Does the RACGP’s restructuring plan represent genuine progress, or is it an opportunity gone begging?
More senior RACGP members are going public with their fears that a planned governance restructuring will weaken the voices of key interest groups and fail to make the college a more dynamic force.
The RACGP has set a date of May 30 for an extraordinary general meeting of members to vote on constitutional changes to create a “skills-based” board of seven, including three experts in legal, financial and governance affairs, which will sit at the top of the hierarchy with the power to reject proposals from the Council.
The existing Council, with seats for state-based, rural and indigenous health faculties, registrars and the censor in chief, would still have input on education and professional matters, but no control over strategic and budget decisions.
Calls for the college to delay the electronic vote and encourage more debate, however, appear to have fallen on deaf ears.
Dr Di OHalloran, a long-serving ACT and NSW board member who originally proposed the RACGP governance review, argues that adopting the proposed model would be a wasted opportunity.
First, there had been no suggestion of working out what matrix would best suit the RACGP. A large, membership-based organisation operating in a difficult political environment needed a whole range of extra skills at the top, she said.
“Another perspective is that of health reform at the leading edge of change and general practice reform,” she told The Medical Republic. “This not only needs education and training; it needs political smarts, in-depth knowledge of health-reform initiatives going on around the world and in Australia, and an understanding of who the thought leaders are.
“It needs to have some perspective from really key stakeholder groups. That doesn’t mean representatives, it means people who have expertise.”
Dr O’Halloran said the perspective of registrars would seem to be essential. GP registrars, now numbering 5000 to 6000, not only formed a sizeable chunk of the RACGP’s membership and financing, but were the future of the profession.
“It might mean a different way of appointing them,” she said.
The college could call for expressions of interest, for example, and appoint a registrar with a particular set of skills to sit on the board and bring fearless advice.
After reviewing the planned new constitution, Dr O’Halloran said the document seemed to be suggesting that the board’s remit was not about the organisation’s overall cultural values and strategic direction, but about financial, fiduciary and regulatory matters.
“It’s as though they have stopped halfway (with the governance reform),” she said.
Another high-profile proponent of the “no” case is former RACGP president Dr Liz Marles.
Even though the proposed new board would have a mandated GP majority – including the finance and audit committee chair, the RACGP chair, president and vice president – the latter three were elected for only two years. As a result, they would probably lack experience and could be more easily led by management, Dr Marles said.
“No board is going to delegate strategy,” she said.
Dr John Kramer, provost of the RACGP National Rural Board, which represents about one-third of RACGP members, said he supported the inclusion of external experts, but strongly opposed the loss of a rural-doctor voice on the board.
“One of the potential skills on a skills-based board should be practical experience as a GP in the country, but it hasn’t been acknowledged as a specific need,” he said.
“The college has done a lot of good things in recent years, but the challenge for a grassroots organisation with a large membership of more than 30,000 members is to remain member-focused. I think that’s probably the core issue here.
“Any organisation can do a better job. The problem here is with the alternative model that is proposed, and also the way it’s been presented, with more ‘pseudo’ consultation than [actual] consultation.”
Similar concerns have been voiced by advocates for Aboriginal and Torres Strait Islander health, who note the current governance set-up, which includes their faculty, has brought important gains in setting standards for Indigenous patients and vocational training.
The General Practice Registrars Association has taken a neutral stance on the May 30 vote, but the association’s recent strategy-development meeting heard misgivings from a number of members, President Dr Melanie Smith said.
“There was talk about the need for stronger GP numbers on the board, instead of the four out of seven currently proposed, and the need for more of a GP majority,” she said.
“Certainly there is a range of views. There are some who see no need to change, some who are happy to have more of a skills-based board, and recognise the business aspects of the college. There are others – and not just registrars – who agree there is a need for change but this model is the problem.
“What we will be telling GPRA members is that they should inform themselves and all should stand up and have a vote. We’re not going to tell them what that vote should be.”
RACGP stalwart Emeritus Professor Max Kamien said he was not convinced of the need for the proposed changes but was more troubled by a sense of apathy among the college membership and low voting rates.
The current debate put him in mind of the words of the Roman satirist Petronius Arbiter, Dr Kamien said.
“We trained hard, but it seemed that every time we were beginning to form up into teams we were reorganised,” Petronius wrote.
“ I was to learn later in life that we tend to meet any new situation by reorganising, and what a wonderful method it can be for creating the illusion of progress while actually producing confusion, inefficiency, and demoralisation.”
