Anatomy of an RACGP advocacy own goal

The RACGP stubbed its toe badly this week and then attempted to mislead its own members on what happened, hardly burnishing its lobbying credentials.

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The RACGP’s insistence that telehealth consults be tied to practice patients has likely landed some of its members in hot water with the Department of Health, adding some fuel to the argument that it’s an organisation that structurally cannot be the most effective group at lobbying in Canberra.

It has also attempted to mislead its members on how badly it got things wrong.

Conscious that this week’s First Draft (a column described by one senior RACGP leadership figure recently as our “Saturday brain fart”) is yet again going to concern the RACGP, and possible deficiencies thereof, I first want to clear a few things up.

This publication is definitively not anti-RACGP.

We recognise a lot of important functions have been carried out by the college over the years, most vitally, the recruitment, training and ongoing education of our GP population.

Without naming names (mainly because one of the groups is so dysfunctional it has been known on a few occasions to threaten litigation as a means of silencing the media) we also note that if you wanted to compare the RACGP to some other important Australian doctor institutions in terms of things like governance, and even financial management, the RACGP does tend to stand out as the best of a bad bunch. But that isn’t a reason to celebrate.

No one is perfect, least of all this publication. Mistakes will be made, and they are by the RACGP, even in their core and original mandate of GP recruitment and training. Last year’s exam fails during the pandemic and subsequent treatment of IMGs were far from ideal. When things like this happen you aren’t going to see the college’s own news service lay into itself and ask hard questions. Which makes you ask, is it a news service really? Answer, no, it’s a college information unit pretending to be a media service for reasons we will address later in this article.

From time to time the RACGP goes feral on the medical media and stops talking to them. It isn’t an organisation that historically has dealt well with criticism, even constructive criticism, which we’d like to think we try for. The college has never had an executive that understood the media or how to deal with it, which might be something they think more carefully about going forward.

Famously the college excommunicated The Medical Republic and Australian Doctor a few years ago after we started reporting member concerns that planned changes to the constitution of the college might not be in the best interests of the ordinary membership. It cut the media off after the vote on the change failed to get up, and used members’ money to start its own media business. That was a wasteful and ineffective reaction to an issue that ultimately its own membership was pushing, not the media.

Today, we, The Medical Republic, are in one of those times where the college thinks that ignoring us maybe might make us go away. This is pretty silly logic and goes to how poorly the executive understands the role of media and how to manage it.

As a media executive of over 27 years, some of it in quite senior roles, I have had many run ins with powerful, political and at times bullying professional associations. No matter how bad things ever got, I was always up for a coffee with who ever was angry with us, just to check we hadn’t got our wires crossed somehow, and we couldn’t somehow sort something out more fruitful for both the membership of the organisation, and the readership of our publication (who, surprise surprise, are the same people).

On a much needed family holiday to the snow once many years ago, I cunningly bribed my wife to stop over in Canberra for a night, with a night’s accommodation at the Hyatt Canberra for the family. Her totem is the foyer of a six star hotel (which we sometimes will sit in when we get the chance and marvel at the passersby, but which we can hardly ever afford to stay in unfortunately).

I used that night to front the CEO of a very large and powerful professional member organisation in the finance sector who was attending their annual general meeting at the hotel. In our last meeting, in the CEO’s office in Melbourne, the CEO had screamed at me in a rage, and after that meeting, for some reason, he had steadfastly refused to engage in any communication with our finance publication, which was one of the largest publications in our company at the time. I’m going to admit here that in that particular meeting, I was stubborn and very annoying. I think I would have shouted at me.

Said CEO was so surprised to see me in the Hyatt that night, and the trouble I had gone to just to have a chat with him (initially I pretended it was an accident running into him as he left the ball room the AGM was being held in for a toilet break), that he agreed to go to the bar next door and give me five minutes. Its’ a nice bar in the Canberra Hyatt, especially suited to such an occasion.

He turned out to be a pretty reasonable and smart executive, as I had always suspected, and the conversation ended up as three beers each and just over one hour long.

After that meeting things weren’t suddenly all peachy again between our organisations.  

But we both came out of it with a very important understanding of each other.

We were both trying to do the right thing by the professionals in that organisation no matter how deluded each of us thought the other was in how we were going about it.

He had conflated doing the right thing with doing what his organisation wanted to do, because he felt his organisation only did the right thing (I see this a lot in the RACGP leadership). Hence if we didn’t agree with what his organisation did, we didn’t understand anything and were screwing things up unecessarily.

He hadn’t stopped to consider until that beer, that someone on the outside might also have his constituents’ best interests at heart, but with an external perspective, free of certain limitations, might not agree with how his organisation was going about helping their constituents. That it was OK that someone on the outside was asking hard questions that he was in no position to either ask himself, or even sometimes to answer.

This is a very brain-farty way of getting to this week’s RACGP own goal on advocacy.

It emerged earlier this week that the Department of Health had been in negotiations with the RACGP (and the AMA, ACRRM and RDAA) on how they would communicate to GPs that some GPs had been inappropriately billing telehealth items. The department was shaping up for one of its now infamous “nudge” letters, and perhaps wisely, was negotiating with the various medical colleges on how to most effectively do this without scaring the living crap out of most GPs.

The irony of course was that those GPs who had been caught out, ran aground on the rocks of an RACGP led advocacy effort early in the COVID pandemic, aimed at protecting college members from pop up telehealth clinics which they feared might be taking business from their members on an industrial scale.

The fear was probably well founded. The solution the college came up with probably wasn’t, as things have turned out.

The government subsequently introduced a relationship rule, which tied a telehealth consult to the condition that a patient had to have physically visited the practice that was claiming the consult, in the past 12 months. One problem with this is that patients are clients of doctors as well as practices, and doctors often move between practices.

The idea that lots of GPs may have fallen foul of the DoH on telehealth claiming had been kept largely secret until this week when the RACGP, using its own news service, published an article by Dr Michael Wright, chair of the college’s Expert Committee on Funding and Health System Reform, which announced to members that the government was warming up to send compliance letters to GPs about the temporary telehealth items.

Dr Wright announced in his article that “30,000 GPs had potentially breached telehealth MBS rules” and might be about to get a letter. He said that the college was negotiating to somehow dampen the whole episode, especially given GPs were about to undertake the COVID vaccination program.

The first thing everyone inside The Medical Republic did when they read that figure was sit back and screw up their faces.

How could it be 30,000, everyone thought? 

If  it was, something was dreadfully wrong somewhere in the whole campaign to bring in the relationship rule and this was a very big story.

Our editor immediately contacted the Department of Health to confirm the number (and ask whether a huge compliance campaign was appropriate in the middle of the vaccine rollout).

Another journo emailed the media unit of the RACGP to ask if it was possible that either the editor, or Dr Wright, could have made a mistake.

We had surmised that given there are only 24,500 fellows of the college, and 30,000 represents nearly 75% of all GPs in the country, maybe what everyone had meant to say was that the department had identified 30,000 inappropriate claims, not individual GPs making inappropriate claims.

Our cousins at Australian Doctor took the college news service at its word and led their afternoon news with the headline Health officials believe 30,000 GPs may have inappropriately billed telehealth items, which was going to significantly amplify the angst among the GP community, perhaps for no reason if it was a mistake. AD had tried to contact the DoH for clarification at least.

Our efforts to clarify the issue were met with a hostile anonymous response from the college media department.

Remember, we were asking if possibly their own chair of an expert committee had potentially made an error which could have freaked out nearly every member of the college.

“Hi XXXXX,

You’ll need to confirm the figure with the Department.”

(No signoff from anyone).

As I’ve mentioned above, everyone makes mistakes. We do all the time.

But this one was a potentially big one, and it wasn’t the department which was making the mistake, it was the chair of a college expert committee, talking directly to college members on an issue that was likely to cause a high degree of anxiety

The DoH eventually got back to us to say it would not, and was never planning to, send letters to 30,000 GPs.

“The department expects to engage GPs who have been identified as claiming in a way that potentially does not meet the telehealth ‘existing and continuous relationship’ requirements; compliance activities will include awareness raising, targeted letters and audit,” the department spokesperson told TMR.

What was the actual number of GPs the DoH felt might need a letter?

Unknown, but fewer than 1000.

So the RACGP news article was out by a factor of 30.

What did the RACGP do about this apparent gross error and miscommunication?

Instead of a correction, and apology, it doubled down with an update and edit of its original article (we have both versions of the same story, which are quite different) to say that the DoH had originally identified 30,000 GPs who had potentially breached the MBS rules, however “following RACGP recommendations [to the DoH], the campaign has been changed, and the vast majority of GPs will no longer receive a letter”.

Now we were starting to get into some very weird territory.

Who was telling the truth?

The RACGP or the DoH? Both can’t be. Which of course means one of them is lying. Yep, lying.

The DoH told us that there was never a plan to send a letter to 30,000 GPs. The RACGP says there was and their masterly negotiation team got that figure cut back down to <1000. That is a pretty big lie on someone’s part.

We tend to believe the DoH if for no other reason than 30,000 GPs always felt a ridiculous figure. We tend to believe the DoH also because as much as it gets annoyed with us hassling their media department each week for answers, and as politic as they need to be in their answers given they report to a federal minister, they are staffed mostly by professional ex-journalists who know how to handle the media.

Tip for dealing with journalists. If you’re going to try to slip one by them, or lie to them, you’d better have all your ducks in a row because if you get caught out, it’s going to be all over the media.

There are so many issues with this situation it is hard to know where to begin.

For one thing, is the RACGP using its news service to deceive its members?To make it appear that the college performed a miracle, rather than stuffing up?

I will concede there is a slim chance that the RACGP is telling the truth, not the DoH, but sheer logic suggests not. Was it ever really a credible statistic that 30,000 GPs breached the telehealth rules? It was suspect from day one. The DoH figure (not insignificant as compliance letter campaigns go) is far more believable.

If the DoH is telling the truth, and the article has been modified to make things appear not as they are, then one could rightly assert that this an egregious breach of member trust by the RACGP.

If they have done this the board had better get off its rear end and get the whole matter clarified quickly for its members.

We would try, but of course the college will not talk to us.

It is the worst thing I’ve witnessed the college ever do in terms of trying to manipulate the narrative of their poor management to their members – ever.

Seriously. What are they smoking down there?

If this occurred in any public company the CEO, the chairman and any senior manager involved would have their jobs put on the line by their shareholders. There would be an enquiry. People would lose their jobs. Structures, rules and processes of governance would be investigated and changed. It would be entirely unacceptable.

What do we think is going to happen at the RACGP though?

Will anyone stand up at the next board meeting and ask the question: “did this all really happen, and if so, who is responsible and what can we do about it in the better interest of members?”

I do not have much faith that this will happen, unfortunately for RACGP members. The RACGP is not governed by a body that will bring them to task if they have deliberately tried to mislead their members. The Medical Board of Australia only watches out for governance issues in respect to the recruitment and training of GPs. It doesn’t care about all this other stuff.

This series of events clearly underlines what this publication has questioned before about the college. It is structurally incapable of lobbying properly on behalf of its members in Canberra.

It is effectively paid by the government via its mandate to recruit and train doctors. That is an important job but it is one which does not mix with having to at the same time attempt to pressure the government over pay for doctors, improve doctors working conditions, and in this instance, oversee a legal framework of some sort to make sure doctors follow the rules.

As the DoH rightly pointed out in our story on the matter yesterday, the timing of sending out nearly 1,000 compliance letters to GPs just as they are about to start vaccinating is not ideal. But they have a legal duty of care to the country to do something to make sure that GPs stay within the rules on how they are reimbursed.

By the looks of how the DoH has handled this episode, with a lot of negotiating and pre warning the relevant colleges, all kept at arms length from a highly stressed GP population, it feels like it has done its best to make the message fair and clear. Something the RACGP almost certainly has not done.

Certainly you wouldn’t think that the next time they attempt to negotiate anything with the DoH, the department will take them seriously, given how they have attempted to spin this episode to its members.

The solution to meaningful, powerful and transparent lobbying on behalf of GPs is not clear.

A new organisation, the Australian Society for General Practice (ASGP), is attempting to get started, with an intent to be just a lobby group, without any of the conflict the college obviously has and the restrictions that come with it.

This has been tried before and failed so it may not work this time around. If the ASGP does anything like what the college has done this week, we will lay into it, as much as we are laying into the college here.

But short of any other ideas at the moment, the ASGP sounds worth a try.

The Medical Republic supports the idea,and we will do our best to help this idea blossom in the better interest of GPs, until such time at least that the idea isn’t working.

We do this occasionally as a part of our purpose statement as a company, which is broader than just being a media group for doctors. We have in the past supported other groups which have attracted the ire of the college but which we have observed doing good for the GP community. GPDU is an example.

GPs need a lobby group that is competent, transparent, isn’t in conflict in its lobbying efforts and has teeth.

The last thing the ASGP needs is the RACGP, which has form, attempting to destroy the initiative before it even gets started, based on the completely misguided idea that the RACGP is the centre of all things GP, and any dilution of its current goals, aspirations, and roles, would be detrimental to the GP community.

This argument does not stack up any more. And if you wanted proof positive of it as a member, write a letter to your president and CEO and ask them to explain to you if their news service has published material this week that has attempted to mislead members on how badly the college has handled this latest attempt at influencing Canberra.

The RACGP needs to take a huge step back, get out of its self-created bubble that only it can lead GPs, and look at the problems facing GPs a lot more laterally. They need help. The ASGP might be that help. It might be that the two groups could be synergistic in a good cop, bad cop type of dynamic. Ironically, if the RACGP left most of the serious lobbying to another group you can imagine that the government might even turn to them for help when things were getting really tough, as the body that has so much responsibility in recruiting, training and education our GPs.

We have asked the ASGP if the RACGP is engaging with them, as it should be if this organisation is going to have any chance of being effective.

We’re told unfortunately that at this stage, and despite efforts to have dialogue, the relationship is seen by the RACGP as entirely adversarial. In the other words the RACGP perceives the ASGP as a threat to its power and influence, rather than a potential mechanism to get their members much better representation on important issues in Canberra.

Why?

I’m not giving up on the idea that the RACGP can wake up to itself and use its powers for good, not for simply sustaining something that now is clearly conflicted and overextended – the college never originally did advocacy

It isn’t working for GPs. It never has.

I’ve written directly to the CEO of the college this week and asked for a face to face chat. I’d be happy with just five minutes. But I hope if I do get a guernsey it will end up as a three beers one hour session at the least.

It can’t hurt.

It’s amazing what happens when you take the time to meet someone face to face to iron out your issues.

I think that every member of college should be thinking and doing something similar. It’s only the membership that can change the college’s intransigence in the end.

This incident is surely a bridge too far.

Note: we have removed some information on the college response to our queries on the grounds that it is unclear if the information was supplied for publication or not