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Annual Conference Reports

Annual Report 2005

The National Executive has met on five occasions since the last Annual Conference with a sixth meeting immediately preceding this Conference.  This is one meeting more than normal because the Executive wished to provide more opportunity to consider the issues arising out of the implementation of the national DHB collective agreement (MECA).  One of these was the regular two day meeting (13-14 April) to allow for an informal strategic planning session on the first day, covering the year’s expected work including the implementation of our national DHB collective agreement negotiations in the context of our membership empowerment strategy.  In addition, at this informal meeting the Executive met the National President and General Secretary of the Resident Doctors’ Association on issues of concern to resident medical officers and former deputy director of mental health with the Ministry of Health (and former National Executive member) Dr Anthony Duncan on the experience and perceptions of working with the Ministry of Health.  At its 14 April meeting it met Associate Professor Phil Bagshaw, Chair of the Council of Medical Colleges, and on 28 July with Dr David Galler, Principal Medical Adviser to the Minister of Health.

The biennial elections were conducted at the beginning of the year with the following elected unopposed—Jeff Brown (President), David Jones (Vice President), Brian Craig, Judy Bent, Torben Iversen, Alastair Macdonald, John MacDonald, Andrew Munro, Gail Robinson and Paul Wilson.   Subsequently, at its 14 April meeting, the National Executive re-elected Brian Craig as National Secretary.  Dr Iversen is a new Executive member.  Dr Anthony Duncan did not stand for re-election and the Association is grateful for his wise contribution to the National Executive in two separate terms.

The national office remains a busy place.  This year its activities have centred on the implementation of national DHB collective agreement negotiations, as well as other collective bargaining (particularly with non-DHB employers), individual employment-related cases and disputes which involved the Senior Industrial Officer, Assistant Executive Director and, more recently, the new Industrial Officer.

The National Executive has approved some changes to the national office in recognition of the continual and increasing workload pressures of the national office, increasing membership numbers and the need to respond to membership enquiries and calls for advice and support more expeditiously.  This led to the creation of a new Industrial Officer role. Kirsty Campbell, whose previous industrial experience included working with the Australian Financial Sector Union, was hired as the new Industrial Officer.  It also led to some minor restructuring with Industrial Officer Henry Stubbs being re-designated Senior Industrial Officer and Industrial & Policy Advisor Angela Belich, Assistant Executive Director.

Consequently the national office now comprises seven full-time staff—Ian Powell (Executive Director), Angela Belich (Assistant Executive Director), Henry Stubbs (Senior Industrial Officer), Kirsty Campbell (Industrial Officer), Yvonne Desmond (Executive Officer), Kathy Eaden (Membership Support Officer) and Barbara Narasy (Administration Officer).  Bruce Corkill, barrister, continues to provide valuable counsel and support.  We have also engaged additional accounting support on a casual basis, usually to coincide with National Executive meetings, to assist with financial accounting and reports.

Implementation of National DHB (Multi-Employer) Collective Agreement Negotiations: MECA

As advised in the 2004 Annual Report the National Executive ratified the settlement of the national DHB collective agreement (MECA) following the indicative postal ballot conducted during late September-early October 2004 (based on a 57% response rate, 98% of members in the 20 affected DHBs voted for ratification).   Subsequently, in 2005, Northland DHB members voted at a special meeting to join the MECA which was then accepted by the Northland DHB and effective from 1 July 2005.  The MECA now applies to all 21 DHBs.

The MECA was signed by Executive Director Ian Powell and the DHBs’ lead chief executive for these negotiations, Stephen McKernan (Counties Manukau) immediately prior to Christmas and then forwarded to the remaining chief executives to add their signatures.  Unfortunately this process took much longer than anticipated with some tardiness in some DHB quarters.   The Association took the initiative in late January writing to all affected chief executives encouraging them to be expeditious in applying the translations to the new national salary scales and implementation of backdating.  This initiative included advice on the specific step to step translations in each DHB.  Regrettably, with a few exceptions, DHBs were tardy in their implementation, in some cases outright irresponsible, which meant that in some DHBs full salary implementation was not completed until mid-year.

The predominant theme of the MECA is the empowerment of Association members over their working conditions, at their workplace and within their DHB.  At this stage, however, it is clear that while some positive signs are occurring in the first, and to some extent the second, of these components, there has not been the recognition of the importance of empowerment by most DHBs who still see the relationship with their senior medical staff as ‘business as usual’.  Shifting the nature of the senior medical staff-senior managerial relationship will be an important ongoing priority of the Association.  The Executive Director also gave a presentation to the Ministry of Health on the MECA’s empowerment theme.

Joint Consultation Committees (JCCs)
The DHB-ASMS consultation committees which are required to meet at least three times per annum have been a major activity for the Association, particularly since the first one was held in May.  By the end of 2005, we will have had at least one JCC meeting in all 21 DHBs (at least two will have been held in eight DHBs and three in another eight; meetings are already scheduled as far ahead as February 2006).   The most common theme of the JCCs has been hours of work/job sizing.  Part of this has been the imperative of the time-and-a-half effective 30 December 2005 for average hours worked on rostered after-hours call duties.  But a large part has also been on reviewing job sizing of both clinical and non-clinical duties.

Although it has considerable potential only limited progress has been made on initiating the joint ASMS-DHB workforce development and education taskforce in each DHB.   This has largely been because of the focus on job sizing but it is expected to be a key area of activity next year.  These taskforces are charged with the responsibility of endeavouring to reach agreement over staffing plans, associated recruitment and retention strategies, and implementation plans for professional development and education, including sabbatical and secondment.

Another significant area of work required by the MECA, but yet to make much progress because of the newness of the JCCs and the emphasis on job sizing, is an agreed evaluation process between the Association and each DHB on the provision of suitable working conditions, resources and accommodation and for a process to address the remedying of any identified deficiencies.

Other issues discussed at some of the JCCs include:

  • Enhancing senior medical staff involvement in decision-making.
  • Compliance with the MECA’s appointment process requirement.
  • Compensation for RMO unplanned absences.
  • Application of the MECA’s consultation requirements for reviews and service planning.
  • Local service provision and organisation issues.
  • Travelling time for CME leave and related issues.
  • Hospital redevelopment initiatives.
  • Restoring access to medical school online library.

What has been apparent is the importance of national office involvement in the JCCs, perhaps more than might have been anticipated.  Some of this involvement comprises organisational arrangements, communication to our JCC teams, and wider membership communication.  But it also requires an active involvement in the JCCs themselves to ensure that they do not lose focus, to counter occasional managerial misinterpretation or misrepresentation of MECA provisions, and for a de facto advocacy role.  To date, with one exception, all this has been undertaken by the Executive Director.

Job Sizing
Job sizing has been a major feature of JCC activity although pursuing it is not confined to this process.  Some of this has involved planning for the implementation of time-and-a-half for average hours worked on rostered after-hours duties in those DHBs where it (or a higher rate) is not already in place and it is disappointing, although not surprising, that too many DHBs are tardy in their approach to this responsibility.

Outside the implementation of T1.5 our work in JCCs has fallen into the following areas:

  • Constructive agreements with some DHBs for across-the-board processes to handle  job sizing reviews (including clinical and non-clinical duties).
  • Constructive discussions with several DHBs over the provision of the 30% minimum for non-clinical duties.
  • Use of the workforce development and education taskforce as an alternative means for addressing job sizing.

Where the JCC is not able to be a vehicle for addressing job sizing reviews due to the negativity of some DHBs, we are encouraging members themselves to be proactive with Association support.  To assist this, as well as to support our JCC activities discussed above, we have produced a new publication, ASMS Standpoint, whose first issue is specifically on hours of work and job sizing inclusive of a guide on how to simplify and implement job sizing.  We will be supporting this with the forthcoming production and circulation of a ‘frequently asked questions’ document for members.  Further, we are considering the use of DHB league tables rating the performance of each DHB in terms of its commitment to recognition of the 30% minimum for non-clinical duties.

At its 14 April meeting the National Executive considered the effect of the 10 working days annual continuing medical education leave provided by the MECA on the 30% minimum for non-clinical duties.  The Executive considered that this paid leave was separate from the CME activities referred to in Clause 49 (Section 5) of the MECA which is for ‘on-the-job’ CME and therefore an ongoing element of members’ regular job size.  Consequently the Executive concluded that the 10 working days CME leave should not be deducted from the time necessary to perform non-clinical duties.

National Processes
The MECA establishes several national processes focusing on implementation, enforcement and extension.  We have not been able to make any progress on these because of preoccupation with other MECA issues and the lack of a readily accessible DHB national process to work with.  Nevertheless the National Executive has been developing policy directions on them.  These issues and our approach are:

  1. Standardising the availability allowance for being on after-hours call rosters. [Developing a paper likely to focus on the identification of key principles whose application can then be negotiated at an individual DHB level.]
  2. Standardised national system for pro rata calculation of remuneration for part-timers.  [An Executive proposal will be presented to Annual Conference.]
  3. Arrangements (including remuneration) for unplanned absences of resident medical officers.  [This is seen as best pursued at an individual DHB level at this stage using the Auckland DHB minimum rate as a benchmark.]
  4. Arrangements (including remuneration) for working on evening, night and weekend shifts.  [This is seen as best pursued at an individual DHB level at this stage.]
  5. National guidelines for enhancing senior medical staff involvement in DHB decision-making to be followed by a national conference.  [Work currently in progress.]
  6. Workforce development and education taskforce national conference.  [Too early to progress but the subject of informal national discussions.]
  7. National guidelines for limiting hours of work including taking into account the European Working Time Directive.  [Work currently in progress but may be subsumed in the next national negotiation following the lessons of the Executive Director’s visit to Britain.]
  8. National strategy for services and workplaces where registrars are not employed.  [Policy paper prepared for National Executive based on developing a set of principles that provide a negotiating basis.]
  9. Ownership of intellectual property rights.  [Work currently in progress.]
  10. Developing a standardised national system for the debiting and accrual of annual leave.  [Work currently in progress.]
  11. Protection from vulnerability to infectious diseases.  [Referred to the Council of Trade Unions health committee for consideration.]

The Association has also approached the DHBs for an informal national meeting, expected to be held in November, to discuss how to approach these matters.

Delegate Development
Due to the magnitude of our work it has not been possible to progress the implementation of an effective delegate system.  To some extent the JCCs have formed an initial basis of this important objective with empowerment of local membership to re-establish and strengthen local branches.

Bargaining Fee

Part 6B of the Employment Relations Amendment Act 2004 provides for a bargaining fee for non-union members to be included as a clause in a collective agreement provided that:

  • It is agreed between the employer(s) and the union.
  • It is first agreed to in a secret ballot covering all employees (members and non-members) who undertake the duties and responsibilities contained in the collective agreement’s coverage clause.  The ballot is to be conducted by the union and the employer(s).
  • A majority of the employees eligible to vote must vote in favour (for a MECA this would be employer by employer).

This amendment to the Employment Relations Act was adopted too late for it to be considered by the Association for the national DHB collective agreement (MECA).  However, it was able to be considered for the nurses’ and resident medical officers’ MECA and was adopted and included in both.  The other main example is the first time supermarket MECA covering three main chains.

The National Executive has considered this new legislative opportunity and has agreed to recommend to Annual Conference that the Association seek to include bargaining fees for its collective agreements.  If adopted the main impact would be on the national DHB MECA but it could also apply to our non-DHB collective agreements.  A background paper will be provided for Annual Conference delegates.

The Non-DHB Sector

The Association’s role in the non-DHB sector is varied.  We have had, at different times, collectives covering general practitioners in union and community health; GPs and secondary care 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.  This year has seen interest in Association membership from other employed GPs working for the Ngati Toa Iwi authority in Wellington, Pasifika Health in West Auckland and “the Doctors” (a private GP company) in Masterton.  Individual employed GPs have also contacted us and received advice though the option of collective negotiations is not open to them unless they have colleagues who also join the Association.  There are about 15 doctors who have joined on this basis.  We have also a few members at ACC (9) who we advise on their individual agreements.  Ministry of Health doctors also contact us from time to time although they are not eligible for membership.

Work in the non-DHB sector has also included considerable work protecting isolated members working for employers where they are the only doctor and the employer is unused to running a medical practice and the independent standards that this entails.  A relationship breakdown in workplaces this small is almost never fixed and as doctors have more options than managers, leads to the doctor leaving.  This means the manager is left to do damage another day.

Collective Bargaining in the Non-DHB Sector

SALARIED GENERAL PRACTITIONERS
An increase in GP salaries this year has placed some strain on the employers we deal with and seen mobility in previously stable workforces.  The salaries in our collective agreements were clearly lower than the market rates identified in the Medical Assurance Society survey of private GP incomes.

Hokianga Health Enterprise Trust
A further variation was negotiated to this collective which expired in October.  As of July 2005 each salary on the scale was increased by $20,000 pa.  This brings the top hourly rate to  $65 an hour.  There is an entitlement to six weeks annual leave.  The Association has three members employed by the Trust.

Auckland Union Health Centres: Otara and Waitakere
Negotiations have taken place at Otara and Waitakere where doctors are covered by expired collective agreements.  The employer has proposed a collective covering both Waitakere and Otara.  We are awaiting a formal offer.  The Association has two members at West Auckland and one at Otara.

Ngati Whaatua Ki Orakei
The collective agreement has expired and most GPs who were our members have left.  The service is presently staffed largely by locums.

Wellington Primary Health Services
This multi-union, multi-employer collective agreement covers the single largest number of salaried GPs (14).   Some of the services covered by this collective faced a recruitment crisis.  The new collective agreement has achieved increases (but from a low base) of from 6% to 14% with the big increases at the bottom of the scale to help recruitment.  The top hourly rate is now $51.92 an hour.  There is an entitlement to five weeks annual leave at the completion of the fourth or fifth year of service.  The new agreement (which is presently being signed by the 14 parties to it) has a provision committing the parties to approach the DHBs concerning mechanisms whereby the DHBs can support salaried general practice.  One of these options will be the provision of direct employment of GPs by DHBs.

Union and Community Health Centre (Christchurch)
This collective agreement covering three doctors has been renegotiated.  The top rate in the new collective is $55.54 per hour.  The doctors also have an entitlement to five weeks leave each year.

COMMUNITY HOSPITALS

Central Otago Health Services (Dunstan Hospital, Clyde)
This collective agreement has been settled with the MECA medical officer scale and an agreement on how to implement the 30% non-clinical time.  The employer has been warned that the implementation of a vocational pathway for rural doctors will result in a claim for the DHB specialist scale.  There are seven members employed at the hospital.

Waitaki Hospital (Oamaru)
A collective agreement has been agreed incorporating the medical officer scale from the MECA.  We were not able to implement the 30% dedicated non-clinical time as the employer argued that there was considerable down time on some shifts.  There are two members employed at this hospital.

HOSPICES
We initiated bargaining in February with six hospices after a secret ballot of our members and have developed a claim.  The process then stalled as the hospices appeared unable or unwilling to even nominate an individual for us to liaise with.  However, recently the chief executive of the Arohanui Hospice Trust where we have historically had a collective agreement has helped to restart the process suggesting that we do as much of the process as possible by email as the costs of negotiation has proved a considerable barrier for the hospices in negotiating the nurses MECA (with a much larger membership than our 20).

NEW ZEALAND BLOOD SERVICE
A separate collective agreement reflecting most of the MECA conditions has been negotiated for the five members in the NZ Blood Service.  The other six doctors have not joined the Association.

FAMILY PLANNING ASSOCIATION
A recruitment crisis has precipitated a salary offer from FPA which improves salaries by a minimum of 7% and introduces a separate scale for some vocational registrants.  This would bring the top salary rate to $51.86 an hour.  The negotiating team is prepared to accept the offer as long as a working party is set up to look at CME and work related expenses.  We are awaiting an employer response.  We have 23 members at FPA.

WIPA DOCTORS
A settlement has been reached reflecting the scales and other conditions in the MECA. It is yet to be signed.  The Association has four members at WIPA.

Senior Industrial Officer’s Activities

The appointment of a second Industrial Officer, Kirsty Campbell, in April has provided very welcome relief for the Association’s industrial team.   Regular team meetings (usually weekly) are now held to coordinate workload and workflows generated by membership enquiries and requests for assistance.  They also provide a regular forum for the industrial staff to share information and consult one another about particular issues and problems faced by our members.

These industrial team meetings are a good opportunity for “peer review” and “quality assurance” and are a useful check to ensure our advice to members, on similar issues, is both consistent and practical.

Routine telephone and email enquires from members to the national office are now usually referred to Industrial Officer, Kirsty Campbell in the first instance.  Accordingly the balance of the Senior Industrial Officer’s workload has shifted from routine enquiries to more complex and time-consuming matters.

In particular, these have included:

  • complex individual cases that raise performance issues, including concerns about a member’s clinical competence; concerns about their health and their ability to continue to work;  misconduct complaints; destructive workplace relationships and complaints about (or from) colleagues or managers;
  • requests from groups of members and specific services for assistance with issues relating to workloads, staffing levels and job sizing.

Some notable features of his activities in the course of the past year have been:

Referrals to Mediation, Employment Relations Authority or Employment Court
In the course of the last year, the Senior Industrial Officer has taken four matters to mediation and assisted Bruce Corkill (the Association’s barrister) in one matter before the Employment Court.  He also assisted the Medical Protection Society legal team to deal with another matter in both mediation and the Employment Court.

In summary, these cases related to:

  • Doctor A was made redundant following a service review and restructure. The matter went to mediation and was satisfactorily resolved.  The doctor was not reinstated.
  • Doctor B was dismissed for serious misconduct.  The matter went to both mediation and the Employment Court, who ordered the doctor’s reinstatement pending a full hearing of the matter.  This matter is ongoing and has yet to be finally resolved.
  • Doctor C had restrictions imposed on aspects of his practice.  The Association and the MPS challenged the restrictions and referred the matter to mediation.  The matter has not been finally resolved and (after more than a year) the restrictions remain.
  • With the support of the Association, Doctor D claims he should be paid as a specialist under the national DHB MECA, as opposed to being paid as a medical officer.  He is vocationally registered as a Fellow in Accident and Medical Practice but his employer refuses to recognise him as a specialist.  This matter has been to mediation but has yet to be resolved.
  • Doctor E lost his claim in the Employment Authority to have his on-call earnings (about 30% of his income) included in sick pay during a long (five month) period of illness.  The collective agreement required “reasonable leave with no deduction from salary” during periods of illness.  The Association appealed to the Employment Court where a full rehearing was conducted.  The decision is expected at any time soon.

Dismissals and Suspensions
In the course of the year, the Senior Industrial Officer has advised, supported or represented eight members who have been dismissed or otherwise had their employment terminated “involuntarily”.

  • Doctor A was made redundant and is the same Doctor A referred to in the previous section;
  • Doctors B and F were dismissed for serious misconduct in separate and unrelated incidents.  The Dr B is the same Dr B referred to in the previous section.
  • Doctor G resigned rather than be dismissed for serious misconduct, related to an issue of “boundaries”.
  • Doctor H resigned after a long period (twelve months) off work on full pay, following an accident.  At the time there was no immediate prospect of a recovery that would allow a full return to work.
  • Doctor I was not appointed to a permanent position (following a long period as a locum), despite some early but rather imprecise “assurances” of a permanent appointment. 
  • Doctor J “retired” somewhat involuntarily after a long career when the conflict between his view as to how his patients should be treated clashed irreconcilably with the requirements of the service and the orders of the manager.
  • Dr K was dismissed after many months of “non-clinical” duties following complaints about his practice, competence and honesty.  MPS were dealing with the Medical Council aspects of this case and in due course the Association declined to represent the doctor further on the grounds his case was hopeless and without merit.

Complaints about Behaviour
The Association continues to advise and support members who find themselves in difficulties following complaints from resident medical officers, nurses, colleagues and managers about abusive behaviour.  Sometimes however the member seeks support to bring their own complaint about workplace bullying or inappropriate behaviour on the part of others.  Two particularly difficult cases saw the Association supporting members who had brought their own complaints against a colleague (in one case) and a manager (in the other).  In both cases, the matter had escalated to a worrying level because of the employer’s (initial) reluctance to confront the real issue, which was one of personality conflict and workplace bullying.

Health Concerns
This year we have assisted three members who have had long-term illness: in one case the lack of full recovery lead to the end of the member’s employment (Dr H above) and in both other cases the outcome has yet to be determined.

In yet another case, the idiosyncratic behaviour of a doctor raised alarm bells with the employer who required the doctor to undergo an independent neuro-psychological assessment; he was subsequently declared fit and well, neurologically speaking.  The real issue, in our view, was that the doctor was overworked and under-supported by his service.

Together with MPS, we have also advised and assisted another member who has now returned to work part-time, after a period of illness, brought on by work-related stress and lack of resources and support in his service.

Concerns about Clinical Performance
The Senior Industrial Officer continues to work closely with the medical advisers and barristers of the Medical Protection Society in cases where concerns have been raised (in the employment context) about a member’s clinical performance or competence.

In the course of the year, seven members have been advised or otherwise supported by the Senior Industrial Officer in respect of complaints or concerns about their clinical performance.  In four of these cases the member was initially suspended and in two of them the Association was able to quickly return them to supervised clinical duties while the substantive issues were investigated.  In the other two cases, the doctor remains completely “off work” pending a performance assessment by the Medical Council (in one case) and (in the other) an agreement with the doctor on the terms of a temporary regime of supervisions.

In two other cases, limited restrictions on practice were imposed pending a full independent external review of the areas of concern.  In one case, the doctor has been “cleared” and has resumed full duties.  In the other the restrictions continue pending agreement on the terms of reference for the review and agreement on the two reviewers.

In the last case, the doctor remains heavily supervised by both the employer and the Medical Council.  However, with the assistance of both the Association and MPS, this member is making some progress and a decision on his future is likely to be made before the end of the year. 

Visits to DHBs and Meetings with Members
Both the Senior Industrial Officer and the Assistant Executive Director frequently travel throughout New Zealand for meetings with members and their managers.  In the last 12 months the Senior Industrial Officer has spent 82 whole or part days out of Wellington, meeting members and responding to their concerns.   This has had a significant impact on his ability to attend to other matters in a timely manner.

The appointment of Kirsty Campbell as the second Industrial Officer, along with the work of Kathy Eaden as Membership Support Officer, has undoubtedly relieved his workload and in future should ensure that routine and urgent membership enquiries will be dealt with promptly, notwithstanding the (at times) demanding travel commitments of other members of the industrial team.

Assistant Executive Director’s Activities

Policy
Health workforce issues were an important part of the workload this year.  The submission to the Health Workforce Advisory Committee is dealt with elsewhere in the report.  In addition there was work on the Mental Health Workforce Plan which was unfortunately given to the Association too late for a substantive submission.

The Assistant Executive Director attended the various Council of Trade Union bodies (National Affiliates Council when the Executive Director was absent) and attended CTU State Sector and Health Committee meetings.  A watching brief has been kept on the CTU contribution to the work of the Pay Equity Taskforce.

 She attended briefings and workshops run by ACC as they continued to pursue their very consultative development of the new medical misadventure system.  Further, she attended the Pan Professional Medical Forum and the DHBNZ/CTU bipartite meeting when the Executive-Director was overseas.  Other policy work appears under separate headings.

Industrial
Much of the work of the industrial staff in the past year has been around national DHB MECA implementation by the DHBs and interpretation of the MECA for members and is dealt with elsewhere in the report.  The lack of forward planning for implementation by DHBs caused considerable work for the industrial team and has distressed members.  This work should not have been necessary.  We continue to find issues where DHB human resource  managers purport to have failed to register the changes made by the MECA.  Where it has been a straightforward omission to implement wages or conditions it has been relatively easy to obtain redress.  It has been harder to untangle processes that have been embarked upon seemingly on a basis of ignorance of the relatively stringent MECA provisions and instead on the basis of some sort of generic requirement to consult.  Particular features of interpretation were the provisions putting vocational registrants on the specialist scale, CME, non-clinical time, sabbaticals and job sizing.   Some DHBs had particular difficulties with the clauses dealing with superannuation and with the timing of salary increments.  Others had difficulty with parental leave and the new requirements for appointment processes.  The work of the new Industrial Officer in taking many of these issues when they can be dealt with by letter, email or phone has meant that increasingly the Senior Industrial Officer and Assistant Executive Director can concentrate on more complex cases or those requiring travel.

The shortage of RMOs over the winter, especially critical in Northland and Southland, is worthy of note and caused a short intense burst of work plus media interest.  It is not clear at the national level that this will not be an issue again next winter.

The Assistant Executive Director formed part of a working party established to deal with difficulties that had occurred between the Waikato DHB forensic service and the local Maori health provider.  While time consuming the only achievement of this process was to agree to a respected independent psychiatrist’s involvement in an ongoing capacity.

The introduction and widening of unsociable work hours in Christchurch, Southland and the Hutt for medical officers caused some work which has not yet been satisfactorily resolved.  A satisfactory template for shift work has yet to be achieved.

Particular services had presented with an initial problem of enforcement that seemed easy to resolve only to reveal a cornucopia of problems almost always arising from a combination of longstanding poor management and under resourcing.

Industrial work in the non-DHB sector is dealt with elsewhere in this report as is the restructuring of laboratory services.

Surveying Full-Time DHB Senior Medical Staff Income

The Association has completed its annual (11th) survey of full-time equivalent salaries (FTE) for DHB employed senior medical staff based on our negotiated collective agreements.  The survey provides the most helpful comparative indicator of the salary gains that have been made since the commencement of local bargaining in 1993.  Advances are attributable to advancement through the salary scales.  The survey was taken before the MECA had been implemented.  The increases are lower than past years largely attributed to delays associated with the negotiation and implementation of the MECA.

The 12th (1 July 2005) survey is currently underway and will provide a direct comparison using the common MECA scale for the first time.

On 30 June 1993 the mean FTE specialist base rate was $85,658.  By 1 July 2004 this increased to $131,740 (a raw increase of about 53.8%).  This represents a 1.5% increase on the 2003 mean.  The mean female salary is $127,290 compared with the mean male salary of $133,175 (excludes Otago and MidCentral who do not supply a gender breakdown).

For medical officers the equivalent salary movement on 1 July 2004 was from $67,457 to $101,640 (a raw increase of 50.7%).  This represents a 1.6% increase on the 2003 mean.  The mean female salary is $99.362 compared with the mean male salary of $103,213.

These are mean full-time equivalent base salaries and do not take into account hours worked in excess of 40 hours per week (i.e. recognised through job sizing), the availability allowance or any other special enhancements.

Surveying DHB Senior Medical Staff Superannuation Entitlements

We undertook our fourth survey of superannuation entitlements in DHBs, effective on 1 July 2004, which covers 2107 senior medical staff receiving subsidised superannuation.  The largest group receiving subsidised superannuation are the 1381 members whose schemes are based on the Association’s collective agreements.  The next largest group, 665, is the former government and legislation-based superannuation schemes (National Provident Fund and Government Superannuation Fund); to which access for new entrants was closed off by 1992.  The balance of members in super schemes, 61, is covered by other subsidised arrangements.

New Constitution

At the 2004 Annual Conference the Association adopted a new constitution, the first major revision of our original Rules since they were first adopted in 1989.  The constitution has now been registered with the Registrar of Incorporated Societies.

Tertiary Intern Grant

In the previous Annual Report we reported that the National Executive supported the campaign by the Medical Students’ Association requesting 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 Medical Students’ Association used our support as well as that from the NZMA as part of its advocacy with government and it was pleasing to note that its objective was achieved in the 2005-06 Budget.

Fit for Purpose and Fit for Practice

The Medical Reference Group of the Health Workforce Advisory Committee prepared a consultation paper titled Fit for purpose and fit for practice: A review of the medical workforce in New Zealand.  In our submission responding to the report we welcomed the paper considering it to be ‘excellent, well researched, well thought out and should have appeared several years ago in order to effectively use the strategies it sets out to address the urgent problems it identifies.’  Further, we identified the following immediate priorities:

  • The number of doctors in training must increase in all specialties.
  • Medical student debt must be addressed systematically.
  • We agreed that a major review of work, staff and training at hospitals is necessary.
  • The nursing and senior doctors’ MECAs provide a basis for addressing workforce and service configuration issues nationally.
  • Ways of streamlining the funding system should be addressed.
  • Doctors’ salaries need to increase to levels more commensurate with global rates.

The Medical Reference Group is to issue their recommendations before the end of the year.

Clinical Training Agency’s Proposed Training Programme for Medical Officers

In late April the Clinical Training Agency sought responses on a series of questions about its proposed training programme for medical officers (non-specialist doctors formerly known as medical officers of special scale).  The Association’s submission identified three broad categories of medical officers—those working as rural hospital generalists, those working in vocational branches of medicine without vocational registration, and those working as hospital generalists partly in response to resident medical officer shortages (this third category may be more notional at present than real).  Consequently the training requirements for these three groups are quite different and the CTA’s paper was unclear which, if any, of these groups it was aiming at.  The Association has also asked the Director-General of Health to clarify where this work might next go.

Relationship with Minister of Health

The Association has continued to meet the Minister of Health, Hon. Annette King, although the frequency changed from a two to three-monthly basis, with both the National President (the Vice President in his absence on one occasion) and Executive Director attending, along with the Assistant Executive Director on one occasion.  The main subjects for discussion were Medical Council nominations, government protocols for private sector involvement in DHB provided health services, proposed privatisation of the Otago and Southland DHB hospital laboratories, above national DHB collective agreement conditions, Family Planning Association funding, and the Pan Professional Medical Forum.  In addition, the Executive Director has also maintained informal contact with the Minister’s office and has had a series of informal discussions.

Following the declaration of the results of the general election and a discussion between the Executive Director and the Council of Trade Unions President, the Association has prepared a paper which the CTU has presented to government seeking a health professional led approach to the provision of secondary and tertiary services through a taskforce established to facilitate the formation and strengthening of national and regional clinical networks and make specific recommendations on resource utilisation, organisation and provision of elective, chronic and acute services in each of the DHBs.  This paper seeks to promote the achievement of two ambitious objectives within the next three years:

  1. Health professionals will have confidence that there are tangible improvements in access to and quality of health services.
  2. The public perception of the health system is that it is improving rather than deteriorating.

The Minister’s annual letter of expectations to DHBs for the 2005-06 year continued to be an improvement on the narrow fiscally based letters of the 1990s.  Particularly pleasing were the continuing emphasis in the letter to shared decision-making with clinicians and ongoing quality improvement activities in DHBs.  The Minister’s implementation priorities included:

  • Progressing the primary care strategy, including stronger Primary Health Organisation infrastructure, workforce and information management.
  • Developing health infrastructure, including workforce, information, performance assessment and management, and developing regional networks between DHBs.
  • Improving elective services.
  • Cancer Control Strategy.
  • Keeping infrastructure costs as low as possible and within the expenditure track forecast in the district annual plans.
  • Industrial relations strategies, including ‘fostering workforce cooperation on DHB initiatives and affordable remuneration solutions.’

The Minister also commented in relation to ‘shared decision-making’:

          While the final responsibility for DHB strategy rests with boards, and for
          operational decisions with Chief Executives, decisions will be best informed
          when clinicians are involved at all levels of the decision-making process. 
          Ensuring good clinical governance is necessary as is providing a direct link
          into service planning and management.

Relationships with other Political Parties

Largely through the Executive Director and our social functions, the Association has maintained and further developed contact and liaison with the other political parties, in particular, National, ACT, United Future and NZ First along with Labour’s junior coalition party, Progressives.  One difficulty with National was the high turnover of health spokespeople, three in little over a year, but we have a good relationship with current spokesperson Dr Paul Hutchison helped by the fact that since the 1999 general election he had previously been an associate health spokesperson.  These relationships along with the Greens and Maori Party will have to be further developed over the next 12 months especially given the shape of the new Parliament.

Meetings with Director-General of Health

The Executive Director continued his regular informal meetings, usually monthly, with the Director-General of Health, Dr Karen Poutasi.  Deputy Director-General Dr Colin Feek often attended.  This year there have been seven of these informal meetings to date that provide a constructive means to raise issues, perspectives and differences that might not otherwise be brought to her attention.  A common discussion point has been reporting back on the main themes and performance of the Joint Consultation Committees in each DHB created by the national DHB collective agreement.

Topics for discussion included:

  • Ratification and implementation of the national DHB collective agreement.
  • A possible DHB-ASMS national workstream looking at workforce development issues.
  • Primary triage and public hospital emergency departments.
  • The effect on senior medical staff of resident medical officer shortages.
  • Government protocol for private sector involvement in DHB provided services.
  • The DHB based reviews of laboratory services including the proposed privatisation of the hospital laboratories of the Otago and Southland DHBs and the Auckland regional proposal (now abandoned).
  • Clinical Training Agency medical officer paper.
  • Nominations for Medical Council.
  • Increased cataract funding announcement.
  • Family Planning Association funding.
  • Capacity of non-government organisations to employ doctors.
  • DHBs employing salaried GPs following West Coast DHB promotion initiative.
  • AC Neilsen poll on performance of health system.
  • Ministry of Health concerns over viability of paediatric neurology.
  • Otago-Southland DHB clinical services reviews.
  • Southland DHB’s engagement of Proudfoot Consulting.
  • Waikato DHB and Hauora Waikato involvement in forensic mental health services.
  • Pan Professional Medical Forum.
  • Possible conflict of interest of DHB chair undertaking consultancy work in neighbouring or other DHBs.
  • Doctors-in-training roundtable.
  • Specific internal DHB problems.

Medical Misadventure

The long anticipated amendment, Injury, Prevention, Rehabilitation and Compensation Amendment Bill (No.3), to the Injury Prevention Rehabilitation and Compensation Act 2001 has now been passed honouring a commitment made by the Minister of Accident and Compensation, Ruth Dyson, to our Annual Conference in 2001.  Under the amendment, ACC’s Medical Misadventure cover was replaced by a new category called treatment injury, which took effect from 1 July 2005.

A treatment injury is a personal injury occurring in the context of treatment by a registered health professional, but which is not a necessary part, or ordinary consequence, of the treatment.  This brings treatment injuries into line with other injuries, such as sports and work-related, covered by ACC.  In other words, treatment injuries will now be ‘no-fault’.

The Association is very supportive and pleased with this change which arises out of an extensive and effective consultation process that the Ministry of Health and several DHBs should well consider following.

Medical Council

General Activities
The Association has continued its networking with the Medical Council over the past 12 months.  The Executive Director and President of the Medical Council have also maintained informal contact on relevant strategic matters, including nominations to the Medical Council and the possibility of conducting elections.

The Association made a brief representation supportive of the general direction of the Medical Council’s draft statement on safe practice in an environment of resource constraint.  However, we opted not to make a submission on the Council’s draft guidelines on doctors using the internet and instead left it to the colleges and individual members (who we advised of the draft guidelines in ASMS Direct).  We also adopted the same approach to the Council’s draft definition of ‘cultural competence’.

Medical Council Nominations
In March the Ministry of Health unexpectedly called for nominations to positions on the Medical Council in a way that would have precluded a reasonable opportunity to make effective representations and also preventing the Council from conducting elections in order that the Minister of Health might consider the outcome as favourably as she did for the Dental Council (on the latter occasion the elections were conducted by the Dental Association and the Minister appointed all the elected candidates).

Consequently the Association wrote to the Minister recommending that she re-appoint all current elected members (elected under the now repealed Medical Practitioners Act) for a further year in order to allow for the current Council to continue to work through transitional issues associated with the implementation of the Health Practitioners Competence Assurance Act and to allow the Council the opportunity to conduct elections in 2006.  Other organisations made similar representations and it was pleasing that the Minister accepted our advice.

The reinstatement of the right to elected representation of practitioners to the Medical (and Dental) Council is likely to be an important issue this year in light of the composition of the new Parliament for both the Association and the Pan Professional Medical Forum.

Performance Evaluation Programme
In response to the requirements under the Health Practitioners Competence Assurance Act, the Medical Council has announced its intention to introduce a performance assessment system, known as the performance evaluation programme, following a trial of 18 volunteers.  The National Executive was initially apprehensive because of the misplaced perception that it would apply to all doctors with a random 10% doing the assessment each year.  However, the situation became clearer following a presentation to the Pan Professional Medical Forum by Professor John Campbell on behalf of the Medical Council.  In particular:

  • The main focus of the programme is those who are not meeting the current CPD requirements.
  • The focus is on general registrants who are not in a college programme.
  • The Council is discussing with a number of colleges to arrange an exemption from the personal assessment where college programmes were deemed to meet the needs of the CPD.

Professor Campbell also kindly provided an article for The Specialist on the performance evaluation programme.

Doctors-in-training Roundtable

As reported to the 2004 Annual Conference the Minister of Health has established what is now described as the Doctors-in-training roundtable to consider workforce and associated training needs prior to vocational registration.  The Association is represented on it by National President Jeff Brown.

Relationships between Senior and Resident Medical Officers

Relationships between senior and resident medical officers continued to be an ongoing subject of discussion by the National Executive and national office staff.  On 9 February the President of the Resident Doctors’ Association, Dr Ian Rosemergy, wrote to the Association expressing his union’s concerns about this relationship.  This led to both him and the RDA General Secretary meeting the National Executive at its informal meeting on 13 April for a useful discussion.  We also invited the RDA to provide an article for The Specialist but this offer has not been taken up.  The National President has also used his regular column in The Specialist to promote closer relations between senior and resident medical officers.

Public Hospital Laboratories

As a result of devolved funding from the Ministry of Health, DHBs have assumed responsibility for funding community as well as hospital laboratories.  Most community testing is undertaken in private laboratories which are now a duopoly.  As these time-limited contracts come up for re-negotiation DHBs have been concerned about the fiscal challenges of the uncapped demand driven nature of these contracts.  Some have contemplated privatisation options that would affect Association members in hospital laboratories.  The Association has been active with success in persuading DHBs not to consider privatisation.

However, the Otago and Southland DHBs opted for a rigid ‘winner-take-all’ single supplier bidding process and then in a highly questionable process without any effective consultation or engagement with their laboratory staff resolved to recommend to the Minister of Health that their hospital laboratories be privatised and run by a merger of the two private laboratories.  However, in addition to the Minister’s approval the decision was conditional on Commerce Commission approval for the merger.  The Minister ‘froze’ all consideration on the process by her Ministry officials.  Subsequently the Commerce Commission declined the application because it was considered to be anti-competitive (this decision may be appealed).  The process is also subject to an Auditor-General’s investigation and the Association has advised both DHBs that its actions fail to comply with the consultation requirements of the national DHB collective agreement.

All this has created a situation of considerable instability for the laboratory staff in both DHBs, including Association members, who do not want to work for the proposed new provider and who have been seriously disempowered by this process.  It has already led to a loss of valued staff in one DHB while the other is similarly vulnerable.  While it is increasingly unlikely that the privatisation will proceed our members have been subjected to a destructive and demoralising experience.

Protocols for Outsourcing (Privatising) DHB Services

Since late February the Association has been involved in informal discussions with the Minister of Health, her advisers and the Ministry over the protocols for outsourcing DHB services.  The current protocols are reasonable with an emphasis on continued public provision but would benefit from more explicitness, removal of ambiguity and updating.  The laboratory reviews in several DHBs plus some other poorly thought out privatisation proposals have highlighted our concern.

Consequently the Association and NZ Nurses Organisation met with the Principal Medical Adviser to the Minister of Health and agreed upon a revised draft.  Apart from some updating the main elements of the draft were:

  • Making the preference for public provision more explicit in order to avoid any ambiguity among or within DHBs.
  • Inclusion of the importance of public provision capacity building.
  • Inclusion of the importance of inter-DHB (regional and national) collaboration and coordination in service provision and delivery.

The draft was forwarded by the Minister to the Ministry whose initial response appeared unsympathetic.  However, further Association discussion with the Minister has led to the Ministry agreeing to engage with the Association and NZNO over the draft new protocol.

Council of Trade Unions

The Association is continuing its good relationship with the Council of Trade Unions (CTU) at both a national office level and with the affiliates.  The Executive Director usually attends the CTU’s quarterly National Affiliate Council (unfortunately only able to attend two of the three held to date) while either he or the Assistant Executive Director participates in the Health Committee along with the Nurses Organisation, Public Service Association and Service Workers’ Union.  The CTU regularly meets with DHB chief executives which the Executive Director (or in his absence the Assistant Executive Director) attends as part of the CTU team.

A major success of the CTU was effective lobbying over the adoption of the Employment Relations Law Reform Bill.  In recognition of the CTU’s effectiveness the Association opted to work with and through it in promoting the health professional led approach to secondary and tertiary care discussed above.

A major initiative in the private sector actively supported by the CTU has been the ‘5% in 05’ collective bargaining campaign developed by the Engineering Manufacturing and Printing Union and quickly adopted by other private sector unions such as the National Distribution Workers Union and Service and Food Workers Union.  The premise is that no collective agreement will be ratified by the union unless it includes at least a 5% wage/salary increase (there is flexibility over effective dates and length of the term).  This campaign is proving to be successful with the large majority of collective agreements achieving this objective and the outcome being reflected in official data on wage and salary movements in the private sector.  It is also demonstrating increased workforce confidence about the relevance and effectiveness of private sector unions.

Issues considered by the National Affiliate Council included:

  • Training union health and safety representatives.  There are now over 20,500 official representatives including four Association members.
  • The amended Employment Relations Act.
  • The significant achievement of a multi-employer supermarket collective agreement negotiated by the National Distribution Workers Union.
  • Union Cooperation Pact and Protocol in response to short sighted and counter-productive disputes between unions over members.  The focus is on developing cooperative inter-union relationships rather than dispute resolution.  This is predominantly a problem in the private sector, such as casinos, ironical given its low union density.
  • Code of Good Faith Bargaining Review Committee which includes CTU representatives.

On 17-19 October the Executive Director and Assistant Executive Director represented the Association at the CTU Biennial Conference.  The conference had the theme ‘Towards 2010’ and was upbeat: celebrating a 17% growth in union membership since 2000.  The focus was on increasing union density in the private sector which is still low and much lower than in the state sector.  The conference was addressed by the Prime Minister, Helen Clark, the Green’s Industrial Relations spokesperson, Sue Bradford and by the new Minister of Labour, Ruth Dyson, only an hour and a half after her appointment was announced. 

There was some tension arising from remits put forward by the Service and Food Workers Union intended to discourage the poaching of members.  However, the conference overall voted to reject them largely because of their impracticality rather than any failure of sympathy for the Service and Food Workers Union’s case.  The conference also voted to set up a campaign fund to support campaigns like the 5% wage campaign and employees taking action to achieve it.

Pan Professional Medical Forum

Within the medical profession, including the colleges and the Association, there is increasing and widespread concern that policy-makers do not act as though there is a single pan-professional body representative of the medical workforce.  Partly in this context the Council of Medical Colleges under the leadership of its new chair, Associate Professor Phil Bagshaw, has developed a new strategic direction.  In the meantime the Medical Leaders Forum convened by the NZMA was discontinued due to a view among several participants that it was not demonstrating sufficient relevance to the medical profession.

On 10 March the CMC facilitated a meeting of around 35 medical organisations including the colleges, ASMS, RDA, Association of University Staff and several professional associations and societies (the NZMA opted to attend in an observer status).  The main discussion point was the acceptance that the medical profession did not have an effective pan professional voice and the importance of developing one.  The outcome was an agreement to form a joint steering group comprising the CMC, ASMS, RDA and NZMA, to further progress the concept of a pan professional medical organisation or grouping.  Initially known as TARDIS it has now become the Pan Professional Medical Forum.  To date four meetings have been held on 14 April, 21 June, 25 August and 27 October with a further meeting scheduled for 6 November.

The main action to date has been to write, based on a draft prepared by the Association, in the name of the Pan Professional Medical Forum to the Minister of Health recommending that she seeks to amend the Health Practitioners Competence Assurance Act to provide for elected representation of medical practitioner positions on the Medical Council and that in the interim she use her discretion under the Act to allow the Medical Council to conduct elections when current terms expire in 2006 and to appoint the successful candidates.  The Forum received a respectful reply while not accepting the request to amend the Act, leaving an open door on the interim proposal.  The Forum has desisted from further action until after the outcome of the general election was clear but this issue is expected to be a major priority.

Other issues considered by the Forum have been:

  • Medical Council performance assessment (Professor John Campbell on behalf of the Council met the Forum on 21 June).
  • Medical student debt which is expected to be another key issue to be pursued by the Forum.
  • Tobacco policy—Forum participants have been asked whether the Forum should endorse the joint paper prepared by the Australasian Colleges of Physicians and Psychiatrists.  The National Executive has agreed that the Forum should endorse it.
  • Autonomous nurse prescribing.
  • The CMC’s initiative in developing a support service for doctors under stress.

In recognition of the CMC’s role in providing secretarial services for the Forum the National Executive approved an initial grant of $1,000 to the CMC.  Associate Professor Phil Bagshaw has kindly provided an article for The Specialist on the CMC’s new strategic direction and the emergence of the Pan Professional Medical Forum and will also address Annual Conference on the Forum.

Relationships with Medical Colleges

On 10 October the Association invited the chief executives/executive officers of the colleges to an informal meeting with the Executive Director, Assistant Executive Director and Senior Industrial Officer in which we discussed some of the key professionally related provisions of the national DHB collective agreement including investigations into clinical practice and job sizing.  The colleges also reported on their most immediate issues.  The meeting was well attended with only three colleges unavailable to attend (radiology, pathology and emergency medicine).  Such was the usefulness of the meeting that it was agreed to hold another one in March 2006.

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.  Much of this involves the Senior Industrial Officer working with the MPS representatives and lawyers on specific cases.

The Executive Director visited the MPS international office while in London in June and also met with them when they visited New Zealand in October.  MPS also provides a regular column on medical-legal matters in The Specialist.  We are grateful for the generous decision of MPS to again sponsor the Conference dinner.

Proposal for the Establishment of a National Advisory Support Services for Doctors under Stress

The National Executive considered a draft proposal from Associate Professor Phil Bagshaw for the establishment of a national advisory support service for doctors under stress linking together legal (already provided by the Medical Protection Society and also where applicable, the Association and RDA), intellectual, emotional and rehabilitation support.  The National Executive has welcomed this laudable initiative which will be discussed at Annual Conference.

International Travel

The following international travel was undertaken by national office staff since the previous Annual Conference:

  • The Executive Director attended the third Australian Council of Trade Unions organising conference in Sydney in September.  He gave a workshop presentation to the conference on the use of collective bargaining as a ‘kick start’ for membership empowerment.  While in Sydney he also met the Australian Salaried Medical Officers Federation, Australian Medical Association (New South Wales), the ACTU organising centre and the Australian Medical Workforce Advisory Committee.
  • The Executive Director visited Europe, primarily Britain, and the United States, between late May and early July with the main purpose of attending a series of British Medical Association craft conferences (senior hospital doctors, staff and associate specialists, and general practitioners) and its Annual Representatives Meeting in Manchester, to update on the experiences of the implementation of the national consultants’ contract, and consideration of other relevant issues such as the application of the European Working Time Directive to New Zealand circumstances.

He also met key BMA officials including the General Secretary, Medical Protection Society Chief Executive, Kings Fund, and the London School of Hygiene and Tropical Medicine.  In Birmingham he attended a National Council of the Hospital Consultants and Specialists Association and visited the Good Hope NHS Trust (under private management franchise).  He visited the Irish Medical Organisation and Irish Hospital Consultants Association in Dublin, Welsh BMA in Cardiff and, in the United States, our two kindred unions, the Union of American Physicians and Dentists and the Doctors Council along with the Committee of Interns and Residents, Physicians for a National Health Programme and the head of a Chicago based doctors’ union.

Another highlight was spending a day with Dr Otmar Kloiber, Secretary General of the World Medical Organisation in Ferney-Voltaire (where he also met Public Services International).  A full report of his trip is available on request.

The Executive Director has been a regular attendee of the twice yearly Industrial Coordination Meeting organised by the Australian Medical Association.  However, due to a late change in dates for the first meeting and the close proximity of the second with Annual Conference he did not attend either meeting this year.

Association Publications

The Specialist, the Association quarterly newsletter (generously sponsored by the Medical Assurance Society) is a cornerstone of our advocacy work.  Feature articles included:

  • Being outcome focused over the national DHB MECA and membership empowerment.
  • Time to achieve non-clinical duties.
  • National DHB MECA on workforce development and education.
  • New strategic directions for the Council of Medical Colleges.
  • Medical Council performance evaluation programme.
  • Significance of new nurses’ national DHB MECA.
  • Pan Professional Medical Forum representation to Minister of Health on Medical Council elections.
  • Payment for public holidays.
  • Sabbatical leave on full pay.
  • Advancement through the national DHB MECA salary scales.
  • DHB-ASMS joint consultation committees.
  • Code of Good Faith in the public health sector.
  • Medical misadventure law change.
  • Minister of Health’s requirements to DHBs on clinical leadership.
  • The Medical Reference Group’s ‘Fit for purpose and for practice’ report.
  • Proposal to privatise Otago-Southland hospital laboratories.

The ASMS DHB News both supplements The Specialist and plays an important role in local matters and supplying other relevant information.  The main theme in all DHB News has been the joint consultation committees.  This communication vehicle is also adapted for our members employed outside DHBs, largely in relation to collective bargaining.

A new occasional publication, ASMS Standpoint, has been introduced covering employment related issues.  The first issue was published in September and covered hours of work and job sizing which included an emphasis of the practicality of undertaking job sizing.  Work is currently underway on professional development and education, with particular reference to continuing medical leave (including travelling time and time-in-lieu), secondment and sabbatical.

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 1870.  To date 12 issues have been produced this year.  Much of this has focused on matters relevant to the implementation, and understanding, of the national DHB MECA and the ASMS-DHB joint consultation committees.

Other subjects covered included:

  • Adoption of the medical misadventure policy law change.
  • Nominations to the Medical Council.
  • Consultation documents from Medical Council on ‘cultural competence’ and doctors using the internet.
  • Association call for greater and more democratic involvement in DHB decision-making
  • The new National Executive.
  • World Medical Association statements on medical migration and dumbing down of health care.
  • Council of Trade Unions statements on private sector wage increases and industrial stoppages.
  • Student debt and loans.
  • Association advertising in BMJ Careers and the linkage with the website job vacancy page.
  • Pan Professional Medical Forum.
  • Association membership growth.
  • Annual DHB senior medical officer salary survey.
  • MidCentral DHB staff shortage survey.
  • Anaesthetists’ industrial dispute in Melbourne.
  • Tertiary Intern Grant.

The national ASMS Direct is also supplemented by local ASMS Directs on Association activities and local issues.

The Executive Director has had for several years a monthly column in the fortnightly NZ Doctor.

Membership

At last year’s Annual Conference we anticipated another record membership year.  This proved to be correct with membership, as of 31 March 2005, 2,574 compared with 2,335 on 31 March 2004, representing an overall increase of 239 (10.2%).  This was our highest annual increase since our formation in 1989 (exceeding the previous record of 162 in 1992-93, the first year of the full impact of the now repealed Employment Contracts Act) and marks the first occasion that our membership has exceeded 2,500.  It represents a 79% increase on our 1,440 members after our first year of existence (1989-90).

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%), 2003-04 (117 – 5%) and 2004-05 (239 – 10%), an overall increase of 47% 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.

The annual average increase since our formation is 77 (5.3%).  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 average increase has been 150 (7.6.%).

Currently membership is over 2,600 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 31 March 2006.  The combination of recruiting new members and strong membership loyalty is the key to our effective representation in both collective and individual matters.

Currently about 85% of our members pay their subscription by automatic salary deduction (about 83% of new members employed during the past year).

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 17% of our current members.  5% of the Association members who joined us in 2005 were members of the NZMA compared with 22% in 1996.

The new constitution adopted by the 2004 Annual Conference included for the first time a clause (7) providing for associate membership.  The National Executive set a subscription level for associate members of $100 for the 2005/06 financial year.

Life Membership

Since our formation the Association has voted to have one life member, former National President John Hawke.  This year the National Executive is recommending that Annual Conference vote in favour of James Judson as our second life member.  Dr Judson was active in the formation of the Association including in one of our predecessor bodies, the Whole-Timers Association.  He was elected to our first National Executive in 1989 and subsequently served as Vice President.  He has attended all but one of our Annual Conferences.   Dr Judson has also been an active member in the leadership of the Association’s Auckland branch including participating in all our single employer collective negotiations and continues to represent the Association on the Auckland DHB-ASMS joint consultation committee.

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 quarterly publication, Hi Society.  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 Executive Officer) and Society Chief Executive Martin Stokes continue.  An interesting and positive initiative discussed at these meetings is the consideration by both the Society and the Medical Protection Society of a joint project to provide counselling support for doctors subject to complaints.

Discussions at these quarterly meetings have also included our national DHB MECA implementation meetings, issues considered at our ASMS-DHB joint consultation committees, the Pan Professional Medical Forum including the developments leading to its formation, the initiative being discussed among the colleges and CMC on supporting doctors under stress, our BMJ Careers advertising initiative (the Society provided helpful advice about contents of our website), the implications of the national DHB nursing and senior doctors MECAs on primary care, and contingency planning for life preserving services in the context of the radiation technologists dispute.

Association Finances

The Association recorded another healthier than anticipated surplus for the financial year ending 31 March 2005.

In summary the main factors for the healthy surplus were:

  • A much stronger than expected membership growth
  • Interest on investments exceeding budget
  • Higher than predicted sundry income received from the online job service, Sovereign (formerly Colonial) income protection commission, and sponsorship for The Specialist.

Administration

Another demanding year meant resources were fully stretched.  Considerable importance is placed on maintaining the membership database and Membership Support Officer, Kathy Eaden does a supreme job ensuring that members’ details are accurate.  The use of email as an efficient method of communication continues to increase in popularity with 70% of the membership subscribing to ASMS Direct.

Strong focus continues on maintaining the professional standard of the Association’s publications; the latest addition being ASMS Standpoint which has received very positive feedback on its presentation and content.  The Association logo and typeface received a makeover, lending a fresh modern look to our printed stationery.

The creation of a new Industrial Officer role led to some minor constructing within the national office in the form of an office and the purchase of furniture and fittings.  Three computers were purchased during the year; two replacement machines, the third for the additional position.

Website

A full refurbishment of the Association’s website was undertaken in September 2004; allowing its content to be readily managed by the national office on a daily basis meaning the site is always up to date, with topics of special interest listed on the home page.  The improvements also make the new site is easier to navigate.

Considerable emphasis was placed on site optimisation, in particular increasing international traffic.  Therefore it is not surprising that visitor numbers have steadily increased during the year to over 10,000 visits each month; more than double that of last year.  The website revamp coincided with the negotiation of the new national collective agreement which we hope will provide a recruitment incentive.

Job Vacancies Online

ASMS Jobs Online allows employers to advertise senior medical and dental vacancies on the ASMS website easily and economically.  The service was introduced four years ago in response to serious concern at the alarming number of unfilled positions within New Zealand hospitals.  All advertisements are linked to the employer’s website and recent modifications allow the inclusion of the employer’s logo.  All enquiries are directed to the employer.

In August 2005 the Association launched an advertising initiative with BMJ Careers, the United Kingdom’s principal medium for medical recruitment, published by the British Medical Association.  The advertisement will be repeated in the third issue of each month of the Clinical Research edition which has a circulation of 68,000 mainly doctors working in hospitals or academic environments.  In addition the advertisement is continually published on www.bmjcareers.com

The main thrust of the advertising is to focus on New Zealand’s unique lifestyle and on the new modern professionally based national collective agreement negotiated by us.  Those interested are then referred to the job vacancy page of our website which lists positions in district health boards.  We hope that this different positive approach will encourage increased numbers of suitable doctors to apply for these positions from overseas including New Zealand trained doctors working abroad.  Early signs are promising with a significant number of recorded visits to the Association website already originating from BMJ Careers.com.

The success of the campaign relies on our website listing the majority of current senior medical and dental vacancies and the Association is encouraging employers to advertise all of their job vacancies on the Association website.

Other Matters

Doctors Debt Casebook
The National Executive at its 2 February meeting voted to donate $1,000 to the cost of the joint NZ University Students Association-Medical Students Association Doctors Debt Casebook.

Private Health Insurance
The NZMA has reached an arrangement with Southern Cross over private health insurance.  The question of exploring a private health insurance scheme with Southern Cross was considered by the National Executive at its 14 April meeting but by majority vote it was agreed not to pursue it.

Locumotion
The Association received by email from an Irish locum agency, Locumotion, seeking to use us to reach Association members.  After seeking further background information from Ireland, the National Executive resolved, on 14 April, to take no further action.

Complaint against Holmes Programme
In the previous Annual Report we commented in some detail about the Association’s complaint to the Broadcasting Standards Authority about the 14 April 2004 TVNZ Holmes programme.  Soon after the 2004 Annual Conference the Authority substantially upheld our complaint in the three prime standards of quality—balance, accuracy and fairness.

Research on Supporting Medical Specialists undergoing Complaints
The Association received a request from a student researching a masterate thesis on ‘human resource management strategies needed to support New Zealand medical specialists undergoing a complaints/disciplinary process or coroners inquest’.  She requested a letter of support stating that the results of her research would be useful to us.  The National Executive was pleased to approve this request.

Brian Craig
ASSOCIATION NATIONAL SECRETARY
27 October 2005

 


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