19 May 2017

The ‘yes’ case (from the veep)


The RACGP traditionally puts its leaders in a position which unfortunately hinders membership representation. Currently Faculty Chairs automatically become a member of Council and director of the RACGP.

An example: as Queensland Faculty Chair I am expected to both represent members and fulfill my duties as director in the best interest of the organisation. By law, directors’ duties take priority. The two objectives do not always align and it can be very challenging to truly represent the membership on Council.

I share the concerns of immediate past RACGP president Dr Frank Jones, who spoke in his recent Yes case video about the irreconcilable conflicts he encountered when he was Chair of the West Australian Faculty.

The proposed model offers a clear solution: Faculty Chairs will be able to speak for and represent their members, and Board members will speak for the organisation.

The proposed Board will look after the business side of the College and the revised Council will be authorised to make the decisions about clinical matters important to our members including education, quality, research and advocacy. Contrary to what the authors of the No case say, Council will not be advisory but has delegated decision-making capacity.

Where multi-million-dollar decisions are made, the Board should stay away from representing interest groups.

Specific groups within the College, including Registrars, New Fellows, the Rural and Aboriginal and Torres Strait Islander Faculties, will have a vote and decision-making power through Council. As Council members have no fiduciary directors’ duties, they will be free to represent the membership.

The authors of the No case justify the current structure based on the 16-year-old Princes Hill report. However, in recent years two things have happened: the RACGP has grown to a sixty-million-dollar organisation and the thinking around ethical governance has changed.

Where multi-million-dollar decisions are made, the Board should stay away from representing interest groups. That’s why the proposed model creates a healthy balance between directors on the Board with experience and knowledge of the organisation and independent directors with specific skills, expertise and a fresh perspective.

The proposed GP-led model includes skills-based positions. This requires a different mindset and a move away from traditional ‘them-and-us’ thinking. To an extent there are similarities with a multidisciplinary practice meeting, well known to many of us: using brainpower from professionals with a different background often benefits the patient, as opposed to having a single discipline in the room.

If you add one nurse to a group of doctors, you may get good advice. But if you add a social worker and a physiotherapist, the discussion will be even broader and more options are considered. This purposely created diversity does not diminish the leadership role of doctors but merely enhances it.

Non-GP Board members, up to a maximum of three out of seven will be carefully selected by a large GP-dominated Nominations Committee. The experience with skills-based directors is that their expertise opens new avenues and opportunities for the College and its members; it reduces groupthink and blind spots. This is different from “buying” advice from a consultant who takes a paycheck and goes home at the end of the day. A director is accountable at all times.

By law, directors, including non-GPs, have to look after the interests of the College. A good Board doesn’t always vote and uses diversity to the benefit of the organisation. As US management guru Stephen Covey said: “Our strength lies in differences, not in similarities.”

The smaller Board will make the College more nimble and responsive. There is no perfect governance structure but variants of the proposed model with a Council and Board are in use by other colleges, and the introduction of skills-based board members is not new either. The Royal New Zealand College of General Practitioners also has a board of seven.

If we keep doing what we’re doing, we’re going to keep getting what we’re getting. This is an opportunity for members to make a change for the better. Vote YES on May 30!

* With assistance from the commonwealth government, a consultancy was set up to recommend to the college a way forward to bring it into line with present commercial practice. Princes Hill presented its report in 2001. Council adopted and put into practice many of the recommendations of the report that fundamentally changed the college’s previous structure.

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