Skip to contentSkip to navigation

Publications

PublicationsMedical Assurance Society

The Specialist

Issue 66 - March 2006

Proudly Sponsored by:

................................................................................................................

ASMS initiates health professional led strategy with Health Minister

There are two broad approaches to drivers in endeavours to effect change in the organisation and delivery of health services—external and internal (in reality in any given health system both are likely to apply but there can be differences in emphasis and prevalence).  In the 1990s New Zealand experienced an external driver in the form of the market experiment through the use of competition and other commercial processes such as ideological pushes for privatisation.  Today in Tony Blair’s Britain (England to be more precise in this instance) this 1990s experiment is being tried out in a process described by some as ‘creative destruction’ through mechanisms such as practice based commissioning, Foundation Trusts and so-called ‘independent’ treatment service centres.

These external drivers are market mechanisms put in place to achieve an objective.  As well as heavily ideological they are top-down and do not derive from engagement with health professionals.  Since 2000 the New Zealand government has shifted away from market drivers but remained top-down in approach still relying to a large extent on external drivers, primarily the Ministry of Health and DHB chairs to effect change.  This does not diminish the fact that there have been instances of health professional engagement but they have not been the norm.

Change largely shaped by internal drivers is not the norm in most health systems.  The best example I’m aware of is the New South Wales metropolitan taskforce looking at mainly acute services.  This is a health professional led approach which has been in operation for over four years and has led to a significant improvement in the quality and robustness of decision-making over where and how services should be provided.

Following the confirmation of the new government and appointment of the new Minister of Health, Pete Hodgson last year, the ASMS took the initiative and forwarded him a paper advocating a health professional (rather than top down managerial) approach to enhancing access and quality in DHB provided secondary and tertiary services.  This was in recognition of the fact that despite the government increasing health spending to record levels, many health professionals at the clinical frontline in secondary and tertiary care believe that the improvements over the past six years have been patchy, difficult to sustain and hard to prove.

The paper embraces electives, chronic illnesses and acutes.  It builds upon some of the positive work done through health professional engagement with the Paediatric Society in the 1990s (Through the Eyes of a Child), the cancer control strategy, with the Orthopaedic Association over increasing joint operation funding, and increased cataract operations.  But it seeks to extend this approach and also looks to the New South Wales experience for inspiration.

The paper is arguably but unashamedly politically opportunist in that it proposes a three year timeframe (the timeframe that politicians are incentivised to think in) with the ambitious objectives of ensuring:

  • Health professional confidence that there are tangible improvements in access to elective, chronic and acute services and improvements in the quality of health services in secondary and tertiary care.
  • Public perception that the health system is improving rather than deteriorating.

We also used the opportunities provided by our affiliation to the Council of Trade Unions (CTU) which provides us with a process in which we can more effectively engage with other health unions such as the NZ Nurses Organisation.  The CTU is a strategically focussed organisation that has developed effective processes of constructive engagement and influence with government and is also taken seriously by DHBs.  Consequently the CTU willingly agreed to endorse the ASMS paper and include it in its own briefing papers to the incoming government last October.

There are always potential risks in such initiatives as ours.  The recipient (Minister) might run with the rhetoric but not the substance and use the ASMS to provide glossy camouflage while he continues with business as normal under the current largely top-down approach.  On the basis that deeds speak louder than words, a key test will be whether the Minister approves the short-sighted and fiscally risky proposal of the Otago and Southland DHBs to privatise their hospital laboratories that arose out of a top-down bureaucratic process to produce a predetermined outcome and exclude health professional engagement.  If the Minister approves this privatisation proposal then it will amount in effect to a rejection of our health professional led approach; but if he rejects it then this will be a promising sign.

On the positive side, however, although yet to advise of his response, the Minister expressed much interest in our initiative in a meeting with him late last year.  He has also studied it over the summer break and we expect to continue engagement with him.  The full paper is published elsewhere in this issue of The Specialist and members are encouraged to read it.  Hopefully the Minister will respond positively and this might lead to an enhanced involvement over the next three years by ASMS members and other health professionals in the shaping of the future direction of the various services they presently work in.

Ian Powell
Executive Director

Top of Page
................................................................................................................

Medical Protection Society: Sentinel events

MPS has recently advised on two cases where inquiry into an adverse outcome was undertaken under the auspices of a ‘sentinel event’ investigation.  The worrying aspect from the MPS point of view was that it resulted more in an exercise in one case of ‘blaming the individual doctor’ and the ‘elevation of an unavoidable event’ to sentinel status in the other.  Line management has the responsibility for this process, which in the cases that resulted in this article, it is the writer’s opinion they fell well short of the standard of care required in exercising managerial responsibility.  The legal costs involved were not insignificant.

The Ministry of Health published in September 2001 a ‘Reportable Events Guideline’ as well as a document ‘Towards Clinical Excellence: Learning from Experience’ (a report to the Director-General of Health from the Sentinel Events Project Working Party).  These can be viewed at the Ministry’s web site www.moh.govt.nz.

‘Sentinel event’ characteristics include:

  • Major system failure
  • Multiple teams, departments or services are involved
  • The potential for serious adverse media attention
  • The potential to seriously undermine public confidence
  • When a group of consumers have potentially suffered harm.

‘Sentinel events’ are not:

  • Events that occur as a natural consequence of the consumer’s illness, disease or condition
  • Events that are unavoidable, expected complications of the consumer’s illness disease or condition.

‘Sentinel events’ it is suggested should be reviewed in a particular manner requiring:

  • A review team being formed and approved
  • A root cause analysis being undertaken
  • Root causes being identified
  • A corrective action plan being developed
  • A report that identifies residual risk and lessons learnt being completed
  • An evaluation of the effectiveness of the actions being completed.

The process has at its core the belief that the potential benefits of learning from our experiences will improve care, save lives and free up resources. Blame shame must never be allowed to muddy these waters in our opinion.

If involved in any medical inquiry seek early independent medico-legal advice.

Dr P H Robinson
Medico-legal Adviser
Medical Protection Society

Top of Page
................................................................................................................

Looking back - to the future

President's Column

Tradition at the changing of calendars has us review the year gone by and vow to improve in the year to come.  To reflect on our achievements and aim to improve on our recognized flaws.  All to enjoy the future, richer for the wisdom time brings.

So what have we learned?  What will compel us forward?

So often we are exhorted to participate in yet another review of clinical services, led by imperatives of predicted budget blowouts.  To minutely examine each detail of a complex dynamic system, with the pretence that understanding the micro management will invariably bring the macro under control.  Yet we know that complex systems, whether the human body, or the economics of the health system, follow non-linear dynamics with seemingly unpredictable, perverse, but often self-correcting behaviour.

So that anything we do will inevitably be associated with a change in outcome, no matter whether there is any true cause and effect.  And the best time to institute change is when the situation seems most dire, either clinically or on the balance sheet.  Then trending to the mean will ensure the patina of success.  For any patient.  For any system.  For any treatment.

So how do we differentiate the natural swings of physical systems from the effects of treatment proffered?  When possible, by double blind randomized controlled trials.  With sufficient numbers in each arm, with ethical approval, with independent analysis and quality control.  To smooth out the egos and opinions and vested interests.  And, of course, our patients, our paymasters, our politicians, our policy makers, our pharmaceutical providers, all demand no less of us when we practice allopathic medicine.

But when health care and delivery, to twos and threes, to groups, to regions, and to populations, is under the spotlight, where are the RCTs, where are the ethics approvals, where are the quality controls and independent analysis?  Or do egos and opinions and vested interests suddenly rule the rationing?

With a change of Minister, and a change of Director General, will we see a change of emphasis?  Will we see national direction and implementation to avoid duplication of effort?  Does a country of just over 4 million need 21 organisations asking hundreds of highly skilled health professionals and managers to spend thousands of hours of their valuable time designing a myriad informed consent forms, a myriad medication charts, a myriad NFR policies?  Surely one form, one chart, one policy would suit all New Zealanders, and those caring for them.  And free up hours of passion and dedication for patient care, and – dare I say it – productivity.

Will we see clinical networks encouraged to grow and develop across DHB boundaries?  Without the fettering of feudal financial fiefdoms?  Where health professional led experiments in collaborative care are welcomed and fostered.  Where regional, sub-regional, hospital and community based initiatives are driven by best outcomes for patients, not balance sheets.  For long term outcomes, not short term outputs.

By looking back, the SMO who has invested so much of their life, their learning, their observational skills, their pattern recognition, their intuition, their science, their art, can see the effects of so much effort going to so much waste.  And find it hard to avoid embitterment, avoid resignation to yet more reform.  Yet the same SMO is the source of the solution.  Enabled and empowered, convinced and complicit, proud and proficient, they can lead networks of care to more efficiently turn the tax dollar to patient outcome.

So will our new Minister, our new Director General, encourage such leadership, by their own leaderships?  Will they learn from the past, and look forward to the future?  Will they avoid repeating perverse incentives, and rather reward risk and innovation?  Will they lead central solutions when obviously needed (such as consent forms, medication charts, not to mention computer systems) and support networks of care driven by age, disease, and specialty rather than artificial geography and politics?

Will Janus represent a two-faced approach to managing the health dollar?  Or will the new year represent renewed opportunity to learn lessons of the past, and heed health professionals with all their gruntled experience, skill and wisdom?  So they can lead through budget blowouts, through price volume perversities, through the seeming chaos of complex dynamic systems, to clinically driven results in the interests of the patients they care for every day.

Jeff Brown
National President

Top of Page
................................................................................................................

Allowing clinicians to lead change

Health professional led approach to enhancing access and quality in DHB provided secondary and tertiary services

Prior to the recent general election an AC Neilsen poll revealed a high level of anxiety among the public about the performance of the health system and a widespread belief that the health system is deteriorating.  Many health professionals at the clinical frontline in secondary and tertiary care share this anxiety and believe that any improvements in the past six years have been patchy, difficult to sustain, and hard to prove.  And yet the government has increased health spending to record levels.

The increasing government fiscal commitment to the health system has clearly concerned Finance Minister Michael Cullen who, in an address on this theme at the Association of Salaried Medical Specialists Annual Conference on 6 November 2003, stated that “we need to learn new tricks in making our health dollar go further.”  One of the positive features of his address was that he demonstrated the importance of active engagement with health professionals.  For obvious reasons Treasury is also focused on the challenging question of ‘value for money’.

The government’s focus to date, including fiscal and capacity building, has been on primary care (and also population based care).  This is essential to the long term future of health care delivery and it is important that it continues.  However, it must be recognised that while this focus will lead to improving quality of life and effectiveness of care, it will not for the foreseeable future have a discernible effect on reducing pressures on secondary and tertiary care.  These pressures have had to be managed with proportionately less of the increased health funding that has gone to secondary and tertiary care.  And yet the tangible gains from improved access to quality secondary and tertiary services are generally more immediate and transparent than those from primary care and population based health.

To manage these challenges New Zealand needs a new strategic direction that is consistent with government goals and that ensures that within the next three years:

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

This new strategic direction should be health professional led.  There is enormous capacity, skill, experience and commitment for this among health professionals of all descriptions.  However, health professionals are largely cast in a reactive role and are an under-utilised resource (perhaps the greatest irony of our health system).  Health professional leadership is the most effective means of ensuring that health needs are met in a fiscally responsible way.

The concept of a health professional led approach is not new.  It was part of the brief ‘effectiveness studies’ project initiated during the short life span of area health boards in 1989-90.  Incompatibility with the ideology of the 1990s made this approach more difficult although the example of the health professional led Paediatric Society of New Zealand’s paper, Through the Eyes of a Child, contained a comprehensive range of proposals that, if implemented, would have significantly enhanced the accessibility and quality of paediatric care in New Zealand.  The energy and commitment of the doctors, nurses and allied health professionals who developed this paper has been eroded by the fact that only a small number of proposals have subsequently been implemented, while those that have been are shining examples of health professional led collaboration and coordination of national services.

Since the Public Health and Disability Act and the formation of district health boards there have been tangible examples of progress in the development of a health professional led approach.  In particular:

  • The cancer control strategy with oncologists and other health professionals (as well as significant community involvement).
  • Increased funding for hip operations following active engagement with the Orthopaedic Association.
  • Increased cataract operations following active engagement with ophthalmologists and optometrists.

There have also been other important factors that help make a health professional led approach achievable.  These include:

  • The government’s approach to longer-term and permanent baseline funding (departing from the uncertainty of the time-limited funding enhancements of the late 1990s).
  • The call by the Minister of Health in her last two letters of expectations to DHBs for increased health professional involvement in decision-making.
  • Increased regional (and national) DHB collaboration.
  • The senior doctor and nursing MECAs which both have a recruitment and retention emphasis and a focus on workforce development and education, including staffing.

However, these activities, including DHB collaboration, are sporadic.  In general there is still too much reliance on top-down, managerially driven initiatives.  These tend not to be as robust as health professional led initiatives.  The Minister’s call for increased health professional involvement in decision-making has yet to lead to widespread tangible improvement.  The MECAs are positive but they can’t achieve the necessary change in isolation.

Secondary and tertiary care systems in broad terms face three demands:

  1. Electives, particularly the high number of patients who are on the ‘active monitoring list’ that have been referred back to their GPs because of the inability of the public hospital sector to provide their treatment.  The observation of Dr Cullen at the ASMS 2003 Annual Conference was timely: ‘The task is to intervene early with the most effective treatment, and thereby reduce the need for more intensive and expensive treatment later on in the course of an illness.’  While the booking system has potential advantages it is dangerous for patients in an environment of either insufficient funding or insufficient resources (the latter rather than the former is more prevalent in public hospitals today).
  2. Chronic illnesses in which the patients do not go away because they require ongoing treatment and support.  The infrastructure is stretched with health professionals in this area struggling to maintain access and quality.
  3. Acutes which public hospitals generally handle well because they take priority but which place health professionals under pressure and stretch facilities.

The most successful and comprehensive example of a health professional led approach, relevant to New Zealand, was in New South Wales with the special clinician-led taskforce established to examine acute (and some chronic) services in metropolitan New South Wales (independently evaluated and discussed separately in a separate paper available from the ASMS national office on request).  Within a three year period it made recommendations to the state government, the overwhelming majority of which were approved.  These have led to practical sustainable improvements across the state.

New Zealand needs to adopt a health professional led approach in order to reap the benefits and achieve the objectives discussed above.  As a first step it is proposed that you establish a steering group including the Principal Medical Adviser to the Minister of Health, nominees of the Council of Trade Unions involved with unions representing health professionals, and managers with operational experience (including demonstrated constructive engagement with health professionals).  It might also include someone from the New South Wales taskforce such as its head, Professor Kerry Goulston.  Its brief would be to advise on using a health professional led taskforce to develop:

  1. A three year time limited strategy to ensure:
    a) health professional confidence that there are tangible improvements in access to elective, chronic and acute services and improvements in the
        quality of health services in secondary and tertiary care, and 
    b) public perception that the health system is improving rather than deteriorating.
  2. A process for developing and strengthening national and regional clinical networks to ensure the provision of high quality and accessible elective, chronic and acute services.
  3. A process that will achieve sustainable and effective specific recommendations on resource utilisation, organisation and provision of elective, chronic and acute services in each of the DHBs.

Top of Page
................................................................................................................

From a roar to a whimper?

Executive Director's Column

At an informal meeting with national DHB representatives late last year the ASMS was given a clear message—the DHBs had concerns over the application of the national DHB collective agreement (MECA), mainly in reference to time for non-clinical duties.  We were told that they had a mandate from all the DHB chief executives to resolve them through the issuing of joint guidelines.  The message to us was oh so clear—they wanted us to agree to joint guidelines to redefine the MECA in such a way as to narrow, fetter and constrain the application of the MECA entitlements over time for non-clinical duties and other matters.

This message was also reinforced by two of the larger DHBs (Capital & Coast and Canterbury) in our joint consultation committees where both kicked for touch on implementation of time for non-clinical duties using the argument that there were to be national discussions on the issue.

The national meeting was in fact an initiative of the DHBs primarily with the purpose of engaging over senior medical workforce issues which was followed up by a second meeting on 20 February (the substantive purpose of these meetings is discussed elsewhere in this issue).  With all this ‘roar’ (an embellishment of the reality but nevertheless useful for the story), we were expecting to ‘really be told’ to engage in narrowing, fettering and constraining’.

Prior to the 20 February meeting this roar had already been muted with the publication of the league table in the December issue of The Specialist which demonstrated that, contrary to the assertions of the DHBs’ national representatives, several DHBs were happily collaborating with the ASMS in a shared constructive approach to job sizing including time for non-clinical duties.  It appeared that what DHBs say to each other can be different to what they individually say to the ASMS, it certainly is the case over time for non-clinical duties.

Nevertheless they did raise the issue at the beginning of the 20 February meeting and proposed the formation of a separate industrial relationships joint national group to discuss.  However, the ASMS argued that time for non-clinical duties was already being pursued among several individual DHBs and we were not into narrowing, fettering and constraining our entitlements.  We said that it was not enough for the DHBs to assert that there was an issue to be addressed; they had to demonstrate why this was so and in this respect they had failed to do so.  It was a good example of the ability to say no to the unacceptable and unsubstantiated.

By the time the afternoon got underway the subject had disappeared.  Time for non-clinical duties was discussed no more and the proposal for a national industrial relations group was quietly dropped.  The ‘roar’ had truly become a ‘whimper’.

If ASMS members come across managerial claims to the effect that there are national discussions on non-clinical duties this can easily be refuted as untrue.  Members who are dissatisfied with the adequacy of their time for non-clinical duties and who are not already undertaking a job sizing process to address it are encouraged to discuss with their colleagues in their department/service the development of a schedule of professionally robust non-clinical duties.  Our publication ASMS Standpoint on hours of work and job sizing is recommended as the most appropriate and relevant guide for facilitating this process.

Ian Powell
Executive Director

Top of Page
................................................................................................................

Senior doctors workforce group

District Health Boards (DHBs) have resolved to take a more proactive role in workforce planning.  They began this new role with the resident medical officers and have been engaged, with the Resident Doctors’ Association, in examining the junior doctor workforce for some months.  Now, together with ASMS, they have established a senior doctors' workforce group.  They aspire to establish a GP group in the future and nurses and allied health groups are presently being established.

Margot Mains, (Chief Executive, Capital & Coast DHB) is the lead CEO for the DHBs for the senior doctors’ group supported by David Meates, Chief Executive of Wairarapa DHB.  The DHBs have assured the ASMS that it will not be simply another report producing exercise.  The DHBs, as the employers of senior doctors, are in a position to make genuine change.  They are on a steep learning curve over workforce trends.  For example, one of the concerns that they have are the likely retirement, over the next 10 years, of around 70 general surgeons and the impact that this will have on the country’s smaller hospitals.

The senior doctors’ workforce group is to cover:

  • understanding the current SMO supply and demand
  • the drivers for change
  • future demand and supply;
  • service delivery needs, and
  • effective utilisation of senior doctors.

In our initial discussions we discussed the principles that should underpin the discussions which included national planning for a sustainable (including financially sustainable), appropriately trained and deployed SMO workforce and the retention of New Zealand trained medical graduates in an integrated/interdisciplinary setting.  A shared direction between the Ministry of Health and DHBs would be critical to the success of the approach and discussions needed to include the Colleges.  Nationally consistent, appropriate standards also need to underpin the exercise and there was some discussion about different levels of staffing in apparently similar DHBs and duplication by each DHB of things like consent forms.

The first part of the exercise will be to gather information on the senior doctor workforce and on DHBs and the services that they provide.  Further meetings are planned for April, May and June.  The ASMS is represented in this process by National President Jeff Brown, Vice President David Jones, fellow Executive members Brian Craig, Judy Bent and John MacDonald, Executive Director Ian Powell and Assistant Executive Director Angela Belich.

Angela Belich
Assistant Executive Director

Top of Page
................................................................................................................


New National Executive member elected

Following the resignation of Dr Andrew Munro as one of the two Region 2 (Waikato, Bay of Plenty, Lakes and Taranaki) representatives of the ASMS National Executive, a by-election was conducted.  The Returning Officer has now declared Dr John Bonning (Emergency Department, Waikato Hospital) elected unopposed, to fill the vacancy.  The other Region 2 representative is Dr Paul Wilson (Tauranga Hospital).

Dr Bonning has been a member of the ASMS and a specialist emergency physician (FACEM) at Waikato Hospital for the last three years.  As an emergency physician he interacts on a professional basis with virtually every specialty in the hospital as well as with all of the hospitals in the region.  He has been a doctor for 15 years.  From a surgical background he went into emergency medicine in the late 1990s, giving him experience in both medical and surgical camps.  Dr Bonning has worked in diverse areas in both the North and South Island, in the United Kingdom and recently in Melbourne as well as rural Australia.  He attended his first Executive meeting on 1-2 March.

Top of Page
................................................................................................................

New service to support doctors

In the September 2005 issue of The Specialist, ASMS national president Jeff Brown wrote:

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?

He went on to ask many more questions like

When was the last time
You suffered from stress?
When was the last time
You knew it impaired your performance?

and ended with

When was the last time
You sought professional help?
When will be the next time?

The Medical Assurance Society and Medical Protection Society have joined forces to bring their members, who may be asking themselves those same questions, a new support service.  The support service provides access to a free professional counselling service.  EAP Services, an independent counselling organisation, has been contracted to provide the service.  It is very simple to access through the MPS helpline and is completely confidential.

Doctors seeking help can call 0800 225 5677 (0800 CallMPS).  The call will be answered by the Medico-Legal Advisor on duty at the time who will then arrange counselling directly through EAP Services.  Doctors can also nominate a psychologist or psychiatrist of their choice.  The service is completely confidential and doctors are not required to give details of why they are requesting the use of the service when ringing the helpline.

The service was set up as a result of the increasing impact of the stress-related effects of the sometimes-protracted complaints procedure.  However anecdotal evidence gathered since the service began two months ago, suggests that the service is attracting more general inquiries.

“There’s no denying the fact that we live in a stressful world,” Medical Assurance Society chief executive Martin Stokes says.  “Medical practitioners are not immune to the stresses and strains of life and this is a practical way of helping them deal with those.  We are always looking for ways to help our members, both professionally and personally,” he says.

“A Doctor facing a complaint needs support in a number of areas and we will be reviewing the service to ensure it remains aligned and integrated with other support services.”

Medical Protection Society medico-legal advisor Dr Peter Robinson agrees.  “Doctors are notorious for not looking after their own health, particularly their mental health.  Evidence suggests that the service is being well received among the profession and we are pleased to be able to provide it.”

While the service is targeted at members of the Medical Assurance Society and the Medical Protection Society, other doctors wanting to use it will not be turned away.  “We want this service to be available to anyone that needs it,” says Dr Robinson.

Other organisations are also referring doctors to the new service and some calls to the service have been made on behalf of colleagues.

“Sometimes it is difficult for those under stress to recognise the effect it is having on them.  It’s often more noticeable to our colleagues.  We encourage those who may think their colleagues are suffering from stress to either inform them of this service or to ring the helpline themselves.”

At its meeting on 2 March the ASMS National Executive resolved to support and actively promote this new support service for doctors

Top of Page
................................................................................................................

Renegotiating the National DHB MECA

It is that time again—time to renegotiate the national DHB collective agreement (MECA).  Until mid-1992 salaried senior doctors and dentists employed in the publicly provided health system (now district health boards) were covered by nationally negotiated terms and conditions of employment in a document then known as a national award.  However, using its powers under the fortunately now repealed Employment Contracts Act the then National government banned the negotiation of national agreements in the health system.

This right to national or multi-employer negotiations was not re-established until the passing by Parliament of the more balanced Employment Relations Act in late 2000.  This led to the negotiation of the first national collective agreement since 1992, the first MECA (1 July 2003-30 June 2006) and now it is time to re-negotiate the second MECA.

The Challenge
The main challenge of the first MECA negotiation was the construction of one new national agreement out of 21 different ones.  In addition to achieving tangible remunerative gains, this threw up various levels of complexity over a wide range of issues.  For the second MECA the challenge will be different but probably greater—delivering fair remunerative increases and improvements in conditions in a climate in which DHBs are claiming serious fiscal constraints and with some of them agitating for a retrenchment in the gains achieved in the first MECA negotiation (in particular, non-clinical time and sabbatical).

As part of our preparation the National Executive spent two days over 1-2 March working through the draft claim for the next (second) MECA recognising that the current MECA expires on 30 June 2006.  The claim is expected to be finalised at the next Executive meeting on 4 May and it is hoped that negotiations will commence soon after.

In the past in both local collective agreement DHB negotiations and the first national MECA the ASMS has delivered salary increases through a range of means, over and above straight increases on salary steps, such as translations to new scales (including taking steps off the bottom and putting new ones on the top) and widening the margins between the steps.  While this has had the effect of delivering compounded increases to members over the years, the form of delivery has been less transparent and obvious to people.  There has also been the cumulative impact of anomalies between newer appointees and previously appointed SMOs in their relative placement on the salary scale.

Consequently the thrust of the Executive’s approach in the claim is to focus on uncomplicated increases in the actual salary steps (along with seeking extra steps on the top of the scale) with the premise being that one should end up on no less than their current salary step number plus a reasonable increase.  This has the advantage of being more transparent and not compounding existing anomalies.  On the other hand, the greater transparency may make it more difficult to achieve.

Direction of the claim
The main (not only) fiscal impact of the claim, at least in its present draft form, is in the areas of (a) salary increase, (b) working after-hours (call duties and what are often described as shifts), and (c) CME expenses.  For the first MECA, much time was spent on resolving various important process and rights issues; these were largely successful and so are expected to be only a small part of the claim for the second MECA.

We are also forming our negotiating team.  It will include the National Executive but in recognition of the time commitment and the extra workload and pressure on them we also want to expand it by inviting other ASMS members with past experience in collective agreement negotiations to join the team.  This will provide the ASMS with a pool of experienced members to draw upon and allow them not to be required to participate at every stage of the negotiating process.  The ASMS advocate is Executive Director Ian Powell supported by Assistant Executive Director Angela Belich.

Top of Page
................................................................................................................

Hospice doctors' multi-employer collective agreement (MECA) negotiations begin

Members of the Association who work for hospices have wanted parity with the conditions of senior doctors in the DHBs for some time.  Currently most doctors working for hospices are on individual agreements and have a mix of salaries and conditions of employment.  Some of the hospices have doctors on the same pay rates as the DHB MECA.  Most do not have the same conditions of employment.  In order to gain parity with the DHB MECA, the Association began work last year on initiating bargaining for a hospice MECA.

The first step was to hold a secret ballot of ASMS members in hospices to see if they agreed to this move.  Accordingly ASMS held ballots in the 9 hospices where ASMS had members who were employees.  The ballot result meant we were able to initiate bargaining in February last year with North Shore, Mercy, Waipuna, Cranford, Arohanui, Te Omanga and Mary Potter Hospices.  (One hospice voted not to participate.)

The response from the employers ranged from an eagerness to engage through a bare acknowledgement to total silence.  Since then the Nurses Organisation (NZNO) has initiated bargaining and started negotiations on behalf of their members.  With the help of several of the hospices CEOs we now at last have had a positive response from the 8 hospices and are meeting with representatives of the hospices on 23 March to discuss a bargaining process agreement.  This is an agreement about how we handle the negotiations and is the first step in negotiating an agreement.  Dr Paul Wilson from Waipuna Hospice and Dr Janet Neale from Arohanui Hospice and ASMS Assistant Executive Director Angela Belich will form the negotiating team.

Top of Page
................................................................................................................

 R E M I N D E R

Pursuing job sizing including time for non-clinical duties

If ASMS members in their department/service are considering reviewing their job size (including time for non-clinical duties) and if you have not already done so, you are encouraged to study our ASMS Standpoint on hours of work and job size which is available on the ASMS website www.asms.org.nz (copies were also mailed to members last year).  The December 2005 issue of The Specialist also contained further advice on pursuing time for non-clinical duties with the emphasis on the collegial development of a professionally robust schedule of non-clinical duties as part of a job description and a wider job size including clinical and after-hours’ call duties.

If you don’t know where your DHB ranks in relation to other DHBs in its attitude towards the provision of time for non-clinical duties the December issue of The Specialist also includes a league table (also available on our website).

Top of Page
................................................................................................................

Student loans interest legislation

In one of its final actions before Christmas, Parliament passed the Government’s Taxation (Annual Rates and Urgent Measures) Bill.  It is the legislation which removes interest on student loans from 1 April 2006 for students and former students residing in New Zealand. It also exempts graduates engaged in full-time study overseas from accruing interest on their loans balance.  This has been welcomed by the Medical Students Association, in particular, as a positive measure to reduce the negative effects of student debt on both young doctors themselves and the medical workforce.  However, clearly more action is required before this difficulty is effectively dealt with.

Interestingly, figures compiled by the Treasury, Ministry of Education, Ministry of Social Development and Department of Inland Revenue released today, report that the operational costs of this measure ($32m in 2005-06, $218m in 2006-07, $256m in 2007-08, $286m in 2008-09 and $269m in 2009-10) are a little lower than the Labour Party’s estimates during the election campaign and considerably lower than the Treasury scenario that attracted much publicity.

Top of Page
................................................................................................................

BMJ Careers advertising campaign

The Association’s international advertising campaign with BMJ Careers continues to attract high-volume traffic to the ASMS website.  The advertisement is repeated monthly in the Clinical Research edition of BMJ Careers which has a circulation of 68,000 mainly doctors working in hospitals or academic environments.  The advertisement also appears as a continual electronic placement on www.bmjcareers.com.

The ASMS initiative is unique in that it is the union, rather than an employer, encouraging qualified candidates to apply for jobs in New Zealand.  The aim, to fill senior medical and dental vacancies in district health boards is the same but the approach is different.

Support for the initiative has been encouraging with two thirds of district health boards utilising the service to date.  The ongoing success of the campaign relies on the ASMS website continuing to list the majority of current senior medical and dental vacancies.  The Association encourages employers to take advantage of its offer of unlimited online advertising for a whole year at a generous annual cost.  The greater the take up of this exciting venture the greater the chance of filling medical/dental vacancies; and at a much lower cost than DHBs advertising directly in BMJ Careers.

Top of Page
................................................................................................................

Diary these dates!

ASMS 18th Annual Conference: Thursday 2 - Friday 3 November 2006

Delegates required
The ASMS meets the cost and makes all travel and accommodation arrangements for ASMS members to attend its 18th Annual Conference on Thursday 2 and Friday 3 November at Te Papa Wellington.

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.

Dinner and Pre-Conference Function
Delegates are also invited to attend an informal cocktail function on the evening of Wednesday 1 November to be held at the Boatshed on Wellington's waterfront.

Further information about the Conference can be obtained from the National Office or online at www.asms.org.nz

Top of Page
................................................................................................................



Web Design by expert and powered by MoST

MoST Content Management V3.0.4416