by the Australian Medical Association in conjunction with the Australian Salaried Medical Officers Federation in September. On this occasion the twice yearly meeting was held in Auckland and hosted by the Resident Doctors’ Association.

ASMS branch representatives: next executive meeting

Members are invited to forward any issues they may wish to be raised with the National Executive at its next meeting on 28 November to their local Branch President or Vice President (this includes non-DHB employed members who work in the geographic area of these regions). It is possible branch officers might conclude that some of these matters might more appropriately be addressed by the national office. Below is a list of ASMS branch officers:

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:

Region 1 (Northland, Waitemata, Auckland, Counties Manukau)

Carolyn Fowler (Counties Manukau)

Judy Bent (Auckland)

carolyn@netinsites.com

judyb@adhb.govt.nz

Region 2 (Waikato, Bay of Plenty, Lakes, Taranaki)

Paul Wilson (Bay of Plenty)

Andrew Darby (Waikato)

paul-wil@xtra.co.nz

darbya@waikatodhb.health.nz

Region 3 (Tairawhiti, Hawke’s Bay, Whanganui, MidCentral, Wairarapa, Hutt Valley, Capital & Coast)

Tim Frendin (Hawke’s Bay)

Hein Stander (Gisborne)

tim.frendin@hawkesbaydhb.govt.nz

heinrich.stander@tdh.org.nz

Region 4 (South Island)

Brian Craig (Canterbury)

John MacDonald (Canterbury)

thecraigs@xtra.co.nz

meljohn@ihug.co.nz

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.

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Ian Powell
EXECUTIVE DIRECTOR