Kincraig Medical Clinic has been at the centre of on-going difficult negotiations with Country Health re the contract which is required to allow the GP’s to carry out services at the Naracoorte Hospital. While willing to accept the standard contract with site-specific conditions, they say they will not accept any further compromise on the fourth doctors mandate for a Cat 1 caesaerean. They issued the following statement a short time ago today Wednesday 23rd September.
The full release follows:-
Doctors at the Kincraig Medical Clinic would like to thank our community and supporters for their understanding of our stand on the important principles behind the ongoing stand-off forced upon us by Country Health SA.
KMC doctors have decided to release this statement in response to many genuine enquiries effectively asking “what is this all about?” and hope it provides some insight into the situation.
KMC doctors are proud of their hard-earned reputation for being community minded and absolutely committed to improving health outcomes for Naracoorte and the surrounding areas.
KMC’s new state-of-the-art clinic adjacent the Naracoorte Hospital demonstrates this long-term commitment and nothing, not even gross mismanagement of contractual negotiations by the State Government, will shift KMC’s focus away from the health and wellbeing of patients.
The basics (what is happening at the Naracoorte Hospital):
There are still no obstetric services, and women in labor are being diverted to Mount Gambier.
There are no anaesthetic services on-call for emergencies/airway management ,critical life support
Locum positions are being advertised, offering twice the standard rate.
The longer the lock-out continues, the greater the threat to elective theatre.
The approximate cost for one temporary locum doctor per day is $2000, but has been advertised through locum agencies at a rate of $1,800 for a 12 hour shift and also a premium rate of $2,500 per day.
In 21 days since lock-out, the “drive-in drive-out” solitary locum has cost an estimated $42,000, compared to 3-4 KMC Doctors would have cost $11,340 for emergency, obstetric and anesthetic on call for the same period of time.
What are the issues?:
The new Royal Adelaide Hospital is costing $1million a day in interest and with the two-month delay next year it is going to cost an extra $835,000 per day in interest.
Therefore CHSA has had its budget reduced as well as being advised to find “efficiencies”. This translates to cost-cutting by way of reducing contracts, cancelling elective theatre and extending waiting lists. Also affected are ambulance services and nursing levels at our hospitals.
Our position is that a mutually acceptable contract is vital for all parties and most importantly for patients.
For KMC, the provision of on-call services in the Naracoorte Hospital it is an essential tool for attraction and retention of skilled doctors, both now and into the future.
Research shows country people are at increased risk of adverse medical outcomes due to lack of existing services in local areas, we cannot accept any further compromise which would undermine regional services and fail to meet the SA Health mandated standards of care for patients.
For example – CHSA suggests that SA Health’s mandatory standards for the management of category one (emergency) caesarean sections in SA does not need to be observed in country areas.
Such standards are mandated and any suggestion that such requirements need not be met in regional hospitals is scandalous.
A history of negotiations:
Our contract with CHSA has worked very well for 15 years, a period in which KMC has provided a quality, cost-effective service.
CHSA have made a number of inaccurate and misleading public statements in recent weeks, including a number of attempts to lay the blame for the stand-off on the KMCdoctors.
For example – “99 per cent of rural doctors have happily signed up, therefore so should KMC”. This is not true. We invite CHSA to publish which centres are signed up and how long for.
KMC is aware that many of the doctors who have signed CHSA’s contract in April 2015 did so reluctantly and were most unhappy with the negotiating process and outcome and is due for renegotiation next month.
Country Health SA medical services/hospitals can be divided into three categories.
1 – The smaller country towns where the doctor is often an overseas GP doing hisrequired regional posting before moving to the city. Such doctors generally accept CHSA’s generic contracts because they have no long-term investment or lasting identification with the local community in question. Unlike KMC, these are rarely teaching practices for the next generation of rural doctors.
2 – Then there are the regional centres, such as Mount Gambier, where a significant amount of money is poured into.
3 – Thirdly, there are sub-regional centres such as Naracoorte, Murray Bridge, Kangaroo Island, Clare, Port Lincoln and Kadina/Walaroo. These vital hubs are located at strategically significant geographic positions and provide essential services via GPs with specialist skills given the towns are not big enough to have resident specialists.
KMC believes the doctors in sub-regional centres need site-specific considerations to attract and retain a skilled workforce.
One only has to reflect on the sad history of what has happened with contractual disputes in the SE and elsewhere in the last 15 years to realise how much long-term, high quality health care is dependent on a successful contractual resolution.
Examples of this have occurred in recent years at Penola, Keith, Bordertown, Mount Gambier and Millicent. Recent unsatisfactory contractural conclusion at Victor Harbor hospital has seen a huge cost blow out and loss of skilled resident GPs from the hospital.
In many ways this impasse is potentially very close to being resolved. KMC has accepted CHSA’s generic contract, with site specific additions. The question of “when is a mandate not a mandate?” remains unanswered by CHSA.
Standards of care for country people, such as having a fourth doctor present for a caesarean section (as mandated by Health SA), needs to be upheld.
As always KMC has offered and remains willing and able to immediately recommence full services (as CHSA locum initially if requested at a reduced cost and without the need to compensate visiting doctors for travel and accommodation expenses).
This would enable full quality services to resume immediately, and provide a significant cost saving for CHSA. It would also be a tool for timelyresolution and we would extend our good will to CHSA.
Finally, KMC wishes to publicly acknowledge the work of Stephen Ramsdall who has been acting as CHSA’s representative in contractual discussions. Mr Ramsdall has been tireless in his efforts to bring about a resolution. However, he is limited by the upper echelons in CHSA and has had no room to make any further decisions other than to follow their instructions.
To that end, KMC invites David Swan, the CEO of SA Health and Rebecca Graham, the acting CEO of CHSA, to meet with us for a satisfactory resolution for all parties in particular country people.
At this stage, all KMC asks of our patients and supporters is for your on-going support, feedback and understanding that this is about long term standard of care for country people and attraction and retention of skilled doctors now and into the future.
Hopefully a resolution will occur in the immediate future.
We are putting a most fair and reasonable offer to CHSA this morning, and by their own standards they should accept it within 15 minutes.
5THE FM will seek a response from CHSA and update as it is received.