Attn:

Peter Somerville            and             Craig Thomson
Executive Officer                              Senior Industrial Officer
ASMOF                                           HAREA

Hello Peter and Craig,

Trust you both had a good Easter Break.

Now that the NSW Election is behind us (+/- new Health Minister), I guess its time to move forward with these proposed changes to the CMO Award, if we are to have anything in place before Jan 1st 2000.

As the newly elected Industrial Officer for the CMOA, I wish to forward you both a copy of our proposed changes to the NSW CMO Award which have now been approved by the CMOA for further development by your good selves.

As they have been prepared without formal legal expertise, I anticipate that they will require some refinement before presenting them for discussion with the Dept of Health.

First of all there are some clear messages arising from recent CMOA discussions.

1. All voting Members want the NSW CMO award to be revised rather than re-named or re-invented.

2. All voting Members want removal of the "Barrier" unique to the CMO Award (currently applies to ALL Overtime, Call-backs, Penalty Loadings, and Public Holiday Payments !!)

3. All voting members want Study Leave to be applicable to ALL conferences and courses relevant to the continual medical educational needs of CMOs, including reasonable funds for expenses related to travel, registration, meals and accomodation, etc.

(The current award appears to only recognise courses leading to "higher qualifications", and provides leave only. ie: no financial support for related expenses. How can we be expected to maintain our clinical performance with current arrangements .. let alone update or improve them ? )

4. All voting members want to see full access to Salary Packaging and Salary Sacrifice currently available to medical colleagues in other States of Australia (and other public servants in NSW).

5. All voting members want to see all Allowances indexed to general salary increases +/- CPI.

6. Although "Skills-Based" Grading Criteria would provide a navigable career path for CMOs, most voting members do NOT want the introduction of skills-based criteria unless "ALL" other proposals are accepted.

(Skills based criteria have been included in their current form as "cost-attractive" proposals to convince the Dept of Health that there is an urgent need to revise and update the NSW CMO Award.)

7. Any "Casualisation" of hourly rates (i.e. "Rolled-up rates" to avoid various penalty loadings +/- study leave) would have to be both generous and with ample protection against excessive rostering during unsociable hours.

CMOs have traditionally provided their services during these unsociable hours and attracted appropriate penalty rates. If "casualisation" allowed Hospitals and Area Health Services to roster some CMOs almost exclusively on Weekends, on Nights and after hours then many CMOs believe they would be exploited and underpaid, as they were no longer attracting appropriate penalties.

The provision for "above award" payments for Sen Medical Practitioners appears to be at the discretion of the CEO, and anything beyond that is nigh impossible (ie at the discretion of the Dept of Health). Therefore CMOs believe that these sorts of arrangements do NOT work.

Considering the AMA's interest in providing reasonable hours of work for all doctors, an "Unpalatibility Allowance" (as described in the proposals) may be the only way to go.

8. Furthermore all voting Members want to see the introduction of double time payments for all hours worked, if returning to duty after less than 8 consecutive hours break, until an "8 consecutive hours" break occurs, as described in other NSW awards that HAREA is responsible to. (also NSW Nurse's Award has this)

In Summary:

=> CMOs would like to see ALL current deficiencies in the award "properly addressed" before any serious discussions about the introduction of "Skills based" Grading criteria. They may eventually become our main bargaining tool.

Please familiarise yourselves or relevant staff with all relevant information available via the "STOP PRESS" table on the CMOA web-site's Main Page at:

www.cmo.asn.au/

I will be sending you both hard copies of this note and the accompanying proposals, which can be found (to print +/- download) on our website at the following address:

www.cmo.asn.au/ind/prop/asmfhrea.htm

Furthermore, I am happy to represent the CMOA and be involved at all levels of discussion with yourselves and the Dept of Health, if needed.

I am currently canvassing opinions from the Area Health Services across NSW, as I assume we will have a greater chance of meaningful change if we can include their desires as well.

Please feel free to contact me, regarding any matter, on:

Work: 07 5536 0443 Home: 07 5576 5775 Mob: 0412 065 775

All the best to you both,

David

Dr. David Brock
Industrial Officer
Career Medical Officers Association

(PS: 1. The MMO Association has provided the CMOA with Credentialling Criteria they use for varied MMO areas of employment such as Accident & Emergency, Medicine, Surgery, Paediatrics, ICU, Anaesthetics and Obstetrics & Gynaecology. These have all been uploaded to the CMOA web-site and are accessible via the "What's New ?" page

2. I am sending copies of this email to CMOA Committee members and other interested members of the CMOA, via our informal email discussion list)

The current award has been neglected for a decade.
It needs to be re-vitalised or re-invented, before it fades into the background.

Many CMOs feel frustrated by an award that hinders their progression, fails to reliably provide for continuing medical education programs, unreasonably limits penalty (and related) loadings when providing their services during unsociable hours.

With an award failing them, some CMOs have moved to private contractual arrangements within their local hospitals or Area Health Services, securing remuneration and conditions well beyond the current award, with 50 to 95% above entry award hourly rates (ie Grade 3 Yr 1). This is approaching or equalling Locum rates. These arrangements may be technically "illegal" and are officially "frowned upon" by the Department of Health. For these CMOs, and the Area Health Services employing them, award conditions have fallen "well behind".

They seek to improve conditions and include the introduction of a Skills-based structure, modelled on the Multi-Skilled Medical Officers Agreement of 1997 currently in place in the Illawarra region.

MuIti-skilling should provide both a focus for staff development, and a navigable career path that would both reward and deliver relevant skills and experience to each area of CMO expertise. This, in turn, may provide significant direct and indirect cost-savings to many areas throughout the health system.

Furthermore, a re-vitalised award may rekindle interest in recruiting experienced CMOs back to Award based conditions. This may renew stability in a workforce that has been prone to fluctuations in supply.

However, it would seem that the overall success or failure of all these proposals depends upon the level of desire amongst Hospital, Area Health Service and Departmental administrators, to address real deficiencies, and renew interest in the NSW CMO Award and prevent Area Health Services and CMOs from participating in "illegal" private arrangements or more costly Locum arrangments in order to maintain basic levels of service.

It is proposed that the NSW "PUBLIC HOSPITAL (CAREER MEDICAL OFFICERS) (STATE) AWARD" be retained and updated to include the following modifications.

NB: Adjustments to the "criteria for determining grading for CMO positions" can also be considered. At this stage we would refer this to ASMOF for their advice and consideration.

5. PENALTY RATES

Details of proposed changes to PENALTY RATES

Increase the penalty rate to 50 per cent for any ordinary hours worked between midnight and 8.00 am, midnight Sunday to midnight Friday.

(ie: Increasing penalty rate for "weeknight" nightshifts. Weekend nightshifts already receive 50% or 75% penalty loadings)

6. Proposals affecting the inclusion of Clause relating to MEAL BREAKS

Meal Breaks are to be defined within the award.

a) In the interests of patient care and the health and welfare of medical staff, officers must have a break from duty for the purpose of taking a meal.

b) There shall be a uniform meal break of 30 minutes except where locally agreed arrangements for a longer period are made (which shall not exceed one hour).

c) If officers are required to work during their meal break they shall be paid for the time worked. Unless the employee is permitted to finish duty early on the same shift then overtime becomes payable once the total ordinary work time of the shift has elapsed.

d) Medical Administrators are to establish simple and effective procedures in consultation with officers to record when staff are required to work through their meal break and to ensure that payment is made.

e) One twenty minute interval (in addition to the meal break) shall be allowed each employee on duty for a tea break during each shift. Such interval shall count as working time. Part time and Casual employees who are engaged for less than a whole shift on any one day shall only be entitled to one tea break of 10 minutes.

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7. Proposals affecting the Insertion of additional paragraph to CLAUSE 12. ANNUAL LEAVE

the following paragraph be inserted into Clause 12. ANNUAL LEAVE.

Addition of Section ii) "if more than 35 such periods on such days have been worked - leave proportionately calculated on the basis of 38 hours leave for each 35 such periods worked

(to allow pro-rata payments if greater than 35 "such periods" as defined in 12 i & ii)

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8. Proposals affecting the addition of CLAUSES providing for  ALL FORMS OF LEAVE currently absent from the Award

Include clauses providing for Parental and Adoption Leave, Personal Carers Leave, FACS Leave, etc.

Including statements that part-time career medical officers are entitled to all the benefits enjoyed by fulltime employees on a pro-rata basis,

including access to pro-rata long service to employees completing 10 years service (whether part-time or any mixture of part-time and full-time service).

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9. Proposals affecting the addition of CLAUSES providing access to SALARY SACRIFICE & SALARY PACKAGING arrangements

Full access to all Salary Sacrifice & Salary Packaging arrangements as they become available to any group of public servants within NSW

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10. Proposals affecting addition to provisions for "LEAVE WITHOUT PAY"

Leave with out pay shall not be unreasonably withheld for the purposes of gaining relevant post-graduate qualifications

The Proposals accepted by CMOs at the AGM was "Include statement supporting adoption of AMA's "SAFE HOURS" NATIONAL CODE OF PRACTICE as varied from time to time." "provision of sleeping quarters for CMOs exclusive use when completing nightshift or extended periods of duty" "introduction of double time payments for all hours worked, if returning to duty after less than 8 consecutive hours break, until an 8 consecutive hours break occurs, as described n other NSW awards such as the NSW Public Hospital Nurses' (State) Award."

Details of proposed changes affecting Adoption of AMA's "SAFE HOURS" NATIONAL CODE OF PRACTICE

Formal Adoption of AMA's "Safe Hours" National Code of Practice provisions as varied from time to time.

Including the provision of sleeping quarters for CMOs exclusive use when completing nightshift or extended periods of duty

12. Proposals affecting additions to LEAVE RESERVED Clause

i) Leave reserved for interested parties to develop skills based classifications suitable for assessing Grading of CMOs for all areas of CMO expertise.

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13. Proposals affecting RIGHT TO PRIVATE PRACTICE

Establishment of a clear RIGHT to PRIVATE PRACTICE

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14. Proposals affecting remaining issues

A. Deletion of OBSOLETE clauses

such as the Removal of "Preference of Employment" for those "who have been members of the Forces during the war"

B. Correction of all DISCRIMINATORY LANGUAGE or OMISSIONS 

Long Service leave entitlements currently appear to be unavailable to defactos or partners of deceased medical officers.

clear statement that part-time CMOs are entitled to all the benefits enjoyed by fulltime employees on a pro-rata basis.

statement that guarantees CMOs, moving from full-time to part-time, can return to full-time positions without penalty.

Ensure portability of Long Service Australia-wide, with recognition of time worked in all public hospitals and community based services in all Australian States & Territories..

CONCLUSION:

All these adjustments have a greater chance of success if we remain relevant to the Health Care system.

We remain relevant when we deliver quality services whilst proving to be cost-effective. We need to remind and repeatedly demonstrate to the Health Dept. that experienced staff, such as CMOs, improve quality of care, whilst reducing overall costs.

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The Department of Health and the State Government need to be shown that this level of service & expertise costs money, yet that same level of service and expertise will be saving them more money, whilst improving overall quality of care.

If we can further demonstrate that educating CMOs enhances further cost containment then we will find our training & education fully funded.

CMOs should continue to be the cost-effective solution we were originally designed to be, providing support to the Healthcare of Australians, in busy service roles that other medical groups have traditionally been unable or unwilling to fill.

For example in the Accident & Emegency setting, we need to demonstrate that experienced CMOs decrease the costs associated with: - unnecessary hospital admissions - unnecessary and A/H investigations, - unnecessary VMO attendances. (eg manipulation of some fractures under regional anaestheseia by CMOs rather than general anaesthesia which would require involvement of VMOs, theatre staff, and general Nursing staff, etc associated with consequent hospital admissions) whilst possessing the necessary skills and experience to improve the overall quality and standard of medical care. Furthermore by achieving earlier diagnosis and initiating earlier definitive treatments, experienced CMOs should help reduce morbidity and mortality, whilst reducing the length of inpatient stays and their associated costsi The world-wide trend of increasing levels of senior staff in Emergency Depts, and reducing junior staff involvement suggests that: The First line in reducing hospital costs is: employ experienced CMOs at the Front Door. The Second line, keep them there with - adequate remuneration - rewarding and navigable Career Structure - adequate opportunities and funding for relevant training and education programs