Publications
The Specialist
Issue 60 September 2004
Proudly Sponsored by:
- Celebration
- MECA Features
- Outline of Provisional MECA
- Further National Negotiations and Discussions
- What are the MECA Salary Increases?
- MECA Provides a Strategic Advance for ASMS Members
- The MECA Provides aids to Objective Job Sizing
- ASMS 16th Annual Conference
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This issue of The Specialist is dedicated to outlining the provisional agreement for a national collective agreement (MECA) reached between the negotiating teams representing the ASMS and the DHBs.
This is a time of some moment in the ASMS’s history. Until 1992 senior doctors and dentists were entitled to national terms and conditions of employment. But, that year, the then National government used its newly acquired power under the narrowly contractualist Employment Contracts Act 1991 to prevent the ASMS and other health unions from negotiating national terms and conditions of employment. In our subsequent single employer collective negotiations we sought to achieve national consistency but, while achieving many successes, this was an inefficient and not always effective means.
It was not until the Labour-Alliance (now Labour-Progressive) government passed the Employment Relations Act towards the end of 2000 that the ASMS was able to consider national negotiations. In 2002 the ASMS Annual Conference voted in favour of national negotiations for members employed by DHBs and, following membership endorsement ballots, these commenced in April 2003. After rocky moments and near breakdowns a provisional agreement was reached in late June 2004 between the two negotiating teams. This is a significant landmark in the ASMS’s history that has immediate direct benefits for our DHB-employed members as well as indirect benefits for our members employed by non-DHB employers.
All the 20 DHBs participating in the national negotiations have now ratified the provisional agreement. The decision over extending the MECA to the 21st DHB, Northland, will be made next year closer to the expiry date of the current Northland collective agreement on
The ‘ball’ is now clearly in the ‘court’ of the ASMS to determine whether to accept or reject it. While the final decision ultimately rests with the National Executive, for guidance the ASMS will conduct a secret postal ballot during September of all members employed by the 20 affected DHBs from Waitemata to Southland. The recommendation of the National Executive and the ASMS national negotiating team is that members should vote in favour of acceptance and we are seeking a majority of members in all 20 DHBs.
The full provisional agreement is outlined in this issue of The Specialist. In considering that outline the following features and themes should be considered:
1. Much, not all, of the ‘best of the best’ is achieved but the ‘trade-off’ is in the lengthy
term of the proposed MECA (expiry date of
implementation dates of specific fiscal enhancements (refer to the outline of the
provisional agreement for details).
2. As part of a strategic shift in direction of the ASMS, there is a stronger focus on the
application and enforcement of its provisions. This has particular implications for job
sizing and hours of work although the stronger focus is not restricted to these
matters.
3. Again as part of a strategic shift in direction of the ASMS, empowerment of senior
medical staff at the workplace over their working conditions and within their DHBs.
4. The range of issues which are both included in a collective agreement and which are
to be subsequently negotiated at a local or national level is widened.
5. Some issues are identified for further national and/local DHB discussions and
negotiations.
6. Overall the wording and contents are generally tighter and more protective compared
with the current separate DHB collective agreements.
7. Those terms and conditions of employment that members might have which are
additional to their current DHB collective agreement are protected in the way that
normally occurs when one collective agreement replaces another.
8. Although this MECA only directly applies to ASMS members employed by DHBs, it has
positive indirect implications for members employed outside DHBs by the setting of
medical/dental labour market conditions.
Executive Director
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Celebration
Yes. Celebrate. The chief executives of the 20 affected DHBs have approved the national collective agreement negotiated over the last 16 months. It is now up to you, the individual members of ASMS. You all now have a chance to ensure celebration; to push towards MECA; to complete the journey begun almost two years ago.
In 2002 your National Executive considered the fragmentation of 21 different collective agreements. The impediments to recruitment and retention amplified by, not only the quantum of the agreements, but also by their marked differences. They put a proposal to the 2002 Annual Conference which membership ratified—to give DHBs notice that we wished to negotiate a national MECA.
The first negotiations commenced
Your negotiating team believes we have achieved the very best we possibly can, short of extremely messy and divisive industrial action; combining and enhancing, uniting while advancing, 21 separate agreements into a single national MECA. It was never going to achieve every wish, fulfil every individual desire, right every wrong, and correct every imbalance. The proposal does promise significant, serious, solid advantages for each and every DHB-employed ASMS member.
The outcome offers different advantages for diverse members. Different advances for diverse DHBs. Different quanta for diverse gain.
A road show of membership seminars has offered ASMS members the chance to hear from Executive Director
There may still be pockets of pessimism. Examined in isolation the bits may at times seem not enough or too late. Individuals will always be able to find areas where they may not seem to gain as much as their colleague or neighbour.
The whole, however, is much, much greater than the parts. Incrementally and synergistically the increased salary scale, the increased annual margins, the rostered after-hours’ rates, all result in enhanced pay and rations not just next year but build in the foundation for years ahead. Add in enhanced
But wait. There is more. There is much, much more.
Pay and rations is the most visible, but perhaps not the most valuable achievement of the proposed MECA. Your negotiating team has spent many many sessions battling to build in clauses empowering senior medical staff. Clauses to underpin clinical leadership; to guarantee non-clinical time (the 70:30 split); to enhance senior medical staff involvement in consultation, public debate, patient safety and primacy of responsibility to patients; to define job descriptions and after-hours’ expectations; covering telephones; providing tools of the trade; providing sabbaticals and secondments; staffing plans; and safe, suitable workplaces.
There is also commitment to joint national working parties to address availability allowances, absences of RMOs, accrual of leave, limitations on hours of work, and more. And ground breaking agreement to provisions for appointment processes, and recruitment and retention benefits.
You should celebrate what your team has achieved on your behalf. The DHBs’ negotiators have worked hard to convince their chief executives that this proposal is the best deal they can broker. The chief executives have accepted and ratified the provisional agreement.
It is now up to you.
Read and study the substance of the provisional MECA. Consider the advantages for you, for those you work with, for those considering working with you. Consider the empowerment of senior medical staff, the advance of clinical leadership.
Vote, and encourage your colleagues to vote. Your National Executive recommends you accept the proposed MECA. Then celebrate.
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MECA Features
- New national specialist scale (vocational registrants) from $111,000 to $161,000
(mix of $4,000 and $4,500 margins between steps) with additional steps higher
than most current scales. - New national medical/dental officer (MOSS/DOSS) scale (general registrants) from
$80,000 to $125,000 (mix of $3,500 and $4,000 margins between steps) with
additional steps higher than most current scales. - Three salary increases through (a) translations to new national scale, (b) $2,500
increase to new scale, and, for most members, (c) widened margins between steps. - Threshold of ‘satisfactory performance’ for advancement through salary scale with
no other performance criteria. - Time-and-a-half (T1.5) for average hours worked on rostered after-hours’ call
duties (eg, call-back and telephone consultations). Current rates above this
protected. - DHB superannuation subsidy (matching dollar-for-dollar contributions) up to 6% of
total gross salary. - Improved hours of work/job sizing and job descriptions clauses.
- Recognition of non-clinical time (30% minimum).
- Process for providing additional recruitment and retention benefits.
- Protection of existing individual entitlements which are additional to those provided
in the expired current DHB collective agreements. - Continuation of reimbursement of work-related expenses (eg, college membership,
medical indemnity, annual practising certificate) as part of improved new clause. - Reimbursement of professional associations relevant to clinical duties (additional to
colleges).
KEY PROFESSIONAL DEVELOPMENT AND EDUCATION ELEMENTS OF THE MECA·
- $7,500 (increasing to $8,000)
per annum. - Additional $500 per annum
- Time-in-lieu for approved
- DHBs and ASMS to develop plans for undertaking professional development &
education including sabbatical and secondment. - Recognition of non-clinical time (30% minimum).
NEW ISSUES IN THE MECA
- Investigations into clinical practice (alternative to suspension).
- Appointment processes.
- Facilities and equipment.
- Workforce development and planning
KEY LEAVE ELEMENTS OF THE MECA
- Six weeks annual leave.
- Paid parental leave (six or two weeks depending on primacy of responsibility for child).
- Protection of existing long service and onerous duties leave entitlements.
- Continuation and extension of open-ended sick leave.
EMPOWERMENT ELEMENTS OF THE MECA
- Commitment by DHBs to empowerment of senior medical staff in preamble.
- Strengthened clauses covering hours of work, job sizing and job descriptions.
- Strengthened consultation clause including establishment and evaluation of reviews.
- Evaluation of workplace conditions, resources and reviews.
- Workforce development and planning—staffing, recruitment & retention strategies, utilisation of professional development & education.
- Development of guidelines for empowering senior medical staff involvement in DHB decision-making followed by national conference.
- Joint DHB-ASMS consultation committees.
- Recognition of primacy of responsibility to patients.
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Outline of Provisional MECA
The proposed MECA has an expiry date of
PART 1. Coverage and application.
PART 2. Remuneration and hours of work.
PART 3. Leave.
PART 4. Union representation.
PART 5. Professional matters.
PART 6. General terms.
PART 7. Settlement of disputes and personal grievances.
In addition, important provisions are contained in an appendix and in attached schedules.
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PART 1. COVERAGE AND APPLICATION
The MECA replaces the current 20 DHB collective agreements. It begins with a statement outlining the core role of senior medical staff (see reference 1) highlighting their distinct nature as an occupational group and the benefits to DHBs by them having ‘significant influence’ in their internal decision-making. The statement also highlights the importance of ‘engagement’ with and ‘empowerment’ of senior medical staff being ‘integral to the internal culture of each DHB’.
It next addresses key underpinning principles (see reference 2) including collegiality, collectivism, ethical and professional obligations, public expectations, increasingly demanding medico-legal environment, and quality workplace conditions.
Part One contains several key protections and rights such as:
- Confirming that the MECA provides ‘minimum terms and conditions of employment’ that underpin job descriptions and any additional provisions that are ‘as favourable or more favourable’ than those contained in the MECA itself.
- Protection of existing individual terms and conditions of employment that are outside the current collective agreements (except where they are inferior).
- Confirmation that all ASMS members, regardless of their branch of medicine or dentistry, are covered by the MECA inclusive of all its entitlements, rights and protections.
- Requiring DHBs to advise new appointees of the MECA, of their right to be covered by it if they join the ASMS, and how to contact the ASMS. This requirement remains after the expiry date if negotiations for a replacement are continuing.
- Requiring DHBs to ‘provide the resources and support reasonably necessary to enable the employees to discharge their obligations’.
- Key definitions confirming that it is the Medical (or Dental) Council which determines who is a specialist (not the DHB); defining who is full-time (40 hours per week); defining non-clinical time (based on the ASMS recommended wording); defining redundancy; and providing a national definition of service.
- Replacement of the uncomplimentary term ‘medical (or dental) officer of special scale’ (MOSS/DOSS) with ‘Medical Officer’ and ‘Dental Officer’. In other words, senior medical/dental officers are either vocational registrants (specialists) or general registrants (medical/dental officers).
PART 2. REMUNERATION AND HOURS OF WORK
Salary Scales
The new specialist and medical officer (previuosly MOSS) scales will both comprise 13 steps. These scales provide the base salary for a nominal job size of 40 hours a week. The new scales will take effect six months after the expiry date of each of the 20 applicable DHB collective agreements ranging from 14 August 2003 (Waitemata) to 1 October 2004 (Bay of Plenty). On
Specialists
The new 13-step specialist scale will commence at $111,000 and end at $161,000. Margins between the steps will initially be $4,000 widening to $4,500 after Step 9 ($143,000). Below is the new scale:
|
Rates ($) |
Rates ($) | |
|
Steps |
6 months after Expiry of |
Effective on |
|
13 |
161,000 |
163,500 |
|
12 |
156,500 |
159,000 |
|
11 |
156,500 |
154,500 |
|
10 |
147,500 |
150,000 |
|
9 |
143,000 |
145,500 |
|
8 |
139,000 |
141,500 |
|
7 |
135,000 |
137,500 |
|
6 |
131,000 |
133,500 |
|
5 |
127,000 |
129,500 |
|
4 |
123,000 |
125,500 |
|
3 |
119,000 |
121,500 |
|
2 |
115,000 |
117,500 |
|
1 |
111,000 |
113,500 |
Medical Officers (MOSSs)
The new 13-step medical officer (MOSS) scale will commence at $80,000 and end at $125,000. Margins between the steps will initially be $3,500 widening to $4,000 after Step 7 ($101,000). Below is the new scale:
|
|
Rates ($) |
Rates ($) |
|
Steps |
6 months after Expiry of |
Effective on |
|
13 |
125,000 |
127,500 |
|
12 |
121,000 |
123,500 |
|
11 |
117,000 |
119,500 |
|
10 |
113,000 |
115,500 |
|
9 |
109,000 |
111,500 |
|
8 |
105,000 |
107,500 |
|
7 |
101,000 |
103,500 |
|
6 |
97,500 |
100,000 |
|
5 |
94,000 |
96,500 |
|
4 |
90,500 |
93,000 |
|
3 |
87,000 |
89,500 |
|
2 |
83,500 |
86,000 |
|
1 |
80,000 |
82,500 |
Translations to New Scales
The premise behind translation from one’s existing scale to the new scale is that one translates to the next dollar amount above one’s current step providing that the minimum increase is $1,000. Inevitably resulting from the one-off translation from 20 different salary scales into one new scale, the initial fiscal increases vary and the outcome is unavoidably the ‘luck of the draw’. The range is from $1,000 up to $5,000, in the main around $2,000-$3,000 (see reference 3 for indications based on translations from notional national specialist scale to the new scale).
Widened Margins between Salary Steps
The most common current margins, which cover at least two-thirds of ASMS members to be covered by the MECA, between salary steps are around $3,000. These margins widen to $4,000 and $4,500 for specialists and $3,500 and $4,000 for medical officers (MOSSs). Almost all ASMS members will receive, in effect, an annualised salary increase anywhere between around $500 up to $1,500.
Advancement through Salary Scales
Advancement through the salary scales is annual based on a simple threshold of ‘satisfactory performance’ of one’s agreed duties and responsibilities (e.g. job descriptions). Unless one is advised in writing in advance of one’s due date of advancement of concerns over performance, advancement will then proceed to the next step. Advancement is not to be denied if failure to achieve satisfactory performance is due to factors beyond one’s control. Performance criteria and processes that exist in some current DHB collective agreements are removed.
If a DHB is considering denying a person advancement to the next salary step then it must advise that person in writing at the earliest practical opportunity before the due date of advancement in order to provide a reasonable opportunity to address the concerns. Anyone who is declined advancement is entitled to a review of that decision by a review panel agreed between the ASMS and DHB. (See reference 4)
Hours of Work and Job Size
The clause covering hours of work and job sizing have been strengthened. Both are required to be ‘mutually agreed’ and to ‘objectively reflect the requirements of the service and the time reasonably required for the employee to complete their agreed duties and responsibilities as set out in their job descriptions’. This includes the reference to non-clinical time for duties not directly related to the care of an individual patient (See reference 5 and also article by Industrial Officer, Henry Stubbs).
The combined effect, especially when read in conjunction with the job descriptions clause (discussed below) and other provisions of the MECA, significantly strengthen the capacity for members to be paid regularly worked unpaid hours. This includes non-clinical duties which should comprise a minimum of 30% of time for routine duties and responsibilities. The significance is that each unpaid hour that then is paid is equivalent to a 2.5% increase on the full-time equivalent salary.
Most senior medical staff would be lucky to have 20% non-clinical time. Using a full-time equivalent (40 hours per week) based on 10 sessions as an example, if the equivalent of two sessions are being paid for non-clinical time, then another session should be paid (i.e. a 10% salary increase), unless other compensating arrangements are made.
The structure of the clause also means that, except for average hours worked on after-hours’ call rosters, diaries are unnecessary for the determination of one’s job size. Instead this can be more effectively and reliably undertaken by collegial assessments of the average times required for routine activities such as lists, clinics and ward rounds (plus related preparation and follow-up work) with the 30% for non-clinical duties then added on.
Enhanced Rate for Rostered After-hours’ On-Call Duties
Except where this rate (or a higher rate) is already being paid, effective on 1 December 2005, the rate of pay for average hours worked on rostered after-hours’ duties (e.g. call-back, telephone consultations) will increase to time-and-a-half (T1.5). This is based on average hours and does not require time-sheets or ‘clock-in/clock-out’. For example, if one’s ordinary hourly rate is $60, for each job sized hour worked on an after-hours’ call roster one will be paid $90.
This is expected to benefit around 50% of ASMS members covered by the MECA with an effective fiscal increase of 5% per person, per annum, although there will be considerable variations on this increase depending on the nature of call rosters. Up to another estimated 10% of members will also benefit by lesser percentages.
The ASMS’s hope was to achieve double-time (T2) for these average hours but only one DHB (Waitemata) pays this rate while another (Bay of Plenty) pays a higher rate than this. However, these Waitemata and
Availability Allowance
The availability allowance is a retainer for being on an after-hours’ call roster. Recognising the considerable diversity between the current DHB allowances, these allowances will continue in their present form except that they will be calculated on higher base rates. In the meantime there will be further national negotiations over whether an agreed standardised national availability allowance might be developed.
Unplanned Absences of RMOs
The ASMS and the DHBs will have further national negotiations to develop agreed arrangements for when senior medical staff might be requested to undertake additional work due to the unplanned absence of resident medical officers (house surgeons and registrars). Agreed arrangements include remuneration. In the meantime the provisions in the current
Part-Timers
Over the past decade the traditional tenths system has been amended, changed and restructured in the numerous local collective agreements that have been negotiated and re-negotiated. In a few instances the old tenths system remains unchanged but in most DHBs it has been changed to different tenths systems, sessional systems (e.g. four or five hour sessions) and hours. Under the MECA these various arrangements will continue in their present form but there will also be further national negotiations over whether an agreed standardised national system might be developed.
Recruitment and Retention Benefits
The challenge of providing additional benefits in order to recruit new appointees has been a vexing question with the risk of creating anomalies and inequities for existing senior medical staff working alongside the new appointee. A new clause has been developed to transparently address this challenge (See reference 6). In determining such benefits there should be regard to similar benefits provided by the DHB in other services. Further, the salaries and benefits of existing staff in the same shall be reviewed for fairness and consistency in the event that a new appointee is offered an additional recruitment benefit.
Superannuation
Except where it is already at this level, the DHB dollar-for-dollar matching subsidy for senior medical staff ineligible for the former government subsidised schemes (National Provident Fund and Government Superannuation Fund), will increase to 6% of one’s total gross taxable salary effective on
Members of the former government subsidised schemes (National Provident Fund and Government Superannuation Fund) will also have the ability to elect to change to the above newer schemes.
Shift Work
This clause requires the DHB to negotiate applicable terms and conditions of employment for affected senior medical staff with the ASMS when considering introducing shift work. In addition, there will be a national negotiation over agreed arrangements (inclusive of remuneration) for ASMS members working on evening, night and weekend shifts.
Retiring Gratuities
Most of our current DHB collective agreements include provision for a retiring gratuity. In some cases this gratuity is grandparented or protected to those senior medical staff employed as of a particular date specified in the relevant collective agreement. All these grandparented protections continue under the MECA. In the case of those few collective agreements were the gratuity continues in full, it will be grandparented for those members employed as at a yet-to-be specified date (perhaps the date of signing). This might appear to be a loss of existing conditions but given that it is only for yet-to-be employed senior medical staff, it only applies in the event of retirement and retirement is becoming increasingly difficult to define, it is more hypothetical than real.
Reimbursement of Work-Related Expenses
This clause has been tightened up from many of our existing clauses to make it clear that all work-related expenses are to be reimbursed including annual practising certificate, Medical Protection Society, vocational registration, and college membership. It also includes all clinically relevant professional associations (additional to colleges) and MOPS fees (where not met by college membership). Reimbursement is to be the full cost for full-timers and for part-timers without private practice (pro rata for other part-timers).
It also includes the full cost of the standard home telephone rental for those who are required to be on-call. This is to be paid as a regular fortnightly allowance.
The MECA also provides for reimbursement of the use of one’s personal vehicle when on-call, when travelling between DHB workplaces, and any other approved travel.
Members who have a right to free car parking in their current DHB collective agreement will have that right protected.
PART 3. LEAVE
Annual Leave
Except for the DHBs which already have it, annual leave increases to six weeks for all ASMS members on
Paid Parental Leave
Among our DHBs there are a range of provisions for remuneration while on parental leave (birth and adoption). Some collective agreements provide nothing; some provide a lump sum payment equivalent to six weeks salary following the return to work; some provide six weeks paid leave; some provide child care supplements.
These will all be replaced by a new entitlement of six weeks paid leave (additional to the legislative entitlement) for the partner that has the prime responsibility for the child and two weeks if one is the other partner.
Long Service Leave and Onerous Duties Leave
Some of our DHB collective agreements include long service leave (usually two weeks every 10 years) and onerous duties (generally under-utilised and up to five days per annum). While they are not extended to the rest of the DHBs they will be protected for both current and new senior medical staff covered by the MECA.
Other Leave
The following leave provisions remain largely unchanged:
- Public holidays.
- Open-ended sick and bereavement leave (extended to
- Attendance at professional meetings including colleges, Medical and Dental Councils, disciplinary bodies and the ASMS.
- Jury service and witness leave.
PART 4. UNION REPRESENTATION
The MECA carries over, in some cases in a slightly improved form, existing union (ASMS) representational rights, in particular:
- Fortnightly deduction of ASMS fees from salary.
- Right of entry of ASMS officials to workplaces.
- Stopwork meetings (two 2-hour paid meetings per annum).
- Paid employee representatives education leave.
PART 5. PROFESSIONAL MATTERS
The MECA is as much about professional rights and responsibilities as it is about ‘pay and rations’ provisions. These are largely outlined in Part Five.
Professional Development and Education
This is a composite clause which in the first instance requires DHBs to ‘actively’ encourage senior medical staff to undertake professional development and education. It is further strengthened by a requirement (contained in the Appendix to the MECA) for each DHB and the ASMS to develop ‘an agreed plan for the effective provision of and access to high quality professional development and education for employees including continuing medical education, secondment and sabbatical.’ The new clause includes three key elements.
1. Continuing Medical Education
DHBs will provide 10 paid working days per annum for continuing medical education leave, normally associated with attending conferences but not restricted to this form of
The level of reimbursement of
Time-in-lieu will be provided for any approved
2. Secondment
Secondment in a recognised unit is the second key element based on an application process. The guideline is two weeks every three years for professional development and upgrading skills relevant to duties and responsibilities.
3. Sabbatical
Sabbatical on full pay based on an application process is available based on three months every six years.
Investigation of Clinical Practice
The MECA includes a new clause which provides an alternative to suspension where there may be a need to investigate one’s clinical practice (see reference 7). Its purpose is to prevent the unreasonable use of suspension or unnecessarily drawn out processes when there are performance concerns relating to clinical practice and its impact on patient safety. It provides for fair and expeditious investigation and review processes including the capacity to place some limitations on clinical practice in certain circumstances.
Other Professional Rights
The following professional rights remain largely unchanged or in some instances enhanced:
- The right to work in a quality improvement environment in which errors that do not result from negligence are not to be handled in a punitive manner.
- DHB encouragement of senior medical staff undertaking research and publication.
- DHB recognition of professional and patient responsibilities and accountabilities of senior medical staff, including to the Medical and Dental Councils, to ethical codes and standards of relevant colleges and professional associations, and primacy of responsibility to one’s patients. This is extended to those DHBs where it does not presently apply.
- The right to participate in public debate and dialogue (sometimes known as speaking out).
- Resolution of patient safety concerns.
PART 6. GENERAL TERMS
Consultation
The MECA has a consultation clause which builds upon and improves similar clauses in current DHB collective agreements. It includes the following important elements:
- DHBs are required to invite affected senior medical staff to be involved in any proposed review which might result in significant changes to structures, staffing or work practices.
- Before commencing any review of DHBs which might impact on the delivery or quality of clinical services, they will be required to consult and seek the endorsement of the ASMS over its extent, process and terms of reference.
- In the event of serious professional or clinical concerns over the recommendations of a concluded review, DHBs will be required to endeavour to resolve them with the ASMS and affected senior medical staff or reach an agreement with us over a process for resolution.
Locums
The locum clause proved to be a challenge because of the diversity of compensation arrangements that apply in our various current collective agreement arrangements. The outcome is a new clause based on the following principles:
- DHBs are required to take reasonable steps to fill all gaps or vacancies on after-hours’ rosters as soon as they occur or are reasonably foreseen.
- Clinical directors and affected senior medical staff are required to advise DHBs when locums are required. DHBs must give this advice due regard and are responsible for the provision of locums.
- Alternative arrangements for service delivery and/or appropriate compensation for increased workload or work pressure are to be negotiated with the affected senior medical staff either on the basis of applicable provisions in the current DHB collective agreements or based on another agreed outcome.
- Senior medical staff are not required to undertake additional work beyond a reasonable period of time.
Job Descriptions
After establishing that senior medical staff are entitled to a mutually agreed job description, a significantly new, considerably strengthened clause largely incorporates the ASMS guidelines (available on the ASMS website) into the MECA as the ‘recommended guideline’. The ASMS guidelines change in status from advisory to contractual. The new clause includes expectations that all job descriptions require:
- A list of clinical activities, including college requirements and rostered after-hours’ call arrangements.
- An express statement about the standards against which clinical performance will be assessed (e.g. relevant colleges and professional associations).
- Non-clinical duties not directly related to the treatment of an individual patient should make up at least 30% of the average hours worked on routine duties and responsibilities and any additional management duties. It includes the Council of Medical Colleges’ endorsement of the 30% minimum for non-clinical duties. These non-clinical duties include professional self-development, audit and quality assurance and improvement activities, grand rounds, research, clinical pathway development, teaching, supervision and oversight, service or department administration, planning meetings and credentialling.
- A list of any clinical leadership activities.
Appointment Processes
There is a new clause in the MECA covering appointment processes which is new to the large majority of DHBs (see reference 8). The key elements are:
- DHBs must consult with affected senior medical staff over the need to fill a position, the nature and level of skills and experience required, and the job description for the appointment.
- The appointment committee should include the relevant clinical director (or equivalent), a nominee of the local senior medical staff committee, and where applicable an external senior member from the relevant professional college or association.
- The importance of thoroughly checking qualifications and other relevant details of the candidate about to be appointed including the accuracy and veracity of referee reports.
- Inclusion of the DHB’s credentialling requirements as part of the appointment process.
Workplace Conditions, Resources and Accommodation
As part of a wider provision covering facilities and equipment, this new clause requires DHBs to provide ‘good quality, suitable and safe workplace conditions, resources and accommodation’. Each DHB and the ASMS are to jointly evaluate the extent to which these are provided and to develop ‘an agreed plan for remedying any deficiencies’ (see reference 9).
Joint Consultation Committees
Consistent with the emphasis of better enforcement and application of its contents and widening the scope of what might be negotiated locally, the MECA requires each DHB and the ASMS to form joint committees to meet regularly in order to consider matters covered in the MECA along with any other matter of mutual interest.
Other General Terms
The following general terms of employment remain largely unchanged:
- Three months notice for termination (e.g. resignation, retirement) of employment.
- Redundancy, including the standard severance formula which will now be extended into all DHBs (currently it does not apply to Waitemata,
- Protection of rights of private practice.
- Protective clothing.
- Access to personal files.
- Subordination of relevant DHB policies to the MECA.
- Medical examinations.
- Access to journals, publications, email and internet facilities.
PART 7. SETTLEMENT OF DISPUTES AND PERSONAL GRIEVANCES
This section of the MECA covers:
- Commitment to re-negotiation of the MECA including use of mediation where necessary.
- In the event of an impasse in future MECA negotiations which can’t be resolved by negotiation or mediation, an agreement that the DHBs and ASMS will meet to discuss a possible adjudicative (arbitration) process to resolve it.
- Standard procedures for resolving employment relationship problems including disputes over interpretation and application of the MECA and personal grievances for alleged unjustifiable actions by DHBs.
APPENDIX AND OTHER MATTERS
As part of the MECA there is an appendix covering a range of issues outlined below which the DHBs and ASMS are required to progress:
Development of National Guidelines for Limitation of Working Hours and Registrar Strategy
The DHBs and ASMS will jointly develop national guidelines to limit the working hours of senior medical staff. The European Working Time Directive (maximum of 48 hours per week by 2009) is identified as a reference point.
We will also be working jointly together to develop a strategy for addressing the issues in services and workplaces where registrars are not provided.
Workforce Development and Education
Workforce development and education is to be advanced jointly by DHBs and the ASMS on both local and national fronts (see reference 10). In the first instance, each DHB and the ASMS will form joint workforce development taskforces to develop agreed staffing plans, recruitment and retention strategies to support these plans, and plans for the utilisation of professional development and education including
In the second instance, the DHBs and ASMS will form a national coordination committee to monitor the work of the individual DHB taskforces and to convene a national conference, most likely late 2005 or early 2006, to consider progress and developments arising out of these local initiatives.
Involvement in DHB Decision-Making
Increasing and empowering senior medical staff involvement in DHB decision-making is an important feature of the MECA (see reference 11) through the following processes:
- A joint DHBs-ASMS national coordination committee is to develop agreed guidelines for consideration by similar joint committees at an individual DHB level.
- A national conference (most likely late 2005 or early 2006) will be held to consider progress and developments in senior medical staff empowerment in each DHB.
Other Issues
Other issues requiring joint ASMS-DHB work are:
- Developing a national availability allowance (retainer for being on-call).
- Developing an agreed system for the accrual and debiting of annual leave.
- Developing an agreed national policy over ownership of intellectual property rights (in the meantime current collective agreement provisions apply).
- Resolution of concerns over vulnerability to infectious diseases.
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Further National Negotiations and Discussions
The MECA provides for a series of further national negotiations and discussions on the following issues:
- Standardised national availability allowance (retainer for being on-call).
- Standardised national system for pro rata calculation of remuneration for part-timers.
- Arrangements (including remuneration) for unplanned absences of resident medical officers.
- Arrangements (including remuneration) for working on evening, night and weekend shifts.
- National guidelines for limiting hours of work.
- National strategy for services and workplaces where registrars are not employed.
- Ownership of intellectual property rights.
- Standardised national system for debiting and accrual of annual leave.
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What are the MECA Salary Increases?
Although only part of the total remuneration benefit, the MECA delivers at least two, in many cases, three salary increases, each through different means.
- The translations to the new scales, effective six months after the expiry date of the relevant current DHB collective agreement, will provide variable increases between $1,000 and $5,000. In the main these are likely to be around $2,000-$3,000.
- $2,500 increase on
- Most members will benefit by the widened margins between salary steps; in most cases this will be between $500 and $1,500 per annum at least once (in some instances twice) during the term of the MECA.
These increases are additional to the normal salary step progressions which will also continue.
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MECA Provides a Strategic Advance for ASMS Members
The proposed DHB national collective agreement (MECA) offers the ASMS with the opportunity to undertake a strategic shift in direction which should be to the considerable benefit of ASMS members employed by DHBs. It also has indirect consequential advantages for ASMS members employed by non-DHB employers.
The obvious gains are the achievement of nationally consistent terms and conditions of employment, always an objective of the ASMS but difficult to achieve in the fragmented bargaining environment of the market-era 1990s. This includes the completion of long-standing ASMS goals such as six weeks annual leave, 30% non-clinical time, and subsidised superannuation (for those members who are ineligible for the former government subsidised schemes). It also includes the national extension of other important entitlements such as more competitive salary scales, improved wording for job sizing, and the enhanced rate of remuneration for average hours worked on rostered after-hours’ call duties (T1.5).
But running alongside this is a strategic shift in the ASMS’s direction. For over a decade we have been negotiating core employment conditions at least 21 different times every one to two years. This has been extremely resource-intensive which, in its earlier days, achieved significant advances but over time the quantum of these advances has gradually diminished.
The MECA means that the negotiation of these core conditions is now reduced from 21 to one negotiation and the outcome is a core that is both enhanced and widened from the mainstream previous single DHB cores.
This better places the ASMS to focus on the application and enforcement of the core conditions, particularly job sizing inclusive of the 30% non-clinical time. The MECA strengthens our capacity for enforcement. This becomes significant when one recognises that most senior medical staff employed by DHBs regularly work in excess of their officially paid job sized hours and few receive the full 30% non-clinical time (many would be lucky to even have as much as 10-15%). The fiscal significance is that an extra hour paid is an increase in take-home pay equivalent to 2.5% of base salary.
But it also better places us to pursue our collective negotiating capacity with individual DHBs in other realms, previously untouched, such as resources and working accommodation, staffing levels and support, proactive planning for the utilisation of sabbatical and secondment, and recruitment and retention strategies inclusive of enhanced remuneration.
Underpinning all of this is a key theme of the MECA which sets it up as the foundation for the enhancement of senior medical staff empowerment over their working conditions and policy-making and decision-making within their DHBs. The MECA offers advantages to members well in excess of the obvious ‘pay and rations’ gains. This is simply too good an opportunity to miss.
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The MECA Provides aids to Objective Job Sizing
The provisionally agreed MECA contains a useful cluster of clauses that link together and, when applied correctly, will deliver an objective and realistic job size for any position. These new and strengthened provisions will give members the tools to objectively measure the work they are required to do (in units of hours) for purposes of determining their remuneration and will also provide a reliable mechanism for determining the resources and staffing levels required to meet the demands of any service.
The key provisions must be read and applied together to ensure maximum protection and benefit. They are:
- Hours of Work & Job Size
- Job Descriptions
- Definitions
- Underlying Principles
- Mutual Obligations
- Quality Improvement Environment.
Of these, the first two are the mechanical provisions that provide the basic tools to assess job size, resource requirements and staffing levels.
Under the MECA, hours of work and job size must both be mutually agreed; ie, they cannot be unilaterally imposed by your employer. Furthermore they must objectively measure not only the requirements of the service (driven by patient numbers and population) but also the time reasonably required (another objective standard) for you to complete your duties and responsibilities (which must also be mutually agreed), as recorded in your job description.
For every ASMS member covered by the MECA, the hours of work and job size must include an allocation of time set aside for non-clinical duties. The amount of non-clinical time must be sufficient to enable you to practice within College guidelines and to meet professional standards. The important point is that these standards are set by external professional or legal bodies and are not determined by your employer’s financial constraints or your manager’s whim. The MECA expressly notes the Council of Medical Colleges’ endorsement of 30% for non-clinical time.
In a new and comprehensive Job Description clause, each DHB has agreed to recommended guidelines for the format and content of new job descriptions. Job descriptions must be mutually agreed and contain comprehensive lists of both clinical and non-clinical duties as well as an explicit statement of your on-call duties. This should record not only the frequency of your roster but also the usual number and level of resident medical officers within the service.
Job sizes will therefore have to be reviewed and may change as resources and staffing levels change.
The definition section of the MECA includes a “non-exhaustive” definition of non-clinical duties which complements and strengthens the non-clinical duties’ section of the new job descriptions.
The impact of the remaining provisions in this cluster: Underlying Principles, Mutual Obligations & Quality Improvement Environment should not be underrated: they contain a number of very significant acknowledgments and commitments from employers, including promises to provide well resourced, professionally supportive workplaces that are “conducive to a very high standard of clinical practice” in an environment that is collegial, open and free from blame.
Finally, the clause on Quality Improvement Environment requires credentialling processes and implementation to be agreed between each DHB and the affected employees. In this way credentialling is promoted as a clinician-driven process for the ultimate benefit of clinicians. Furthermore, under the MECA the parties have agreed that credentialling will also consider the resources required for a particular service. In this way, credentialling of your service will become another tool at your disposal to secure sufficient resources, including staffing for the service.
Henry Stubbs
Industrial Officer
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ASMS 16th Annual Conference
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Reporting on National collective bargaining
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Industrial and employment issues relevant to members
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Medico-legal issues
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Industrial relations and health policy
Dinner and Pre-Conference Function
In addition to the Conference there is a Conference dinner on the 3rd and an optional pre-Conference function on the evening of the 2nd.The function will be sponsored by Medical Assurance Society again but this year it will be held on the Wellington waterfront at Dockside.
Leave
Many of our employment contracts include provision for members to attend Association meetings and conferences on full pay. A minimum notice period may be required when applying for this leave. If you have any doubts please contact Henry Stubbs (Industrial Officer) or Angela Belich (Industrial and Policy Adviser) without delay.
Registration of Interest
To register please contact Executive Officer Yvonne Desmond at the national office or your local branch representative.
Further information about Conference can be obtained from the national office or online www.asms.org.nz.
Your interest in registration will be confirmed with your local branch secretary as each branch is allocated a set number of delegates. Extra members are welcome to attend the Conference as observers.
