12 February 2021

The end of the RACGP as we know it?

Comment Political RACGP TheHill

In Part II of our analysis of the colleges’ fitness for purpose in GP advocacy, TMR looks at whether bigger is actually better, at how so much waste has been built into the college over the years, and what we could better do with that money.

Somewhere along its long journey as a medical college charged with the very important national public service of recruiting, promoting and training doctors to become GPs, the RACGP started to lose its focus in a rapidly expanding membership and revenue base.

As revenues grew, it decided to do more things not directly associated with its original mandate.

Why?

Mainly because it could. The board thought a medical college should or could do more things with all the additional money it was making, so it did. 

It’s likely they looked to big overseas doctor organisations such as the British Medical Association (BMA) and wanted to emulate their position of power and influence (and doing good for its constituent doctors).

Over time the college became an empire turning over more than $83m, offering all sorts of services, many not directly related to its original mandate.

Underlying this journey would be a government decision in the late 90s to grant the college a virtual monopoly which locked in increasing membership and increasing revenues:

  • You have to be a fellow of the RACGP or ACRRM to officially call yourself a GP and attract higher Medicare payments. Ka-ching No 1: everyone has to train through the college for at least 2-5 years and pay the college for the privilege.
  • You have to have your CPD monitored and reported back to the government via the college, once you become a fellow of the college, in order to keep getting those higher rebates. Ka-ching No 2. A bigger longer, even life long, ka-ching (the best kind of ka-ching).

The increasing membership and revenues were taken by the executive and the board of the college to represent performance. This would be an easy mistake to make, especially at the start.

A lot of the new activities the organisation started to spend its money on, such as providing CPD to GPs, became commercial ventures in their own right, and profit making. The monopoly position was creating ‘virtuous circles’ of new money making opportunities.

Other new activities, such advocacy, health system reform and public communication, attempted to emulate organisations like the BMA, although for very well understood reasons, the RACGP can never be an organisation like the BMA, which is first and foremost a union, not a training and education college.

Many of these additional activities we now see reported in detail in each year’s annual report.

The focus of reporting is most often on number and growth of activities – numbers of reports, members, submissions, committees, media appearances, and of late, a lot of numbers on social media engagement (apparently this is a modern sign you are important, influential and doing a great job).  

None of these activities outside of the core original mandate of the college were specifically requested as services by the membership. They are the ideas of the leadership of an organisation that does not have to answer to anyone, so long as it does nothing wrong governance wise.

Importantly, virtually none of the additional activities that the college added over the years to its original mandated role are:

  • indexed or measured against performance benchmarks in order to deliver the organisation, and its members, demonstration of value and return on investment (ROI)
  • tied in a meaningful way to or measured against the goals the college has set itself over the years, or even its original and core objective of recruiting and training GPs

The RACGP is a government sanctioned virtual monopoly

It’s an old story.

Power, influence and more money than you actually need, tends to do funny things to organisations and the people running them.

What do we do with all this money?

We can’t give it back (they could) so maybe we need to build more stuff?

If we do build more things, we will be demonstrating value to members, won’t we?

Oh, we will need to pay ourselves more to run and manage this bigger and more complex entity I guess.

What do we build?

Our own commercial investment arm, a public media unit, our own media unit, an advocacy infrastructure (even though we will never be able to effectively advocate because we would be biting the hand that ultimately feeds us – government), events, journals, awards, fellowships and more?

Where does such a process end if you can keep growing your revenue base without effort or competition?

It doesn’t specifically end at this place, but with so little oversight and so much power to keep growing and making money, the college has become a niche version of the worst of the most famous industry based monopolies in history: the railways, the telephone networks, the TV networks, and now, the internet networks.

At least with each of these, at some point in time, the government got fed up with how these monopolies were failing to provide value to the public (maybe more importantly, politicians) and regulated them.

But in GP land, the monopoly that the government granted the RACGP was in political terms relatively small, non-offensive, and, importantly, convenient.

Who cares if the organisation that is supposed to be promoting, training and representing GPs starts to get a little bloated with committees, odd commercial ventures, their own media outlets, and odds and sods which aren’t much to do with efficiently recruiting and training doctors to become GPs?

Just so long as someone is doing this job so the government doesn’t have to, and, just so long as they aren’t giving the government any political grief, which the RACGP never has. That your average member GP is not participating in this value process, and that the value they get from this set up is constantly declining, is whose problem?

A convenient and compliant set up for government

This set up, which is delivering less and less value to its constituents, and more to its organisation’s leadership, remains convenient for government.

GPs are not a political problem, paying them more isn’t necessary, and getting them front and centre of health system reform isn’t a priority with politicians, who find building big shiny new hospitals in key state electorates gets them elected more than them looking after primary care.

The RACGP does manage to do a lot of good work, including an OK job of recruiting and training GPs (we would say ‘good job’ but last year’s exams debacle has dented their performance rating a bit), raising awareness around important issues of public health and researching those issues, and even representing the profession well on TV and in the newspapers.

That’s not the point.

The point is the cost of delivering these services is woefully high and the value to the membership is woefully low for what they are paying for membership, CPD and training.

And no one is watching over what is going on.

Record low member engagement

If you are a member of the RACGP, ask yourself if you feel engaged, listened too, valued and you get value for money in your membership.

This of course is a qualitive measure of college performance, but it’s an important starting point to understand who has power in this set up.

There have been countless surveys of members over the past few years which reveal an alarming degree of apathy and disconnect with the membership.

In a survey of members conducted two years ago, when asked “Would you recommend the college to a peer who is not a member?”, 64.5% of respondents said no, 21.4% sat on the fence, and only 14.3% said yes. That resulted in a net promoter score (NPS) of -50%, which when benchmarked with like organisations suggests the college is very seriously underperforming for its members.

Of course, the question is a moot one for most GPs because there really has been no option but to be a member of the college (or ACRRM) if you want to continue to have your CPD monitored and reported to the appropriate government department so you can continue to claim your status as a GP and receive higher Medicare rebates.

You are bound to be a member for your working life, or you won’t get paid properly.

A proper assessment of return on investment of RACGP work

Who assesses day to day performance against key goals, including financial performance, of the college, to make sure that things stay in line for members?

If you are an investor in a public company, as a shareholder you have quite a few checks and balances on performance. For one thing you have share price, which is sort of the ultimate score board for a shareholder.

But in a cascade of management checks and balances from this scoreboard down, you have a board charged with assessing the day to day effectiveness of strategy and the management delivering that strategy which has the power to change things up if the share price isn’t going well.

And if the board isn’t up to snuff, then the shareholders themselves can band together and change the board.

Where is that for the shareholders – the members – of the RACGP?

Outside of the college doing something illegal which the government won’t sanction, the RACGP board and executive mark their own homework every year.

If you read their annual reports, they mark themselves high each year.

Most of the marks are given for doing a lot of things or growing things, like membership, revenue and social media interactions.

There is virtually no setting of hard goals from year to year (which you will see in a public company) and measurement against achievement of those goals.

Let’s check this proposition against the last few annual reports of the college.

No targets, budgets, or goals set year to year to measure performance

Most companies with invested shareholders (members in the case of the college) set short, mid and long term goals, which are reflected in budgets, which are monitored against actual results and reported against; monthly, quarterly and yearly.

The idea is you measure yourself and reflect that measurement in regular reporting so you can benchmark progress against goals. Simple, right?

Try to find anything like this in a college annual report.

It largely does not exist.

You can read an attempt at it in the ‘Directors Report’ on pages 120-121 of the statutory report in 2019-20. But it is a pretty feeble attempt. It lists six objectives, says the board monitors performance to the objectives, then under the heading ‘Results of Operations’ it makes no reference to these objectives or what measurable progress was made against them.

Such reporting would get any CEO reprimanded pretty quickly in a public setting, and sacked if things weren’t changed quickly.

But in the case of the RACGP, the CEO is being measured by a board made up largely of GPs with very little grounding in such ways and various levels of vested interest in maintaining the status quo.

No one is asking why there is no specific reporting against the objectives set out in the report.

No one is even asking why they don’t set specific benchmarks for performance against each goal anywhere.

The fact is, it is not needed. No one holds the board, the president or the CEO to its stated goals, because no has to.

There’s lots of money and lots of ideas. It’s a bit of a love in. Any CEO would die to run a group that is pretty much a monopoly and mostly has to invent new ways of spending the money it makes.

And why set yourself up to fail when you are all getting paid good money to run an organisation that literally has to start storing cash in special funds or buying property so it is not so obvious that it has more money than it can spend?

There is no mechanism or motivation to change this dynamic in the executive or board of the RACGP.

Is doing more and growing performance?

The RACGP seems to think that doing more things in itself constitutes better performance. Hence it is obsessed in its annual report with reporting the number of things it does, and how much more it has done in each year compared to past year.

This is a trap for anyone new to a company board. Simply doing more and more does not always translate to you are performing better.

In fact, doing more, without measuring whether you are making a dent in the objectives you have set yourself, can be a red flag that you are actually creating more waste.

We think that this dynamic could be in play with the RACGP.

Here’s a few things the college did more of which they reported on last year: 197 submissions made to state and federal governments, 43,603 members (up 6.6%!), social media follows all up – Facebook 22%, Twitter 29%, Linked In 50%, Instagram 50% and Youtube 41%, 930 articles published on newsGP attracting 4.3m page views, 37,000 copies of AJGP distributed 11 times to members, more than 3,000 committee member interactions, 1,336 AFP exam candidates, and so on (and on).

It’s a lot of numbers, many of which are growing. But at no virtually no point are the numbers referenced to the objectives or goals of the college.

Waste occurs if you aren’t clear about what you are trying to achieve

From any perfunctory examination of the financials of the college you can see enormous waste, if, you imagine you were trying to run the college to a robust financial regimen of achieving maximum progress on its objectives and goals.

Some specific examples follow but a thorough examination might be enlightening at some stage by an auditor or consultant of some description with appropriate access and remit.

For reference, the RACGP’s 2020-22 strategic plan (great that they at least have one) states:

“By the end of 2022, we will:

  • transform the member experience to deliver exceptional value
  • more effectively advocate for quality, well-funded general practice
  • develop and implement a nation-leading education framework
  • become more operationally effective to better serve our GPs.” 
  1. Advocacy is probably the biggest ticket item of waste: $6-9m per annum?

The exact amount spent on ‘advocacy’ isn’t easy to specifically glean from the current financial reporting, but you can do some sums which indicate roughly how much money is being thrown at what the college considers advocacy.

Advocacy is managed, according to the college annual report, by its Membership division.

According to the annual report “The Membership division’s focus is on assisting members by providing events, information, programs and support, as well as by supporting advocacy efforts through media, communications and marketing campaigns.”

This division employs 149 of the total 411 RACGP employees at a cost of over $16m for labour alone.

Let’s say just half of this is devoted to advocacy. Add travel, accommodation, and other sundries and you look like you might be paying about $9m each year for the RACGP to ‘advocate’ for you to be better paid and have more certainty in health system reform so you can plan your life better.

Amortise this cost over the last five years and we are in the realms of $50m spent by the college on an objective which the late Dr Harry Nespolon told TMR had only one meaningful measurable outcome – GPs being paid better.

If the key outcome or goal is better pay for GPs, then most of this money has been wasted.

$50m?

After 2020 you can make an argument that GPs might be better paid as a result of telehealth, but that is another article altogether.

The RACGP took the credit for getting telehealth across the line. Which it might have done. But not without a very unusual, rebellious and charismatic president, who regarded most of what the board did back in Melbourne as waste. And not without a global pandemic which put the government in the worst corner it has been in to deliver healthcare more efficiently in 100 years. The RACGP helped, but the government really had no options in the end.

The RACGP structurally can’t succeed in advocacy

The RACGP was never originally set up to be an advocacy organisation, and if you consider that its mandate for making money to fund its original core activity of recruiting, promoting and training doctors to become GPs comes directly from the government itself, the college literally can’t effectively advocate for better pay for members.

It shouldn’t even be trying.

By pretending this dynamic doesn’t exist, it is wasting a lot of member money.

If the college was an advocacy organisation it would have a laser sharp focus on the issue of pay, and it would have mobilised its members (it has vastly more latent membership power than the Pharmacy Guild and any other medical college in the country with its more than 43,000 members) to put a blow torch on Canberra.

It has never done that, and it won’t.

If it tried, the government would quickly change its view on the monopoly set up it has granted the organisation and thus far thinks of as being ‘convenient’. It would move to stop the college somehow, probably by covertly pointing out to leadership that they might be the ones that kill the golden goose monopoly positions on training and CPD.

This is understood by the college, its board and its leadership. They do practice advocacy activities certainly. But proper lobbying and advocacy?

No way.

This wouldn’t be good for the existing leaders and management, all the employees and all those multitudes of GPs who are engaged by the college in some capacity to work for it and who benefit from that engagement, not just monetarily, but also from a career perspective.

To be clear, we aren’t accusing the leadership, the management and any GPs paid by the college of anything dastardly. They college goes as far it can.

There is just a lot of built up self interest in the college leadership sustaining itself in its current format, including a hugely complex network of interdependencies for the many people involved in, and wedded to, how the organisation currently operates.

  1. Why are you building a media, social media and medical journal publishing empire again?: $3m per annum.

As a medical publishing company we constantly get accused of self interest and conflict by raising the following point. We do not publish medical journals and we aren’t a social media play. We do news.

The RACGP justifies its more than $3m spend on its newsGP service and its medical journal, AJGP, by saying it meets the criteria of keeping its members informed, and that such activities educate members, and extend the college’s influence in advocacy.

There are a couple significant ROI value problems with this argument:

Firstly, in the case of producing a print medical journal and sending it to all 37,000 members each month, the RACGP can’t claim that by doing this it is adding in any meaningful way to the education of its members. Two very high performing independent medical journals already exist in Australia. One of them, Medicine Today, has to exist on its own commercial two feet. It does what the AJGP does and better. The other, the Medical Journal of Australia (MJA) is much more a real medical journal and a lot better than AJGP. But the college thinks that losing about $1m a year on its own journal is a worthwhile investment in improving the education of its members. It’s a bit of an ego trip. It’s also just a bit ‘this is what medical colleges do’, without any thought for return on investment. The quality of the AGJP is OK, but nothing out of the box that a GP can’t access anywhere anytime on the internet these days. If the service already exists in the outside world, then spend the money on something more directly related to your stated goals which will provide better return. The AGJP is a legacy vanity project for the college (to be clear again, the commercial dynamics of TMR would not benefit one cent if this this journal was ceased).

Secondly, newsGP is a complete online news service for GPs for which members probably pay something like $1m per year. Before it started, there were already four independent daily online news services for GPs in the market. Two of them, provided by the long serving and high quality Australian Doctor Group had existed in market since 2002. Why did the RACGP think members needed another service like this in market? Sure, send your members regular information that the RACGP has exclusively developed or can impart on behalf of its members. But why reproduce an online news service which replicates 85% of what four other services already do? Why not focus on your unique and important 15% of information you can exclusively provide your members?

At the time newsGP  was birthed the reason was made plain to the independent commercial news services. The college did not like what these services wrote about it, so it was going to start its own in competition. It could do this because it was rich enough and powerful in terms of email data. All this power has been granted it by government. OK, even if you don’t see the important abuse of power issues at play here, how does launching your own news media group relate to your core objectives in your own strategic plan, one of which very clearly states that you will provide a “strong, lean and effective RACGP”? In what way is this lean and effective in communicating the college’s important information to its members?

The reason the college launched the service was to damage the independent services which would not toe the line on the college narrative. The college set out to replace these services in an attempt to gain control of the narrative. This has nothing to do with the goals or objectives of the college, even as they are stated today. In fact, members should worry that the college is adopting techniques usually reserved for dictactorships. It’s an abuse of its virtual monopoly power. But mainly, it’s a huge waste of members’ money.

(To be consistent, TMR is a news organisation and does theoretically compete with newsGP, so you can accuse us of conflict here. Nevertheless, this is a waste of member money.)

Between newsGP, the AJGP and its failed attempt to overturn the emerging influence of the independent Facebook group GPs Down Under, the college has lost about $10m of members money in the last 5 years.

That is not lean and effective, which is one of the college’s clearly stated strategic goals.

  1. Saving on the basics: $3-8m per annum

No one benchmarks or even questions the basics of the deployment of college resources as described in its annual report.

If you commissioned a consulting firm with appropriate access to see how much could be saved if you made the college stick strictly to its knitting, and perform core functions more efficiently, you are likely going to find a lot more lazy money lying around.

One example might be the size of the ‘Corporate Services’ group within the college.

According to the latest annual report this group looks after finance, human resources, legal services, digital technology (IT), knowledge management and procurement, and has 90 staff out of the college total of 411. This is 22% of the entire staff of the organisation, which as a percentage of the total college salary bill adds up to $9.7m.  It’s probably more than that because these departments tend to harbour your most expensive executives – lawyers, accountants, knowledge managers and so on. We estimate that this might make the cost over $12m per year, or over 15% of the entire expense base of the college.

We have tried to benchmark this cost against similar member organisations in Australia but it is very difficult to do because each organisation reports their overheads and services in very different ways (the RACGP isn’t the only member group that benefits from confusing reporting as it turns out) and don’t tend to break down their costs into ‘corporate services’.

As a not particularly well benchmarked comparison we found one public company with a not totally dissimilar profile of running communication, media and the like, with revenues of $90m, a staff of 350, which was paying $5m for its finance, HR, IT legal, rent and consulting each year. This is equivalent to about 6% of its total cost base.

So what is going on between using 6% of this group and the 15% of the RACGP spend on corporate services?

It might be that something unusual is going on in the reporting of the RACGP and the 15% figure is skewed in some way we don’t understand.

But for an organisation of its size, with that many staff, doing what it does, 15% of your cost base on services looks inordinately high.

Is anyone asking this question at board level in the RACGP?

If the interpretation of the figures here is way off for some reason, it’s not just that we aren’t good at maths or analysing company reports. It’s that the reporting does not provide enough detail to assess what is actually going on.

Maybe the RACGP does benchmark these numbers or it benchmarks with like organisations.

But it doesn’t report that.

One thing the college often does do usually is have well structured and documented governance, procedures and process in place.

But detailed governance is not benchmarking or performance monitoring.

  1. The cost of the board per annum + the CEO:  $1.4m ($2.3m last year)

This cost isn’t extraordinary in the scheme of what some companies and member organisations spend on their board and CEO.

But you can’t find many public companies with a revenue as low as $83m spending that much on their CEO and board. We couldn’t anyway.

Last year the college spent a total of $1.4m just on its CEO, which makes the year a one off spend of $2.3m on board and CEO. It spent $1.4m getting rid of its old CEO and then trying to get a decent new one.

The college did at one point benchmark its CEO salary – there were ructions from members on whether the CEO was being paid too much. That benchmark indicated that the CEO was paid within the same range as similar organisations. But at the highest band of that range.

Did members get value for money out of that?

  1. Why do costs expand in line with revenue?

A revealing trend of the RACGP annual reports is that costs tend to expand in linear fashion with revenue.

This isn’t normally what happens in an efficient company.

Of course, the RACGP is not meant to be for profit, so it could say that expanding its costs in line with revenue is simply the board spending more money as it gets it, on more member services.

Another interpretation is that the more money the organisation gets, the more it finds things to spend it on, because if it didn’t, it would look silly.

But spending like this has very obvious pitfalls for return on investment.

For example, in 2015 the board spent $1.3m on IT in a year it had revenues of $45m. Last year it had $83m in revenues and spent just over $3m on IT. So revenue nearly doubled along with IT spend.

This is not how IT economics works. In fact, IT is supposed to work the opposite way. More scale less cost in ratio terms.

IT costs do not increase linearly with the more people you have to service so doubling IT costs is not justified because your membership doubles.

It seems likely that the increased IT cost is simply because the college can afford to do more IT things than it used to do. So it does.

Is that efficient?

It might be but the college is not measuring it so no one knows. It depends on what the new projects are, how they related to objectives and goals and how they are measured.

Broken record: that doesn’t happen in the RACGP.

If you look at things like the massive exam failures last year, you’d have to think, at least superficially, that IT in the organisation is not delivering more easily recognisable value for members than it used to.

Another major expense item cost that consistently has tracked up in the same ratio to revenue when it wouldn’t normally in most companies is staff costs.

Over the years the ratio of what the college spends on staff to revenue has remained the same.

Even though the college is a not for profit it isn’t a very logical pattern for labour costs. Again, it likely happens because the college has more money so they come up with new things to do, for which they need more staff. Growth for growth’s sake, and for the sake of not generating embarrassing profits (called operating surplus in the annual report).

Again, if the college does defend itself by saying it’s increasing staff to increase services and value to members, it isn’t tracking and reporting on these new services so there can be no assessment of value or return on the investment being made.

We are not saying that the more money being spent isn’t being spent with good intention or goodwill. We are saying it’s being spent without proper benchmarking of value for the additional investment being made. We are saying that despite all the governance the board installs around the college procedures and practice, their spending is laissez faire – or, reckless if one of things you are aiming for is providing your membership value.

We will leave this perfunctory look at ‘value for money’ and ‘return on investment’ that the college offers its members, and reports to its members here.

Suffice to say, there’s little oversight, measurement, or checks and balances on an organisation that continues to grow revenue through a set of government mandates that gives it a mostly monopoly position and the ability to keep generating more revenue.

Shareholder judgement of value

So how do the RACGP shareholders – its members – ever make a judgement of whether the board and other college leaders are doing a good job?

They can’t. There is no mechanism for it.

Is that by design?

It’s more by historical happenstance than design. There aren’t many, if any, evil doers in the bowels of the RACGP scheming based on the monopoly the college has been granted.

Most are trying hard to do their best and many are working hard and believe in what they are doing.

But they are trapped inside the college by a set of circumstances and inter dependencies that is almost impossible to upset over time.

Most college members have come to accept the college for what it has evolved into. A bloated, self perpetuating empire, which largely gets the job done in terms of its original mandate on recruiting and training GPs, but at an increasingly and extraordinarily high cost and low return to its membership.

So nothing changes ever?

It’s hard enough being a GP without exerting additional energy on trying to alter the course of a very large, complex and expanding oil tanker.

As a result, most of the members don’t care enough about the situation to be pro-active about trying to change it.

Not that they wouldn’t like better representation in Canberra, better Medicare rebates, cheaper membership, and less pomp and ceremony from their college.

Most would.

In a survey conducted by Dr Nespolon prior to him becoming president a couple of years back nearly 90% of members expressed discontent with the leadership, engagement and value they felt the college offered.

The other dynamic in play here is that the context and dynamics of being a GP is changing quite a lot.  

The biggest change is the profession is rapidly going part time, has more female membership and fewer GPs owning practices. Most of this demographic love being a GP a few days a week, don’t actually mind too much how much they are paid and do other things to keep their lives fulfilling.

It’s a sort of acceptance of things, one part of which is the college isn’t that good, is expensive to join and stay joined to, but it’s all part of the deal of being a GP.

To some extent, the expansion and modus operandi of college works well with this dynamic as well.

The end of the RACGP as we’ve known it?

You might be wondering after this significant rant why is this instalment of First Draft titled The end of the RACGP as we’ve known it ?

Because behind the scenes there are people who are thinking out all the problems outlined so far, like they haven’t been thought out before.

They are trying to work out how the functional demographics and dynamics of GP practice ownership and the commercial business model of being a GP, owner or otherwise, can be re-engaged.

They are thinking outside the box, and enrolling the help of some seriously talented business and strategy minds, in order to map a path to a better membership structure and paradigm for the future representation of GPs in Canberra.

Part of this new paradigm, and most immediately worrying for the college is that, for reasons still unknown to this publication, the government has declared quite firmly that enough is enough in terms of the colleges’ most important monopoly position: CPD.

Theoretically, at least, in the near future (we think we find out in June), you will not have to be a member of the college to have your CPD tracked, collated and reported back to government so you can maintain the higher Medicare rebates you earnt yourself by becoming a college fellow.

When that occurs, potentially, you just have train for a few years with the college, then, if you think the money you’re paying for your college membership is best spent elsewhere, then you can spend it elsewhere.

Eeek.

If this proposition took holding quickly, the RACGP might be in for a lot of short term pain.

It will have competition. For members and for CPD services.

We would find out very quickly what the real cost of tracking and reporting CPD is for an organisation,  as entrepreneurial competitors jump in and make a proper market for delivering CPD services.

In case you are worried the college may get hammered too hard too quickly and have its ability to recruit and train GPs severely hampered, this is not likely to happen.  

If you accept any of the above rant that the college has increasingly bloated itself with extra things to do over the years which have very little impact on GP pay and position in health system reform pecking order, it has a long way to fall before it can’t actually afford to recruit and train GPs well.

We estimate it could do it effectively on half the revenue it has now. Which means it could if it wanted to get competitive and provide a value signal, charge its members half of what it charges for membership today. But that’s another First Draft.

The RACGP isn’t going away.

God forbid.

It does do a lot of good work we can’t afford to lose. But it looks a lot like it might be forced to get its act together quite a bit in response to its changing circumstances. It likely will do this in one way or another. Word is the new CEO is pretty competent.

But it won’t ever be the same. It is the end of the RACGP as we know it.

And if things really did get dire, the government would step back in, as it did in the late 90s, and help. It can’t afford for the RACGP to fail in its core function of supplying the nation with enough well trained and competent GPs.

A new paradigm: two to three organisations not one, spending the money better

When the college does get its act together, obviously advocacy should not be part of its remit.

Not the sort of advocacy that keeps a health minister awake at night, and ultimately gets GPs better paid and much higher in the pecking order of health system reform.

What if there was another organisation, which was free from the constraints the college has to do advocacy, which was well constituted, governed, led and supported, not just by individual GP members (why should they carry all the load), but also by new strategic and commercial allies which are also trying to shape how general practice operates into the future as well?

What if the RACGP recognised the issue with it doing advocacy, and created a strategic relationship with this organisation, which on the one hand, combined the power of the college with the power of a new organisation, but on the other created enough distance between them, so the government doesn’t blame the college for all the new grief it is going to get?

What if the new lobby organisation was lean, set itself smart achievable and reportable goals, and transparently went about its business of awakening and unleashing the latent potential of some 40,000 GPs around the country, and all their patients, most of whom love them?

A lot of ifs here.

But if it sounds like an interesting new way to redirect the money that the college has been wasting on doing stuff that provides very little return to its members, then there is a growing group of professionals organising right now, and thinking out the mechanics and nitty gritty, if you are interested in helping in any way.

Bigger is not better: structure, tactics and planning might be

In response to the news that a group of people are going to try for an alternative GP organisation, which will primarily be focussed on lobbying and advocacy in Canberra for better terms and conditions for GPs as a profession, there has already been some predictable responses.

One argument from the naysayers is “bigger is better”.

This argument goes that everyone should get behind the RACGP because GPs are far more powerful with one voice, particularly one backed by a big powerful college which GPs already have.

Put another way:

We should persist with a college that has become confused as to why it exists, is wasteful as a result and is increasingly diluting its focus, effectiveness and its value to members, because if it gets smaller, and has less money, we won’t have as much clout in Canberra?

The opposite is true:

  • The RACGP has no meaningful clout in Canberra despite it being a monolithic organisation, many times more powerful financially and in terms of latent community mobilisation power than the Pharmacy Guild.
  • As has been discussed above, it can’t influence politicians because politicians, through the DoH, and the MBA are its gatekeeper and masters.

Another argument put, is that “it’s all been tried before”. We aren’t sure that’s actually an argument.

Over the years there have been several breakaway groups frustrated with the RACGP, usually with a large base of GP owners at their heart. All have started with energy and excitement, and all have eventually, slowly gone by the wayside.

Gravity seems to pull everyone back to the RACGP mothership.

It doesn’t mean people shouldn’t keep trying.

The degree of difficulty of changing the training, education and advocacy paradigm for GPs is extremely high.

There will be many logistical challenges – funding, management, strategy, constitution, government, reporting, marketing, and so on – and that’s before you get to the nasty politics.

There will almost certainly be nasty politics. And it won’t be at the outset from politicians in Canberra. It will be from within the GP community itself.

The RACGP has built up an ecosystem of interdependencies. Outside of its immediate staff it pays hundreds of GPs to do work which those GPs have often put their hearts and souls into. A lot of GPs will stand to lose something of their souls in their current living and working life if the RACGP changes tack to engage with a new organisation that does lobbying only.

Would the RACGP even consider such a change ?

It’s a very big pill to swallow for the current leadership of the RACGP to accept the argument that they can’t be any good at being lobbyists and someone else needs to do it.

It will be hard because it’s not just dropping advocacy that the RACGP will need to consider.

It will need to make itself far more focussed on its strengths and in that far more efficient, so money is released into the ecosystem for the new organisation to work with.

It will need to consider significant restructuring to align with such a paradigm, in part to give the new organisation the  chance to breath itself into life.

If the RACGP leadership doesn’t end up supporting this new organisation in some way, it will have a very good chance of squashing it before it even gets started.

That would be an ugly occurrence, and of course, more wasted money.

The RACGP leadership – its president and CEO first, then its board – have a lot to think about.

If they think that all of the above is bollocks, that the college is doing a great job in advocacy, and in returning value to members,  then this idea would be significantly handicapped before it gets a chance to get traction.  

It could even be born dead if things got really dirty in terms of allegiances and power plays.

If the new organisation does survive its first 6-12 months but the RACGP and the new organisation become adversaries in some way, the energy and infighting that will be generated may well create a situation where GPs end up worse off than they are now.

But let’s not even go there for now.

What we have now isn’t working.

Trying something new is a positive step no matter what most people think of diluting the current power of the college. If various important and powerful GP interests can manage to work together on trying to find a new approach, everyone can’t be worse off than they are now.

It’s worth a try.

If the RACGP leadership rejects the new organisation, covertly or otherwise , you could be forgiven for thinking that it may have become too big, too political and too rotten to ever change (fix?).

If you are interested in contributing ideas to the new lobby organisation, or in expressing interest in becoming an individual member, a corporate member, or contributing in some other way, you can start your journey HERE.

Remember, this is very early days. Keep an open mind.

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22 Comments on "The end of the RACGP as we know it?"

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Peter Bradley
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Peter Bradley
14 days 2 hours ago
Hey, Medical Republic. You are really onto something here. Jeremy, I congratulate you on the article, which was spot on in revealing the real issues. It was lengthy, but summed the status quo so accurately. And hey, 21 comments already – a bit of a record for on here for sure..? It has also been a good platform for Chris to launch his concept of an effect lobby body, if I could call it that. That is the real nub of the issue. The colleges, both of them, are not primarily lobby orientated, nor ever claimed to be, but in… Read more »
Marcia
Guest
Marcia
14 days 6 hours ago

Thank you.
I agree with much written here.
I haven’t been a member for a long time but have been forced to pay an enormous sum to have my points registered.
I hope I can submit my own list of activities for the next triennium as my salaried position and now only two days work most weeks mean that I can ill-afford the exorbitant RACGP’s fee.

Joe Kosterich
Guest
14 days 18 hours ago
An excellent piece. The RACGP is detached from the needs of its members. Over the last 30 years it has benefited from government policy which generates income for itself at the expense of its members. This started with VR and continued with accreditation. Whilst the pharmacy guid extracted benefit for its members from its deals with government the RACGP did not. The path of a new body has been walked before without success. Does that mean it cant work this time? No but it will need a different approach. Making CPD separate to the RACGP could be the proverbial “game… Read more »
john barr
Guest
john barr
14 days 20 hours ago
Every year at subscription time, I feel that I’m giving the College a large lump of my money for nothing. Well not quite nothing. For the unedifying spectacle of the College rolling over and allowing the government to freeze my salary for 5 years, which means that the lump of my money becomes a larger percentage each year, as item number rebates don’t even rise in line with inflation. There didn’t even appear to be a word of protest. I would certainly welcome a separate organisation to lobby the government with the intent of increasing my salary in line with… Read more »
Sue McDonald
Guest
Sue McDonald
15 days 20 hours ago

Good article.
Will someone just bite the bullet and set up a group who CAN advocate for GP’s
as it’s obvious the RACP can’t.
All the money the College has wasted on building an empire should be redirected from us to proper advocacy before General Practice dies. God help us all.

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