30 May 2020

Dr Harry’s excellent report card

Policy RACGP TheHill

When Dr Harry Nespolon was announced as winner of a three-way race for RACGP president nearly two years ago, there were audible gasps of surprise from those “in the know”. Dr Nespolon, who had tried twice previously to win the presidency and failed, was supposedly a rank outsider. But he ended up with what was pretty much a landslide win.

How that win came about should have been a sign of things to come for “those in the know”, and for those in the long-term executive of the College.

Dr Nespolon was an accomplished businessperson in his own right, in and outside of medicine, and although his style was brash and forthright, something which may have held him back in the past, he’d worked out how to tap into the membership during the election, by asking members directly what gripes they had about in the College, and what they really wanted in the way of change. Members felt they were being listened to, for the first time in some time. His survey of members prior to his election was a simple but extremely effective direct marketing ploy: talk to the people directly.

That he could pull it off so easily spoke somewhat to how little  the executive and others vying for the role might have been in assessing their rival.

A couple of days after Dr Nespolon got the job he apparently got a call from the then CEO who said something like:

“I’ve heard a lot about you. You’ve probably heard a lot about me. Let’s park all that shall we and start from scratch.”

If the rumoured conversation was  true, apparently the presiding CEO did have some inkling of what might be coming.

Dr Nespolon had maintained that ignoring the members was something the College had been doing for years and as a result there was a massive disconnect emerging between what the members really wanted, and what the executive wanted, or, at least what they felt was best for the College.

The executive sought and found a lot of protection in its not insignificant financial and membership performance. However this performance was largely locked in for the College by the status granted it by the Medical Board of Australia as a virtual monopoly provider of training, education, governance and ongoing professional development. This was something the executive did not seem have much perspective on. They acted like the College’s  10-year growth in profit, revenue and members was a result of their of skill and management savvy.

It wasn’t.

Dr Nespolon knew that. He just needed a way to break the stranglehold the executive had on the day-to-day running of the things, without either getting mesmerised by this impressive financial performance and membership growth, or clipped and disabled, as previous presidents had been if they stepped out of line.

Dr Nespolon, taking a page from leadership 101, delivered almost immediately to his constituency by giving the members the head of PLAN on a platter within weeks of starting.

PLAN was the most polarising thing the executive had foisted on its  members in years and it was stubbornly pushing on with it, despite very serious resistance to the concept by members.

And then, suddenly, PLAN was dead.

Dr Harry killed it.

He didn’t parade PLAN’s head in any sort of triumphant ritual but his message was fairly clear to all: “Im just getting started here”.

With PLAN Dr Nespolon bought himself credibility, support and time to go to go to work on what he percieved to be the dysfunction of the  executive itself. This was something previously off limits for most presidents who are only ever on two-year stints, who were often there for career advancement , who usually had little management experience , and who had, as a result, very little will or skill to rock any boats.

Dr Nespolon wasn’t that sort of president. He was already very successful in his own right. It was doubtful he would have given a toss if his tenure ended in a manner that might normally reflect badly on a GP who was making their way up some sort of influence ladder so they might one day become a Chief Medical Officer, a minister in state or federal parliament, or, perhaps, head of a large and prestigious government quango.

Dr Nespolon wasn’t there for any of that. He ran so he could change what he thought was a vital institution for Australians and the healthcare system into something he felt was far more functional than it had been. If he failed, he would have moved on, having given it his best shot.

So, can we say if he has failed or succeeded yet?

What we might say is he has achieved more than most could have possibly foreseen and set a lot of change in motion. Probably the most significant change was  the spill of the long-term CEO, and, we assume the imminent appointment of the new one.

Without constitutional change, the  appointment of a new CEO is likely to be the most important in the RACGP’s history. If the constitution doesn’t change and the CEO retains the current power inherent in executive and its head, then it will be the new CEO who completes what Dr Nespolon has set in motion, or not.

The “or not” doesn’t bear much thinking about, but again, without constitutional change to how the doctors relate and communicate to the executive, a new CEO could easily become an empire builder who loses touch with the members (if that rings any bells for anyone).

Perhaps I’m just a bit of a Dr Harry fan, and all of this is conjecture really of someone who has chosen their side of politics, and is push-polling, as newspaper editors and owners are often want to d .

Before he got the job, Dr Nespolon already got on well with all the medical media. Once he became president, Dr Nespolon immediately crossed a demarcation line set by the RACGP executive a year or so before which demanded a total snubbing of the medical media.

It was another smart and tactical win that Dr Nespolon achieved very early in his tenure.

A year or so before the College had decided to cut off access for both of the most important medical media groups in the country. It did this without any notice or consultation. It then launched its own version of media in competition, called NewsGP, at a huge cost to members, and then pretended it didn’t happen. NewsGP is a good service with good journos working for it. But it replicates more than 90% of what the major medical media were already producing. How was that a good return on investment for College members? And who asked them if they even wanted the service?

When Dr Nespolon made himself completely available to both The Medical Republic and Australian Doctor as president, the College tried to stop him immediately, assuming he just didn’t know what the set up was.  He didn’t ignore the College’s pleas, but he did more or less defy them. He gradually mediated between the media and the College as best he could.

His idea was simple. No institution was above the media in the end, and to have a dysfunctional ongoing relationship with the media was always going to end badly. He also recognised that the relationship was always going to be a difficult one. But he knew it was a  role that any leaders of any publically facing institution had be good at – managing the media. Apparently it was one the past executive felt it could simply bypass instead.

Dr Nespolon’s diplomacy and engagement was certainly noticed at The Medical Republic by all the journalists, and we guess by those at Australian Doctor as well.

Today, you might still notice that Dr Nespolon conducts a lot of engagement via third-party media to the College. Witness his compelling and regular “Going Viral” poccast (and Webcasts), which he organised with major face-to-face and digital CPD and education provider Healthed.

Was it strange that he didn’t do this podcast with his own College? Not really. If it was being broadcast outside of the restraints that the College necessarily has to put on its own media – it can hardly allow a president to go off reservation on matters that affect the College – then Dr Nespolon could achieve a lot more cut through to both members and non-members in the manner he desired. Also,  a lot more people were listening to Healthed because, as good as the RACGP media offerings are, there is a big limit to what they can and can’t cover. They aren’t independent and this affects how they are perceived as an information source.

If you think that I am just a bit of a Dr Harry fan prattling on then you might be interested in some fascinating comparative survey data which arrived this week which suggests I may not be alone.

Remember when Dr Nespolon, as part of his election campaign, surveyed the College members and got nearly 500 responses? In this last week, Healthed, did its own version of the same survey to see how things had changed ,or not, in the last two years of Dr Nespolon’s reign.

Things seemed to have changed a lot.

Perhaps the most compelling single piece of comparative data in the survey conducted last week, in which there are now over 330 respondents, is the College’s Net Promoter Score (NPS). NPS is a  measure used across the world by major corporations, institutions and not for profits to measure, largely, customer and or member satisfaction or brand satisfaction. Last year we wrote about the College’s disastrous score of -50. This year, when asked exactly the same question, with nearly the same sample size that score has risen a quite incredible 33 points to -17.

Minus 17 doesn’t sound great either, but one of the key aspects of net promoter methodology is measuring progress in terms of member or customer engagement. This is one of the largest single year jumps I have seen in many years of being involved in net promoter. When running a large publishing corporate locally in the past we were made to do NPS religiously every year and even had large parts of our bonuses tied to it.

Do I think minus 17 is bad? The average NPS score of 150,000 organisations across the world is 32.  The official line on scores is that any score above 0 is “good” (50 and above is great and 70 and above is  “world class”)  Anything under 0 “needs improvement”. We couldn’t find the average score for a member organisation such as the RACGP but the benchmark score for education and training institutions is 26, for doctors is 11 (lawyers -22) and healthcare organisations 27, if that helps you gauge anything.

The main thing here though is this is a massive improvement in one year.

So will the momentum started here continue, or is this some sort of anomaly?

Other answers in the survey suggest that Dr Nespolon could be implicated heavily in the upward shift. See the two results below.


These are fairly robust numbers in Dr Nespolon’s favour so I’ll attempt to put some dampener on them by pointing out that Dr Nespolon’s podcast, “Going Viral” has been running daily on the Healthed channel, and it is enormously popular. We know, because we run it as well.

But that is a great example of the smarts of Dr Nespolon. He is out there engaging directly every day with members. He is doing daily interviews with his constituents!

Why wouldn’t his scores be good if his understanding and delivery of issues on his podcast channel are great? He’s being a smart leader and politician. Before Kevin Rudd became a popular prime minister in 2007 he was all over the media, including a daily stint on a national morning show.

So there is a likely skew in the results of this Healthed poll created by Dr Nespolon’s popular podcast. But good luck to him. In any case, skew or no skew, if just 2.32% of your constituents are dissatisfied with your performance, you are likely doing something right.

We have more comparative results from this survey which we are going to publish next week in a follow-up analysis of where the College now finds itself.

As a teaser to that, it feels like the College is at its biggest impasse since Dr Michael Kidd pulled it out of the fires of imminent bankruptcy and ruin many years ago. This is despite its best bank balance and healthiest membership statistics ever.

Why is this?

For our detailed view and analysis of data you’ll have to tune in next week, but the subjects of that analysis are fairly obvious:

  • COVID-19 seriously interrupted the agenda of the current president and will cut short an already very short tenure. What might that mean for progress?
  • The College is supposedly selecting its new CEO before the end of July. But because of COVID-19, or the executive, members have hardly been involved or informed about this most important process. Why?
  • A new president isn’t due until about September, and that president will have virtually no overlap with Dr Nespolon because of COVID-19 upsetting the timing of elections, and also with the new CEO. What might that mean?
  • There is no hint that the College is going to look at the potential role its own constitution played in getting it into its current, albeit not financially, messy state.
  • The big question that broke this week: legislation is due to be passed by the upper house of federal parliament which will break the monopoly the College has had on CPD forever and open its role of running CPD administratively to competition, first from other Colleges, and then from ,likely, other smart CPD vendors. When that happens, much of the value of being an RACGP member might go out the door.We have some interesting survey data on that. If the RACGP doesn’t respond to this change well, it may start to bleed members, money and influence rapidly.
  • Very worrying leading indicators of future growth of the profession – registrars choosing the GP path – which suggests that the College is going to have a lot of trouble convincing good doctors to adopt general practice as their choice of specialisation into the future.

The College, we suppose, with some help from Dr Nespolon, has come a long way in one year. Far further than anyone might have imagined. But Dr Nespolon has merely prodded and woken a sleepy giant. Where it goes from here will be determined by a whole new set of people about to take the stage.

Mark: A-

Marker’s comment: A talented and brash individual with a surprising, even risky, tactical playbook.  But you can’t argue with results. Dr Nespolon only missed out on an A+ because we’ve never given one before and are reluctant to give that mark before the job is finished. Perhaps the College really did need to give Dr Nespolon another year?



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2 Comments on "Dr Harry’s excellent report card"

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Peter Bradley
Peter Bradley
7 months 24 days ago
He did good in scrapping PLAN, but for some reason went quiet on the main plank folk voted for him for, and the thing that would have aided GPs the most, and gone a long way towards freshening up Medicare in general. That being to get the clause in the Medicare act amended that prevents Medicare being used like all other health funds, by direct billing of the rebate, and the punters only having to pay a market lead, discretionary gap. Unless that is achieved, as gaps get wider – as they will with ongoing inadequate indexing – Medicare as… Read more »
GeorgeQuittner Quittner
GeorgeQuittner Quittner
7 months 26 days ago

I’M JUST WILD ABOUT HARRY …too. But sadly the College has presided over the total destruction of General Practice by Medicare, governments, competition within and without the profession … and the only hint of effort to reverse this tragic slide to oblivion was the excruciating campaign “THE GP IS YOUR SPECIALIST IN LIFE”.
What a load of crap. Very few young doctors want to be GPs other than as a part time job on their way to somewhere else.