Lifting our game; providing equitable hospital stroke services for all Australians

Lifting our game; providing equitable hospital stroke services for all Australians 

The Australian Stroke Coalition is inviting hospitals with stroke units to participate in a certification scheme to recognise hospitals that have the essential elements of stroke unit care.

Recent issues with appointment documentation at several Local Health Districts demonstrate the importance of seeking advice before signing Visiting Medical Officer Service Contracts. The Workplace Relations Team at AMA (NSW) are well-placed to review VMO contracts and to advise VMOs accordingly.

AMA (NSW) contract negotiations – recent wins

AMA (NSW) successfully negotiated changes to the appointment documentation at Nepean Blue Mountains Local Health District and Western Sydney Local Health District. We acknowledge those VMOs who raised issues with AMA (NSW) and assisted the negotiations. Achieving change was possible with the support of VMOs at the Local Health Districts.  

In the most recent round of VMO reappointments we have seen increasingly lengthy letters of appointment, some of which have incorrectly set out certain issues or purported to incorporate matters that are not appropriate for VMO arrangements.  

AMA (NSW) also identified concerns regarding the lengthy schedules that have been included in some contracts.  

What should a VMO contract include?

The NSW Ministry of Health has issued Model VMO contracts, which provide for the entitlements and conditions as set out in the VMO Determinations. These are available on the Ministry of Health’s website, and we encourage VMOs to familiarise themselves with them to identify any discrepancies in contracts that may be issued to them.  

The relevant VMO Determination, either the Public Hospital (Visiting Medical Officer Fee-for-Service Contracts) Determination 2014 or the Public Hospital (Visiting Medical Officer Sessional Contracts) Determination 2014) form part of the terms and conditions of the VMO Contract.  

In addition to the VMO Contract, VMOs also must comply with relevant NSW Health Policy Directives.  

The particulars of each VMO’s arrangement are set out in the schedules to the VMO contract. The matters to be addressed in those schedules should be the following:

• The clinical privileges granted to the VMO

• The Hospital or Hospitals where services are to be provided

• The budget for services to be provided by the VMO – this is most commonly expressed as an agreed number of hours

• The remuneration payable

• The on-call commitment – usually expressed as the obligation to participate on the on-call roster

• The classification of the VMO as a Specialist or Senior Specialist

The lengthy letters of appointment an contract schedules that AMA (NSW) took issue with included matters that were not consistent with the terms of the Determinations and / or applicable NSW Health Policy. Those issues included (but were not limited to) purporting to restrict the rights of VMOs to take leave, restricting the number of Requests for Admission a VMO could submit, budgeted hours that were not consistent with the services to be provided, and seeking to address various matters such as intellectual property rights and performance reviews other than according to NSW Health Policy.

AMA (NSW) will continue to advocate for consistent appointment documentation across the State.   This will ensure a more streamlined process and ensure all VMOs are contracted on the same terms.

When should VMO Contracts be issued?

There is no prescribed timeframe within which a VMO contract should be issued.

AMA (NSW) will be advocating for Local Health Districts to be better prepared and issue contracts well before the commencement of the new quinquennium. VMOs in NSW are routinely appointed for five-year periods (the quinquennium). The VMO re-appointment process commences in the penultimate year of the quinquennium. Despite this, VMOs are frequently provided with contracts for the next quinquennium within weeks or days of the commencement of the next quinquennium, and in some cases after the quinquennium has commenced. This places VMOs under pressure to simply sign and return their contract without properly considering the documentation provided to them.  

VMOs are always entitled to seek advice and while it is less than ideal, if a Local Health District is late in issuing contracts, then the appropriate course is for existing contract terms to be extended to afford VMOs the opportunity to consider the offer made and the terms of the contract before signing.

Annual review of hours and services

AMA (NSW) is calling on Local Health Districts to abide by their contractual obligations including meeting with VMOs on an annual basis to review the VMOs budgeted hours and assess whether there needs to be an adjustment in the hours allocated under the contract to meet service need requirements. Many VMOs report to AMA (NSW) that the hours allocated under the contract are regularly exhausted well before the anniversary date of the contract and this results in considerable delays in payments being made to VMOs for services provided. The annual review provisions under the VMO contract should mean that variations in hours and services can be regularly assessed and addressed, thereby creating greater certainty for the VMO and the LHD as well as ensuring timely payment for the provision of services.

Contributed by AMA (NSW)’s Senior Workplace Relations Advisor, Juliette Paterson and Director of Workplace Relations, Dominique Egan