Understanding Schedule 10 and ASMS approach

A brief ‘snapshot’ survey was distributed to all DHB-employed members in early October 2018 to gauge members’ knowledge of Schedule 10 of the RMO MECA, and 24% (1053/4346) responded. Despite the relatively low response rate, the results do provide ASMS with an informative view of members’ awareness and experience of the implementation to date of Schedule 10. This helps shape ASMS’ future approach on this issue, including advice to members. The full results of the survey are available online at https://www.asms.org.nz/wp-content/uploads/2018/10/ASMS-Snapshot-Schedule-10_170882.1.pdf.

First, a reminder. ‘Schedule 10' (Safer Rosters) from the RMO MECA negotiated by the DHBs and RDA contains two parameters – no more than 10 consecutive working days and no more than 4 consecutive night shifts. All new rosters listed in the Schedule are required to ensure these two parameters are complied with. Thereafter the implementation of Schedule 10 comes down to co-design and agreement at a service level, not just between the RDA and DHB but also the affected SMOs.

Snapshot results

Of those who responded to the survey, the majority (77%) had not read Schedule 10 and those who were aware had gleaned their information about Schedule 10 from informal sources, ie, other SMOs or RMOs rather than their DHB. In other words, most members were unaware of the strong co-design features of Schedule 10 (including the application of rostered days off) and the role of SMOs in this co-design. This represents a major failing by DHBs to communicate and engage with those who train RMOs (ie, aside from RMOs themselves, those most directly affected).

Most respondents were unaware whether agreement had been reached between their DHB and the RDA over roster compliance for either house surgeons or registrars, and very few were aware of the specific details of the Schedule. Contrary to what I had thought, there was little difference between members working in the tertiary DHBs, which undertake around 80% of RMO training, and those in other DHBs.

A total of 38% of respondents believed that agreement has been reached in their service for house surgeons (but 45% did not know). For registrars, the respective percentages were 31% and 47%. This reinforces the lesson of poor engagement by DHBs with affected SMOs.

Even more revealing is that between 66% and 80% of respondents were not aware of the following key co-design features of Schedule 10:

• It allows for a variety of non-prescribed options to be agreed in order to implement its compliance parameters.
   
• A new RMO roster (house surgeon or registrar) can’t be deemed to be compliant with Schedule 10 until both your DHB and RDA reach agreement based on consensus over the form of compliance. Note: given their role in training, service provision, clinical leadership and potential workload flow-on, this consensus logically involves affected SMOs.
   
• It requires a consultation process whose aim is to “achieve a consensus on the appropriate change”. Note: the same point about consensus and affected SMOs above applies here also.
   
• If a consensus is not reached through consultation, your DHB and the RDA “may agree to trial a ‘best fit’ change proposal for a defined period of time where this is practicable”. Note: as above re consensus and affected SMOs.
   
• If there is no agreement on setting up a trial and disagreement remains, both your DHB and the RDA are required to seek mediation.
   
• If outstanding issues are referred to mediation, 2 of the 4 factors required to be considered are the impact on both the “quality and safety of patient services” and “RMO training opportunities”.
   
• It allows for agreements to be reached over alternative arrangements for the taking of these ‘rostered days off’ following weekend work (ie, it is not obligatory to take them immediately after the weekend).

ASMS action over Schedule 10 implementation concerns

ASMS is aware of several serious concerns of members over Schedule 10. Much of this appears to be influenced by the failure of DHBs to engage with SMOs on the important protections that are built into the document. But there are genuine concerns over unintended consequences around continuity of training, changeover (including where this is linked to rostered days off following weekends), and impact on patient care. These concerns are not new. They pre-date Schedule 10 and arise out the challenge of synchronising the move to safer working hours with the continuity of training of RMOs through the generally well performing apprenticeship model based on service provision.

But the implementation of Schedule 10 has added to them and brought them to the fore in several services. Further, there is the risk of a major addition of increased work pressure on an already burnout out SMO workforce due to significant specialist shortages largely unrecognised by DHBs. This is where new RMO rosters are deemed to be compliant but there are insufficient RMOs to fill the additional positions required for compliance. This leads to the pressure on SMOs to fill the gaps.

While the ASMS MECA provides for financial compensation to members filling these new roster gaps, the main issues have been the effect on training and increasing the workload of an SMO workforce that suffers from its own severe shortages and resultant high level of burnout (which DHBs generally turn a blind eye to). These concerns have been raised with ASMS on many occasions, including by branch officers and our delegates at the Joint Consultation Committees.

Consequently, at its meeting on 30 August, the National Executive adopted the following resolution:
That the Association invite the Resident Doctors’ Association and the 20 District Health Boards to a meeting to discuss the formation of a national process to consider matters relevant to the employed senior and resident medical and dental workforces.

While not restricted to it, these matters included Schedule 10 and its unintended consequences. While the Resident Doctors’ Association responded positively to our initiative agreeing to attend, unfortunately the DHBs declined. They expressly stated that they wanted to resolve Schedule 10 issues in their current RMO MECA negotiations with the RDA. Only then would they consider meeting.

This response from the DHBs was both disappointing and a lost opportunity. Collective bargaining is a blunt instrument to resolve complex RMO rostering issues. But it is the only instrument the RDA has available. Once a union has achieved a desired outcome, especially one involving health and safety (eg, Schedule 10), it is going to fight hard to ward off threats, real or perceived, to it.

Consequently, ASMS was advocating a more nuanced approach in order to develop a consensus over addressing both further implementation of Schedule 10 and unintended consequences of implementation to date away from the bargaining table and in a non-adversarial environment. However, the national leadership of DHBs prefers the blunt, more adversarial approach in the MECA negotiations, which is likely to set the scene for a level of unhelpful industrial strife early next year.

Following the DHBs’ rejection of ASMS’ initiative, new Director-General of Health Dr Ashley Bloomfield stepped in to call for a meeting of various parties including ASMS, RDA and the DHBs. This is a positive initiative, although there are concerns that too wider involvement and the handling of the meeting might water down the sharp focus ASMS is seeking.

Advice to members where RMO rosters are not yet compliant with Schedule 10

ASMS advice to members working in services where RMO rosters have yet to be deemed compliant with Schedule 10 is based on the premise that while the Schedule is firm on the requirement to implement the two requirements of no more than 10 consecutive working days and no more than 4 consecutive night shifts, it also allows for a variety of non-prescribed options to be agreed to achieve compliance.

In terms of these non-prescribed options, affected members in a service for which compliance with Schedule 10 is being considered should make it clear to their service management that they are part of the required ‘consensus’ under the document. Further, nothing should be agreed or implemented without the agreement of SMOs in the affected service.

More specifically, affected members should be explicit to their service management that:

1. Rosters should not be deemed to be compliant with Schedule 10 without your agreement over the form of compliance.
    
2. The agreed ‘form of compliance’ should include the continuity of training, impact on SMO workloads and effect on patient care.
    
3. The ‘form of compliance’ should include that compliance should not be deemed to have occurred until there are sufficient RMOs to comply with the new roster without dependence on SMOs to carry additional workload (this would not preclude agreed acceptable temporary arrangements in the interim period).
    
4. The agreement of affected SMOs is required over whether a trial change proposal should occur and its form.
    
5. If disagreements remain unresolved, then affected members should insist that their DHB seeks mediation as provided for in Schedule 10.
    
6. When, in the following week, ‘rostered days off’ are taken after a weekend, agreement is required including with affected SMOs.

We encourage you to adopt this approach with your operational service management. Separately, ASMS will inform DHBs of our position and advice to members.

If you run into obstacles over this issue, please contact the ASMS industrial officer responsible for your DHB for advice or support. But you are in an influential position should you act collectively with your SMO colleagues – you can’t say no to the two requirements of no more than 10 consecutive working days and no more than 4 consecutive night shifts, but you and your affected colleagues can say no to how it is implemented if you collectively believe that some or all of it might lead to risks to, for example, training opportunities or quality or safety of patient services.

Contact details for your ASMS industrial officer are on our website at https://www.asms.org.nz/employment-advice/agreement-info/.

Entitlement for monetary compensation

Although it is not the main purpose of the ASMS Direct and overwhelmingly is not the main membership concern with the wider issue, it is important to remind members of their right to be paid a premium rate for covering for RMO gaps in a roster deemed to be compliant with Schedule 10. The entitlement is covered in either Clause 47 “Vacancies and Locums” where suitable extra payments can be negotiated or in Clause 13.4 of the MECA where the rate of additional pay is calculated at, as a minimum, a premium hourly rate calculated on double time on Step 6 of the specialist medical scale.

Again, please contact your above ASMS industrial officer should you require advice or support on obtaining this additional payment.

Kind regards,

Ian Powell
EXECUTIVE DIRECTOR