Publications
The Specialist
Issue 64 - September 2005
Proudly Sponsored by:
- New Strategic Directions for the Council of Medical Colleges
- ASMS Standpoint
- Infallible and Bullet Proof
- DHB MECA Consultation Committees Show Promising Potential
- Medical Indemnity News and Advice
- Performance Evaluation Programme (PEP)
- Pan Professional Medical Forum letter to Health Minister on Medical Council Elections
- ASMS Launches Ambitious Advertising Campaign for Medical/Dental Job Vacancies with BMJ Careers
- ASMS Annual Conference Thursday 3- Friday 4 November
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New Strategic Directions for the Council of Medical Colleges
This article has been written for The Specialist by Associate Professor Phil Bagshaw, Chair of the
A year ago, I took over the Chair of the Council of Medical Colleges from Dr
In order to get ongoing input into the new policies and programmes, the colleges divided into four developmental work streams as follows:
(i)
and defining a media policy;
(ii) Communications Strategies – creation of a website, seeking consumer and
medical trainee input into
issues;
(iii) Student, Young Graduate & Trainee Issues – student debt, college training
programme, etc ; and
(iv) Medical Workforce Issues – recruitment & retention, rehabilitation, and public
safety.
It was clear from the start that
1. Pan Professional Medical Forum (PPMF)
In order to get traction on any of the major medical issues of the day, it is necessary for the profession to find sound common ground from which to speak publicly with a unified voice. For this reason
The four members of the PPMF discussed a number of issues of common concern. We went on to sign a letter to the Minister of Health expressing our support for a continued process of open elections for medical representatives to the Medical Council of NZ. Our letter, and the Minister’s reply, will be discussed elsewhere in this publication.
Four meetings of the PPMF are planned for this year. I believe the formation of this forum is potentially a most important development. I hope its collective strength and support continues to grow, so the united voice of the medical profession will be increasingly hard to ignore on future serious health issues.
2. New Working Relationship with Ministry of Health (MoH)
CPMC is approached by government over major health issues, and has regular contracts to provide reports and advice. CPMC then works through its council to decide on which colleges and other organisations should provide input into policy and planning in each particular case. This is seen to be an effective and acceptable way for government to decide from whom it should take advice, particularly over issues that cross the aegis of several colleges and numerous specialties, such as the provision of rural health services or the regionalisation of secondary and tertiary services. I am hopeful that
3. Support for Doctors Under Stress
There was not unanimous agreement, however, about whether there should be one national support programme or if individual colleges should go-it-alone. There was also disagreement about whether such programmes should be for stressed doctors in general or confined only to those subject to complaints and disciplinary processes. I believe that this problem is sufficiently serious for us to put these differences aside and concentrate on the production of an effective, totally confidential, doctor led and run service. I hope
4.
In order to improve communications between its members, and to increase its public and professional profile,
In conclusion,
Philip Bagshaw
Chair
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ASMS Standpoint
ASMS Standpoint is a new publication designed to outline our position on key employment and related issues. The first issue of ASMS Standpoint affirms the ASMS position on job sizing under the national DHB collective agreement (MECA) and is distributed to members with this issue of The Specialist . Future issues will discuss other MECA issues such as the utilisation of professional development and education provisions (e.g. CME, secondment and sabbatical).
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Infallible and Bullet Proof
When was the last time
You admitted confusion and hesitancy to a patient,
That you really did not know what to do next,
Or whether anyone else could help,
And you told your colleague the next time you met?
When was the last time
You praised a registrar,
For coming up with a diagnosis you hadn't thought of,
And you admitted you had not thought of,
In front of a patient,
And you told your colleague the next time?
When was the last time
You praised a nurse,
For thinking of something you had not,
And told a registrar,
In front of a patient,
And told your colleague next time?
When was the last time
You admitted an error to a registrar,
One that had harmed a patient,
In front of a nurse,
In front of a patient,
And told your colleague next time?
When was the last time
You sought a registrar's opinion,
Of what you had done well,
And what you might do better?
When was the last time
You sought a nurse's opinion,
Of what you had done well,
And what you might do better?
When was the last time
You sought a patient's opinion,
Of what you had done well,
And what you might do better,
And told your colleague next time?
When was the last time
You acted on that opinion,
To be proud of the positive
And work out how to do it again,
To be aware of the negative
And know how to avoid it again?
When was the last time
You modelled the behaviour
You so desired in those you work with,
And told your colleague next time?
When was the last time
You made time for self reflection,
On what you do well,
And what you could do better?
When was the last time
You shared your reflections,
With a registrar,
With a nurse,
With a patient,
And told your colleague next time?
When was the last time
You suffered from stress?
When was the last time
You knew it impaired your performance?
When was the last time
You admitted as much to a registrar,
To a nurse,
To a patient,
And told your colleague next time?
When was the last time
You sought professional help?
When will be the next time?
Jeff Brown
National President
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DHB MECA Consultation Committees Show Promising Potential
A central feature of the national DHB collective agreement is the principle of empowering ASMS members over their work conditions, at their workplace and within their DHB. One of the vehicles for this is the joint consultation committees (JCCs) set up between each DHB and the ASMS which are required to meet at least three times a year. These JCCs have considerable potential and a largely unlimited range of issues that can be considered—from matters contained in the MECA to local matters outside it.
Beginning with Lakes (Rotorua) in May by the end of September we will have held JCCs in all but two of the 21 DHBs (the other two will be held in October). In fact, in some DHBs we have had two already. Two pleasing features of the JCCs have been the increased level of membership participation in them (more than we used to have in our pre-MECA local DHB collective agreement negotiations) and, in the large majority of cases, the participation of the DHB chief executive along with other senior managers. It is clear that the DHBs are taking the JCCs seriously even to the point of chief executives comparing notes and experiences at national gatherings. If they are a tad nervous perhaps we should be a tad pleased?
The most prevalent issue discussed at the JCCs has been job sizing. Some of this has involved preparing for the implementation of the enhanced time-and-half rate for average hours worked on rostered after-hours call duties (e.g. call-back, telephone consultations) in those DHBs where there is no enhanced rate.
Much more significant has been the need to address the reality that the job sizes of many SMOs in most DHBs does not reasonably reflect the average regular hours they are working on scheduled clinical duties and also the professionally necessary time for non-clinical duties (minimum of 30% of scheduled clinical duties) that they are either undertaking or would wish to undertake. We are gradually resolving in the JCCs processes for reviewing job sizing to address these concerns.
But while important and prevalent fair and reason
As discussed in the last issue of The Specialist , one exciting feature of the MECA is the commitment of each DHB and the ASMS to establish joint taskforces to endeavour to reach agreements over staffing plans and implementation plans for the undertaking of professional development and education including secondment and sabbatical. Although it makes sense in some DHBs to focus on job sizing first, the formation of taskforces is taking off in some others under the auspices of the JCC. Over time this will become an increasingly important part of the work of JCCs.
Another feature of the MECA is the requirement for each DHB and the ASMS to agree upon a process for evaluating the adequacy of the DHB’s provision of safe and suitable working conditions, resources and accommodation, to identify any deficiencies and recommend remedies. Although it is early days and there has been a preoccupation with job sizing, in one DHB the JCC has agreed to initiate the first stage of this evaluation.
An issue raised in one DHB as much by management as by the ASMS has been how to give practical effect to enhanced clinical leadership at both micro and macro levels. We have agreed to facilitate a workshop of key SMOs and managers to discuss how more practical application and effectiveness of clinical leadership might be implemented with a tangible focus.
These JCCs have much to offer providing that we are on the front foot and do not let the sometimes understand
Ian Powell
EXECUTIVE DIRECTOR
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Medical Indemnity News and Advice
There is often much comment on the
We have noted a sustained increase in the work over the last two years with the issues more often than not requiring legal input. The lawyers MPS instructs on behalf of its members are chosen for their experience and skills. They are independent barristers and, contrary to a view a member made last week, do not receive any form of ‘retainer’ from the MPS.
The recent changes to the ACC legislation that removes the fault finding of medical error and proof of rarity and severity should mean less work for MPS in this area of the business. My concern, as yet not proven, is that the patients desire to ‘find out what went wrong’, or to ‘prevent it from happening to anyone else’ may not be fulfilled. These desires on the part of the patient or their family appear in the first three reasons given for suing in medico-legal studies undertaken. The desire of patients who had a claim for medical misadventure accepted as ‘mishap’ who went to review on the basis of wanting the decision turned to ‘error’ was a troubling and increasing trend noted over these last two years. Whether this means more work for the Health and Disability Commissioner’s office will be something that may take time to see. All claimants who lodge a claim for treatment injury will be sent ‘a publication outlining the role of the HDC and its advocacy service’ by the ACC. There is also the provision that where ACC determines that there is a risk of public harm the event will be referred to the appropriate authority for patient safety. How such a determination is to be made is far from clear to the MPS at this time. While we encourage the earliest cooperation in assisting patients to make claims, and indeed support ACC in this goal, it must be remembered that any written information can and most likely will be used against the writer and/or in cross examination should such a situation arise. Care in expression and with good advice is our desired position for the membership, if in doubt call 0800 2255677 (0800 CALL MPS).
Dr P H Robinson
Medico-legal Advisor
Medical Protection Society
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Performance Evaluation Programme (PEP)
Professor John Campbell, Chair of the Medical Council, has kindly provided the following article outlining the Council’s new performance evaluation programme for medical practitioners. The article endeavours to explain this new programme and clarify some of the misconceptions that have arisen .
Under the Health Practitioners Competence Assurance Act the Medical Council has the responsibility “to protect the health and safety of members of the public by providing for mechanisms to ensure that medical practitioners are competent and fit to practise their profession”. This can only be achieved through collaboration with the profession and, in particular, through a close working relationship with the royal colleges and the vocational branch advisory bodies. Continuing Professional Development (CPD) programmes, which include the essential components of peer review and audit, are essential for continuing competence. All practitioners need to participate in CPD either through their colleges or through a collegial relationship with a vocationally registered colleague working in the same field.
Council is now investigating a patient, colleague and self assessment instrument to be used in conjunction with CPD audit as a further mechanism to ensure competent practice. This would produce what we have called the “Performance Evaluation Profile” (PEP).
The PEP instrument
Council investigated a number of performance evaluation instruments and decided that one modelled on the Physician Achievement Review developed by the
Further information about the
The PEP instrument seeks an evaluation from colleagues, other health workers and patients as well as a self evaluation. Completing and analyzing the questionnaire takes the time of all involved and therefore comes at a cost to individuals and employers. Council is testing its use to ensure it can be used efficiently and effectively without duplicating existing evaluation methods.
Pilot studies
PEP was first tested in
The second pilot is underway and involves those who, on their APC applications this quarter, have indicated they are not participating in a CPD programme. We have also asked for volunteers and have had a good response to this request.
Participant evaluation and the effect of the process on CPD participation may be the only evidence of benefit from PEP that we are able to gather from the pilot studies. Additional information about the validity of PEP will come from its use as one component in more comprehensive performance reviews.
A randomized, controlled trial to demonstrate the benefit of the introduction of PEP on clinical outcomes is simply not feasible. The use of PEP would be a small intervention in a complex system so that sample size would be too large to be either fundable or practical.
Future use
Council will only use PEP where there is considered to be benefit to medical practice and patient care.
There are a number of ways in which the PEP instrument could be used by the Medical Council, colleges and clinicians:
i) As a systematic review of aspects of performance of those who state on their APC
renewal forms that they are not participating in a CPD programme. PEP could be
used similarly for those who, on a random audit of CPD returns, are not
participating adequately in CPD programmes. PEP would not be a replacement
for CPD but a method to ensure the practice of these practitioners is considered
adequate by colleagues and patients.
ii) As a regular assessment for doctors who are registered in a general scope of
practice, not in a training programme and not registered in a college CPD
programme. These doctors need to be in a “collegial relationship” with a
vocationally registered doctor in similar practice. The extent to which such a
relationship ensures adequate participation in CPD is not clear. PEP may be of
value in ensuring competence has been maintained.
iii) As a component of college CPD programmes.
iv) As a voluntary exercise to gain an assessment of one’s practice from patients and
colleagues.
v) As one component of a fuller assessment of provisionally vocationally registered
international medical graduates when they apply for vocational registration. At
present full vocational registration is dependent on satisfactory supervisors’
reports or satisfactory reports and a college examination. Council is discussing
whether a more detailed review of the doctor’s actual practice might be a fairer
and more valid assessment than a college examination for some overseas trained
specialists. PEP might be one component of this assessment.
vi) As one of several instruments used in Council’s performance assessment process.
vii) As a means of ensuring continuing competence in some doctors who have
completed an educational programme ordered by Council.
Potential benefit
PEP does provide a broadly based evaluation of a doctor’s practice. It encourages reflection on practice both during and after the assessment. It may well identify problems which need addressing by the doctor him or herself. It might also alert Council to a more serious situation where a doctor may be practising unsafely and further assessment and an educational programme are needed. It will not identify those doctors who are practising in a criminal manner. It is not designed to do so.
We are publicly accountable for our professional performance. Appropriate use of the PEP may be one way of assuring the public that standards are best maintained through self regulation and that the medical profession takes this very seriously.
John Campbell
Chair
Medical Council of
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Pan Professional Medical Forum letter to Health Minister on Medical Council Elections
On 20 May the Pan Professional Medical Forum wrote to the Minister of Health, Hon Annette King, (as referred to in Phil Bagshaw’s article) outlining the reasons why she should favour
The Minister’s reply was considered but did not accept the first request. However, she acknowledged that a subsequent Minister of Health, including from her own party, might see it differently. She is, however, as was confirmed in a recent meeting with the ASMS, receptive to the Medical Council holding an election and forwarding the outcome to her for consideration. There is already precedent for this over the Dental Council.
This was the first activity of the Pan Professional Medical Forum as it endeavours to pursue issues that the medical profession has a common position on. The Forum intends to pursue this further once the outcome of the general election is known and the next health minister appointed. The Forum’s letter to the Minister is outlined below.
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Dear Annette ELECTIONS TO MEDICAL COUNCIL The Pan Professional Medical Forum, facilitated by the Council of Medical Colleges, has recently been established. The Forum includes organisations that, collectively, represent nearly all registered doctors in The Forum has recently determined that one of its first actions is to petition you over our combined and strong agreement regarding elections to the medical practitioner positions on the Medical Council of New Zealand. As you will be aware this was one of the most contentious issues relevant to the medical profession during the debate leading to the enactment of the Health Practitioners Competence Assurance Act in 2003. We wish to commend you on your decision to reappoint the current Medical Council members, including the elected medical practitioners for a further year. This has the important advantage of ensuring continuity during this key period of transition but also has the benefit of en You will be aware that this approach is not the first choice of the medical profession as most of the organisations which make up our grouping have made representations to you previously on this issue. Our organisations, and we believe the profession as a whole, consider that election by registered doctors of representatives onto the regulatory authority, the Medical Council of New Zealand, is a vital component in ensuring the credibility of the system of regulation set up under the Health Practitioners Competence Assurance Act 2003. (As you know, this is not guaranteed under the Health Practitioners Competence Assurance Act where S120 (4) gives the Minister power to pass regulations that allow for such an election.) Self-regulation is a crucial component of professionalism which is the best guarantor of patient and public safety. Doctors need to know that this is reflected in the regulatory body and that this body is one in which they have a degree of ‘ownership’. With ownership comes responsibility. It is important for public and patient confidence that doctors feel the decisions of the Medical Council are their own decisions as a profession and not simply decisions imposed from above through government appointees. When these issues have been traversed with you before, you have made the point that it is unthink The overwhelming view of the medical profession is that election of a proportion of members of the Medical Council should be guaranteed in statute as it was in the Medical Practitioners Act 1995. Disputes between members of the medical profession and various governments have occurred in the past and will doubtless occur in the future. Though, we hope, it is unlikely that a future Minister will use the power to appoint all the members of the Medical Council to force through policies opposed by the medical profession, even the possibility that this may occur could affect the Council’s credibility when such a conflict occurs. We request that you amend the Health Practitioners Competence Assurance Act 2003 so that election of at least four medical practitioners is reinstated as it was under the Medical Practitioners Act S124(c). Thank you for considering these points. Yours sincerely Phil Bagshaw Jeff Brown Deborah Powell |
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ASMS Launches Ambitious Advertising Campaign for Medical/Dental Job Vacancies with BMJ Careers
On 20 August the ASMS launched a novel international advertising campaign in the weekly British Medical Journal publication BMJ Careers in order to recruit senior doctors and dentists from overseas to fill vacant positions in
The main thrust of the advertising campaign is to focus on
The success of the campaign relies on our website listing the majority of current senior medical and dental vacancies and the ASMS has invited employers to take advantage of the initiative by placing all senior medical and dental vacancies on the ASMS site each month; unlimited online advertising for a whole year for a generous annual cost. The ASMS initiative is unique in that it is the union, rather than an employer, encouraging qualified candidates to apply for jobs in
Early signs are promising with a significant number of recorded visits to the ASMS website already originating from BMJ Careers.com . The greater the take-up by DHBs of this new exciting venture the greater the chance of filling medical/dental vacancies; and at a much lower cost than DHBs advertising directly in BMJ Careers .
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ASMS Annual Conference
Thursday 3- Friday 4 November
Delegates required
The ASMS meets the costs and makes all travel and accommodation arrangements for ASMS members to attend its 17th Annual Conference as delegates. It will be held at Te Papa on 3-4 November (Thursday, Friday). Members who have not already registered are reminded and encouraged to make leave arrangements and register without delay.
Dinner and Pre-Conference Function
In addition to the Conference there is a Conference dinner on Thursday 3 November. Delegates are also invited to attend an informal cocktail function on the evening of Wednesday 2 November. The function will be sponsored by Medical Assurance Society again and this year it will be held at the Boatshed on
Leave
Clause 30.1 of the MECA includes provision for members to attend Association meetings and conference on full pay. Members are advised to start planning now and encouraged to make leave arrangements and register without delay.
Registration of Interest Form
Please help us to plan for another great Conference and to assist with travel and accommodation reservations by taking a minute to fill out a registration form and either post, fax or email the details back to our Membership Support Officer,
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.
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