TREATING STAFF BEING CRUEL TO BE KIND RACGP

TREATING STAFF? BEING CRUEL TO BE KIND. RACGP & AGPA MEETING 14 TH NOVEMBER 2017

OUTLINE • State of play last time we discussed this 5 yrs ago. • Medical Board and Insurer recommendations. • Our personal experience. • Pitfalls of changing policy. • Experiences of other practices who have changed. • Your experiences?

STATE OF PLAY 2012 • Discussed this issue and 1 of 14 practices did not treat staff under any circumstances (except emergencies). • 3 of 14 had a formal policy not to treat staff for workers comp. • 10 had no formal policy. • None prohibited family of staff. • My feeling is that this has changed in the intervening 5 years.

MEDICAL BOARD & INSURERS • Medical Board: “inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the doctor and patient. ” • MDA: “It is black and white, you should not be treating staff” • Withholding information from GP employer • Fragmentation of care • Corridor consults • Confidentiality issues

CAUTIONARY TALE • St Elsewheres, good GPs. • Receptionist has bad migraines, referred to Neurologist who starts Deseril. • Deseril works well, in the corridor just asks for another Deseril script, sees 6 GPs over a 4 year period. No one GP taking ownership of the care. • Presents in the 4 th year with swollen ankles. • Echo detects Mitral Stenosis, eventually found to be secondary to uninterrupted Deseril. • Will likely need a MVR.

OUR CLINIC’S EXPERIENCE • Raised by our UK contractors. • Lots of wringing of hands and long debates and we bit the bullet. • Entered in to a reciprocal bulk-billing arrangement with our largest neighbor. • No new consults with GPs if no existing relationship. • 6 month transition period.

OUR STAFF’S RESPONSES • Up in arms, eg“I’ve been with Dr X for 44 years!” • Signed petition and anonymous comments. • “We see you because we trust you not because you bulk-bill us. ” • “I thought you were a family practice, you don’t even look after your staff” • Working on some of the owners to weaken – very important you are all united.

FEEDBACK FROM OTHER CLINICS • One did it 12 months ago: • Definitely worth doing • Should have had a transition period • Not all doctors on board – 2 older owners still seeing staff • Initial staff angst settled and now it is just accepted and all new staff know.

FEEDBACK FROM OTHER CLINICS • One did it 4 years ago • Don’t treat staff or their family, following a situation with a nurse & husband who divorced. • All GPs on board from the outset. • Any new GPs and staff know that it is the policy of the practice. • “No way we’d go back” • Advice is to announce it, ensure all the GPs are on the same page and weather the storm.

EXPERIENCE FROM THE FLOOR • Treat staff for all conditions? • Treat staff for all but W/C? • Don’t treat staff at all? (Bar emergencies) • Experiences of those who have stopped treating staff? • Any cautionary tales? • Questions?