Country Health SA LHN Contract Negotiations 2017 – 2020

RDASA have been formally invited by Country Health SA LHN to negotiate terms for the 2017 – 2020 Rural Doctor Contract Agreements.

 

We are happy to represent South Australia’s rural doctors in these negotiations and we look forward to a productive and positive dialogue with Country Health SA LHN over the coming months.

 

Dr Peter Rischbieth and Dr Scott Lewis will be representing RDASA and encourage member’s to contact them with any issues or concerns they may have to ensure the voice of all rural doctors are heard during the negotiations.

 

 

Over the months, they will be joined by GP representatives from a range of rural communities to ensure a  balanced view from South Australia’s doctors is presented.

RDASA and CHSA LHN are both committed to seeing a sustainable South Australia rural medical workforce and we look forward to working respectfully together and creating positive health outcomes for our rural communities.

 

RDASA believes that the creation of the new Contract Agreement 2017 – 2020 supported by country doctors, CHSA LHN and the SA Department of Health will build a stable rural doctor workforce and create opportunities for junior doctors to work alongside rural doctors to provide high quality services for our rural communities.

 

Below is a list of issues RDASA will be raising with CHSA LHN during the Formal Contract Negotiations.

 

Local rural doctor and hospital Meetings

Workforce and service provision planning meetings with rural doctors are not being consistently held across the state as set out under the terms of the current Contract.

 

These meetings should allow for the communication of important policy changes especially in regards to Transforming Health policy and facilitate discussion around local hospital and clinical issues. They are invaluable for strategic workforce planning and RDASA looks forward to working with CHSA LHN to progress this issue.

 

Quality and safety audit meetings

While funding had been put aside for these important audit meetings, they are only occurring in a handful of sites, often without consistent terms of reference. In addition, there is a lack of consistent remuneration to support doctors to attend these meetings.

 

To ensure a consistent Quality and Safety Framework, rural doctors wish to engage in this important process and RDASA calls upon CHSA LHN to support this process in a formal and meaningful way. RDASA also recognises there is a cost to implement these important meetings and they require adequate budget support.

 

 

Training of junior doctors

In a recent RDASA survey of 100 rural doctors 40%+ of GPs indicated their capacity to train junior doctors would be increased if they received greater support from CHSA LHN.

 

RDASA have consistently advocated for Teaching Hospital status funding to be allocated across country sites. This was a key component of previous RDASA Contract negotiations and it has yet to be supported by the SA Department of Health.

 

IT/IM Supports

Country hospitals do not have an electronic health record and RDASA has previously alerted the SA Department of Health to the pitfalls of EPAS after it was imposed on country doctors at Port Augusta.

 

Due to the lack of IT systems, many rural doctors are reliant on their own practice software, which is installed at the clinic’s expense to create discharge summaries and medication management. RDASA believes this should be recognised in the discussion of the new Agreement.

 

Fee For Service Changes in SAMSOF

RDASA firmly believes that all SAMSOF payments must have 6 monthly CPI increases. RDASA consistently argued for this in the last negotiation process. The current linking of SAMSOF to Medicare CMB increases has resulted in a prolonged freeze in state FFS payments which is inappropriate. The precedent to use a CPI increase has already occurred with CHSA LHN paying CPI increases for emergency item numbers as per the amended offer in April 2015. RDASA also calls for a significant corrective increase in SAMSOF to recognise the extended freeze that has occurred thus far.

 

Introduction of long consult item number Level E (Extended) indicating that a doctor has spent considerable time on a specific clinical scenario.  For example, long psychiatric counselling and organising referrals for telepysch or mental health reviews for in patients who don’t fit SAMSOF 50 or 160 triage level 1 or 2 posing a risk to themselves or others.

 

There have been many occasions reported by members where fee-for-service officers have claimed that consultation time is only to include the time spent face-to-face with the patient. This neglects the significant amount of time that must be spent performing duties directly related to patient care, including writing of notes and referrals, liaising with other hospitals when arranging transfers, counselling family members, coroner’s paperwork, SAPOL paperwork etc.

 

Complexity around referrals for transfer continues to be a major issue, often requiring multiple phone calls to Tertiary centres and bed managers, Medstar SAAS etc for advice and arranging transport. This is becoming an even greater problem under the current Transforming Health environment. We expect that the time required to perform these tasks be adequately recognised.

 

Remuneration for forensic examinations as requested by SAPOL remain an issue. RDASA believes that these should be paid under SAMSOF.

 

RDASA also wishes to discuss consideration of a change to flat-rate time based remuneration for all Triage 1-3 emergency presentations, irrespective of admission status or patient category.

 

Strategic Direction Plan 2015 – 2020

RDASA is concerned that no specific mention of rural doctors and general practitioners exists in the CHSA LHN Strategic Direction Plan 2015 – 2020. This lack of workforce planning is a risk to the rural workforce and places greater pressure on existing services.

 

Building a strong Industrial Contract and introducing practical changes will greatly assist in the viability of the rural workforce, utilising well trained physicians in a supportive environment who are committed to provide high quality services for their rural communities.

 

Site-specific supports

Offered under the previous contract was site-specific support for towns struggling to provide full Emergency departments and procedural services. This support is yet to be realised.

 

Wallaroo and Port Augusta emergency services are operating under extreme pressure with no sign of resolution.

 

Mt Gambier is struggling with staff withdrawals, a workforce crisis and a lack of adequate supervision of junior doctors.

 

In the South Coast, an expensive model of care is in operation that does not utilise General Practitioners and has resulted in a rural training loss for students and registrars.

 

Goolwa has lost their emergency room grant from CHSA LHN leading to fragmented care and greater transport costs for the region.

 

There are other smaller towns in the Mallee, Far North and West Coast where services are under stress and the initiation of the SAVES program is still a work in progress.

 

Account recovery

Doctors are currently responsible for settling accounts with MVA patients and international travellers. RDASA requests CHSA LHN to pay SAMSOF monies for the provision of these services direct to the treating as it is for LHNs in metro hospitals.

 

Many doctors are continuing to report non-payment or lack of payments despite a fee recovery proposal in the last Contract Agreement.