Abstract
COLLEGE AFFAIRS
As this is my last report as Honorary Secretary I take the opportunity to thank the College for the privilege of serving as Honorary Secretary for the last two years. In doing so, I would like to thank the many Fellows of the College who have assisted me in my role and to whom I am very grateful. In particular, I would like to thank the members of the College Executive Committee with whom it has been an enormous pleasure to work over this period: Dr Janice Wilson, Dr Richard Astill, Dr Jonathan Phillips, Professor George Lipton, Dr Keith Mayne, Professor Pete Ellis, Professor Phil Boyce and Dr Noel Wilton. Of course, enormous thanks must go to the Secretariat Staff in Melbourne who work tirelessly on behalf of all the Fellows, Affiliates and Trainees of the College and who provide particular assistance and support to the Executive Officers. Most particularly, I would like to thank our Executive Director, Dr Robert Broadbent, for his dedicated work on behalf of all Fellows and his enormous assistance to myself in the role as Honorary Secretary. I wish the incoming Honorary Secretary, Dr Don Grant, well in his new role.
As outlined in our Annual Report (which was separately mailed to all Fellows at the end of April), during my time as Honorary Secretary a range of important projects have been undertaken, particularly those in the context of the key initiatives flowing from the College strategic plan. It has been particularly rewarding to work on these projects and to be involved in their developmental phase. Other major changes over the last couple of years include initiatives of the Board of Research led by Professor Phillip Boyce and of the Fellowships Board led by Professor Pete Ellis. Key achievements include approval to establish a PhD scholarship for a recently graduated Fel low of the College, plans to establish a binational practice network in Australia and New Zealand, and the development of generic guidelines for advanced training in subspecialities of psychiatry. A further key and extremely important step has been General Council's approval of representation of trainees (psychiatrists in training) on General Council and College Boards and Committees. It was particularly pleasing to see two trainee representatives attend and participate in debate at the General Council meeting in Perth in April this year. A further important milestone has been the development of the revised Code of Ethics by the Ethics Committee under the leadership of Dr Ben Steinberg. These very substantial achievements for the College highlight the enormous amount of work and dedication of very many Fellows within the College and demonstrate the College's commitment to ‘core’ professional activities-clinical standards, education and research.
FIONA JUDD.
General Council and the College Executive Committee met in Perth in association with the College Congress in the early part of April. There were many new Councillors attending their first meeting and the usual large amount of business to deal with. It was also the first occasion when Trainee representatives (Dr Andrew Darby and Dr Debra Wood) attended a Council meeting in observer capacity. In addition, Council had a special briefing from Professor Ross Kalucy on the preliminary findings of the AMWAC review of the psychiatrist workforce in Australia. In the following paragraphs I have set out some of the highlights of the Council meeting and the General Meeting of Fellows on 14 April. A summary of the meeting is presented separately to my report.
Over 500 Fellows and Trainees and nearly 100 accompanying guests attended and appreciated an excellent scientific program and an enjoyable social program at a very successful College Congress in Perth on 11–15 April. On behalf of all in the College, the Executive Officers extend congratulations and thanks to the Western Australian Branch and its Congress Committee, especially the Congress Convenor, Dr Aaron Groves, for all their effort both prior to and during the Congress, and for the wonderful outcome achieved. For those who were unable to attend, abstracts of papers, symposia and workshops presented at Congress have been published as a supplement to the College Journal. (Due to an error by the printers, you might notice that the contents page is missing.) As a result, a replacement copy will be circulated.) Some of the highlights of the official functions of Congress week are reported elsewhere in this issue. A full report will appear in the next issue.
Election of College Officers 1999–2001
Congratulations are extended to Dr Wayne Miles (NZ) who was elected President-elect of the College for 1999–2001 at the General Council meeting GC1/99 held in Perth immediately prior to Congress. Dr Miles will assume office as President at the College AGM in 2001. We are pleased also to report that Dr Donald Grant (Qld) was elected Honorary Secretary for the period 1999–2001 following A/Prof Fiona Judd's decision to retire at the conclusion of her current term as Honorary Secretary at the College AGM on 12 June 1999. General Council also re-elected Dr Richard Astill (Qld) as Honorary Treasurer for his third and final term, and Dr Keith Mayne (NSW) for his second term as Chair of the Board of Practice Standards. The changeover of Officers occurred at the Annual General Meeting in Sydney on Saturday 12 June 1999 when Dr Jonathan Phillips assumed the Presidency and 1997–99 President, Dr Janice Wilson, became Immediate Past President.
Dr Miles served on General Council 1993–99, was Chair of the New Zealand National Branch 1993–98 and is currently Chair of the Council of Medical Colleges of New Zealand. Dr Grant was inaugural Chair of the Committee for Training 1985–1991 and represented the Queensland Branch on General Council 1993–99. More information on each of them, and on incoming President, Dr Jonathan Phillips, is presented in personal profiles elsewhere in this issue.
College Officers for the coming year are:
President: Dr Jonathan Phillips (NSW) Honorary Secretary: Dr Don Grant (Qld) President-elect: Dr Wayne Miles (NZ) Immediate Past President: Dr Janice Wilson (NZ) Honorary Treasurer: Dr Richard Astill (Qld) Chair, Fellowships Board: Prof Peter Ellis (NZ) Chair, Board of Practice Standards:
Dr Keith Mayne (NSW) Dr Phillips and Dr Grant constitute the Executive Officers of the College with the power to act on behalf of the General Council in between Council meetings.
MBS Item for Telepsychiatry
As I reported in the April issue of Australasian Psychiatry and earlier in Psych-e-Bulletin, the Funding and Financing Options Working Group of the National Telehealth Committee (representing all Australian States and Territories) has prepared a draft proposal for Telepsychiatry services to be included in the Medicare Benefits Schedule.
Our understanding is that the Working Group is awaiting responses from all States and Territories to this paper. General Council reviewed a confidential submission prepared by the Working Group and was presented with a preliminary draft College position paper on telepsychiatry at its meeting in Perth in April. Council deferred consideration of the position paper to seek further advice in a number of important areas where there are divergent views. Deferral will allow time for further expert input. It is intended that every effort will be made to clarify these issues so that a College position can be agreed prior to the next scheduled meeting of General Council in October and the submission taken for ward to the Medicare Benefits Consultative Committee for Psychiatry. The Executive Officers are interested in the experience of Fellows currently using telepsychiatry, especially those involved in private or mixed public/private practice, and specifically its application in the provision of clinical services. Please contact David Norman <
Financial Arrangements for Executive Officers
College President, Dr Janice Wilson, reported to the General Meeting of College Fellows held in Perth during Congress on the outcome of General Council's consideration of financial arrangements for the Executive Officers (see Psych-e-Bulletin #5&6). This was a matter arising from the 1998 College Annual General Meeting. General Council decided not to continue its consideration of remuneration options for the Executive Officers, particularly the suggestion of substantial payment for their period in office, after receiving legal advice on the implications for the College of implementing such arrangements.
The legal opinion emphasised that the College is incorporated as a company limited by guarantee but with a special licence to omit the word ‘limited’ from its name. General Council is the governing body of the company and members of General Council are the directors of the College as a company. The College is therefore subject to the Corporations Law and the regulatory framework of the Australian Securities & Investments Corporation, as well as its own Memorandum & Articles of Association (its ‘constitution’). These prohibit the College from making such payments to the President other than reimbursement for out-of-pocket expenses, and limit payments to the Secretary (in addition to reimbursement for out-of-pocket expenses) to circumstances where such duties should, in the interests of the College, be performed by a practising psychiatrist and the amount is reasonable and proper. The legal advice further indicated that to remove such impediments to allow these payments would likely result in the loss of the special licence and thus make mandatory the inclusion of ‘Limited’ in the College name wherever used, i.e. presentation of the equivalent of ‘RANZCP Limited’ on all official documentation and other references to the College. Revocation of the licence was seen as likely to affect the current income tax-exempt status of the College.
In the light of this legal advice and its implications, General Council voted to maintain the existing financial arrangements for the Executive Officers, i.e. payment of out-of-pocket expenses.
Boundary Violations
The issue of professional misconduct, especially boundary violations, by psychiatrists and trainees has been of concern to General Council for some time. Over the last year there have been a number of Fellows who have been deregistered and otherwise disciplined by Medical Boards for such transgressions and who have consequently forfeited their membership as Fellows of the College. General Council received further reports of more recent and ongoing actions against Fellows and Trainees, including complaints currently being considered by the College Professional Conduct Committee. As well, the Board of Practice Standards renewed its submission to Council re development of an educational approach in this area to assist Fellows and Trainees.
While offenders represent only a small proportion of the profession, Council acknowledged that they do great harm to patients and undermine the credibility of the profession itself, not the least by the adverse and sometimes sensationalised publicity such cases attract. Council recognised that offenders fall into a number of categories and, as research shows, only some are susceptible to education and influence by the College. General Council resolved on action to emphasise the ethical standards of the College and requested the Board's taskforce on professional misconduct to continue its work and to report to the next meeting when budget decisions are made.
Professional Conduct Complaints
The Chair of the Professional Conduct Committee, A/Prof Norman James, reported to General Council the concern of the Committee about inconsistencies in the manner in which complaints are handled at Branch level in the College and about the apparent lack of understanding about the College powers and processes for dealing with breaches of expected standards of practice and ethics. Council recognised that there was confusion, too, about the respective roles of the Professional Conduct Committees (binational and Branches), Clinical Practice Advisory Committee and Ethics Committee (binational and Branches). General Council agreed that a uniform process should be adopted for handling all complaints of this nature, to develop clearer guidelines for Branches and to prepare informational material for Fellows and Trainees, and for consumers.
Indigenous Mental Health Issues
On the recommendation of the Board of Professional and Community Relations and its Aboriginal and Torres Strait Islander Mental Health Committee, the General Council adopted a position statement on the ‘stolen generations’ in response to Bringing them home, the report of the inquiry by the Australian Human Rights and Equal Opportunity Commission into the practice of removal of Aboriginal and Torres Strait Islander children from their families. This statement recognises the professional, moral and social obligation of the College to comment on these social policies and practices which are harmful to mental health. The statement is printed in full in this issue of Australasian Psychiatry.
As well, Council approved a statement of principles and guidelines for psychiatrists and trainees in relation to Aboriginal and Torres Strait Islander mental health. This is provided as an insert with this issue.
Other statements and guidelines were approved as reported elsewhere. All are accessible on the College website http://www.ranzcp.org/publish.htm and hard copies are included as inserts.
Medicare Relative Value Study
The PricewaterhouseCoopers (PwC) draft report on the Practice Cost Study consultancy for the Medicare Relative Value Study was released at the end of March for further consultation with the profession. The Medicare Schedule Review Board requested professional organisations to respond in writing to the Medicare Schedule Review Task Force by the end of May. The Practice Cost Study aims to determine fair and reasonable practice costs associated with Medicare services and options for their recovery through fees. The consultants sought information from case studies involving a small number of private psychiatrist practices, from survey and Medicare data, and from discussions with nominees of the College and the AMA. This is a draft report that represents PwC's preliminary findings. It has not yet been endorsed by the Board.
The report comes in five volumes. Copies of each volume can be downloaded from the following address on the MRVS Website http://www.msrtf.gov.au/Draftpcs.htm
Relevant sections of the draft report were distributed to Councillors, Branches, Faculties, Sections and members of the College RVS Consensus Group for consideration and comment. This is a complex and technical report that is difficult to analyse. Some previous work commissioned by the College suggested that earlier costings by PwC were underestimated. Preliminary analysis of this draft report indicated that this is still the case and the College has forwarded a response that argues for significant upward revision of the draft practice costs.