Medicare Locals

Jan 4, 2013

North Adelaide Medicare Local crisis?

Croakey has received information that the Board of North Adelaide Medicare Local has been rolled and all staff locked out of office over the Christmas/New Year break. We have been unab

Croakey has received information that the Board of North Adelaide Medicare Local has been rolled and all staff locked out of office over the Christmas/New Year break. We have been unable to obtain any further information about this situation and the office is not answering calls.  Does anyone have any information about this issue and its potential implication for services in the North Adelaide area?

Update, 10 January

Thanks to Paul Smith from Australian Doctor for allowing republication of his story:

Paul Smith writes:

The division that ousted the CEO and board of a Medicare Local in a bizarre ‘putsch’ last month claims it had no other option because services were at risk.

Members of the Adelaide Northern Division of General Practice (ANDGP) have been accused of “forcibly” entering the headquarters of the Northern Adelaide Medicare Local <>  late on 20 December. The building was apparently “occupied”for five yours by senior staff  from the division until 11.30pm that evening.

The locks were changed and, by 9am the following day, the staff and CEO of the Medicare Local were prevented from working by the division.

On Monday, the Medicare Local’s CEO Marj Ellis was dismissed along with several senior members of the Medicare Local.
Members of the ousted board — including local GPs Dr Simon Hall and Dr Chris Gillis — claim they had been removed from office as part of a “hostile takeover” with no explanation given as to why.

The division behind the coup said the Medicare Local was failing to meet its obligations to the community that had been laid down by the Federal Government.

Adelaide Northern Division — as the only formal member of the Medicare Local — originally held an extraordinary meeting on 17 December where it voted to dismiss the board.

None of the board members were informed of the meeting beforehand or that a motion of no confidence had been put forward.
In a statement, the former board said their removal “involved the delivery of a letter to the [Medicare Local] CEO on 20th December advising of the dismissal of the existing board, a direction to the staff not to communicate with existing board members and an instruction to make all records available to the incoming administration”.

“As a result the ANDGP forcibly entered the [Medicare Local] premises at 11.40pm that evening and changed the locks. By 9am on 21st December, the [Medicare Local’s] CEO and staff were prevented from functioning in the workplace.”

Former board member Lea Stevens said the actions were “extraordinary and unprecedented” and feared the situation would “seriously inhibit the potential for improved health outcomes” in the community.

“We had no warning in writing or verbally about any problems the division had with the board or the running of the Medicare Local. No formal process seems to have been followed. We don’t know what the issue is.”

But Debra Lee, one of the new directors appointed to Medicare Local, today told Australian Doctor the action had been justified because of concerns about the “slow progress” of the organisation over the 12 months since it was launched.

“It was not an easy decision for us to take … [but] the issue was particularly the [Medicare Local’s] progress against the five key objectives laid down by the Commonwealth which included objectives on issues like population planning and engagement with stakeholders,” she said.

“It was a vote of no confidence in the existing board.”

The sackings have been accepted by the Federal Health Department which said the removal of the board was “in accordance” with the organisation’s constitution.

Ms Lee claimed existing services provided by the Medicare Local, which serves some of the most disadvantaged communities in Australia, would have been put at risk if the division had not acted.

She also dismissed suggestions that members of the division had “forcibly” entered the Medicare Local’s headquarters.
“The process was lawful and respectful and transparent,” she said.

“We entered the premises with a key. As the new board we had the legal right to enter the building … We entered through the door.
“No services are at risk at this stage. As far as we are concerned, it is business as usual.”

Both sides accept the removal of the board was done legally.

Unlike many Medicare Locals, Northern Adelaide Medicare Local has only one member — the Adelaide Northern Division of General Practice — which means the division has the constitutional power to remove the board.

The Medicare Local now has an emergency transition board in place made up of four GPs and three non-GPs drawn from the division’s board.

Ms Lee said, over the coming weeks and months, the board and also the membership of the Medicare Local would be expanded with a “wider range of local stakeholders”.

• This article was first published by Australian Doctor

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7 thoughts on “North Adelaide Medicare Local crisis?

  1. M P

    To put this crisis into context, Medicare Locals were created because it was believed that GP Divisions were not working. So what do they do in this case, make the only voting member of the NAML the old GP Division! Fox in charge of the chicken coup or what?! (Note from Croakey: a section of this comment has been deleted for legal reasons)

  2. Stephanie Miller

    I have just returned from leave today and am shocked by this news.

    It is a very worrying development for health consumers in the northern Adelaide region. From the perspective of the Health Consumers Alliance of SA, NAML had got off to a very good start. A very skilled and expert Board and senior staff had been recruited and I believe they were well on the way towards achieving the national priorities for medicare locals. HCA had been actively engaged by the CEO and I recently represented consumers on their After Hours Grants Program Evaluation Panel.

    This is a good example of why it is so crucial for ML’s to have been set up with a broad membership from the beginning. HCA is a founding member of Central Adelaide and Hills ML and Country South SA ML. We have recently joined Southern Adelaide Fleurieu KI ML.

    For ML’s to be successful and realise the population health outcomes that we need as a community they must be open and transparent organisations with a strong commitment to real partnering with consumers and other stakeholders.

  3. Passionate about PHC

    I too am concerned about power (see Dr Whom’s comment), but not in the same way and for very different reasons. The misuse of power by ANDGP in the takeover of Northern Adelaide Medical Local is concerning indeed.
    ANDGP were concerned that the original NAML Board and staff were ‘misinterpreting the meaning of health reform’ and failing to meet the Commonwealth’s requirements. These concerns were not communicated to the NAML Board prior to the takeover.
    NAML was conceptualising their local health planning and assessment tasks through the lens of the Social Determinants of Health (SDoH) (see James Lamerton, Croakey Nov 30th). The northern area of Adelaide is home to some of the most disadvantaged people in Australia, and for a significant proportion of people, this disadvantage is intergenerational in nature. These people also experience the poorest health outcomes. They are over represented in the tertiary health system, the child protection system and the justice system.
    NAML recognised the interconnected nature of the issues faced by these individuals and families and was making good progress in developing respectful and collaborative relationships between diverse stakeholders to underpin planning and delivery of interconnected, well coordinated high quality services and programs. In stark contrast, the covert and subversive actions of ANDGP are counter to the principles of good governance for collaboration and transparency/accountability.
    Action on the SDoH means tackling the inequitable distribution of power, money and resources and addressing the inequities in the way that society is structured and organised. The dynamics of unequal power relations (mirrored in the actions of ANDGP) are fundamental drivers of continuing inequities in health and social outcomes.
    Genuine cross agency collaboration around complex and often contested social health issues is not easy. It requires a commitment to a sophisticated level of communication with diverse stakeholders, particularly among those in leadership positions. The undemocratic and hostile takeover by ANDGP raises serious questions about their interpretation of health reform and their leadership capacity to achieve the promise of Medicare Locals.

  4. Very Worried

    Can somebody please tell me where the CEO and Board of ANDGP have been while all this has been going on? Given the personal stress and duress that NAML staff were placed under (due to being treated like criminals by being locked out by a security guard, having their desks searched and all IT access cut), why on earth have neither the CEO or a single board member been seen since the takeover occurred? Neither party was present to address staff concerns when they returned to work on 7 January. Instead they had a junior staff member who was unable to answer any questions and responded to each question with a “I’m only doing my job”. In such difficult times why is the CEO on vacation rather than supporting staff?

    In addition, I understand from recent media comments that both ANDGP and DoHA have defended this takeover action as being “Constitutional”. That may be so, but can anyone actually say that it is ethical, moral, appropriate or in the best interest of the community in the northern suburbs of Adelaide who are the intended beneficiaries of funding provided to NAML? ANDGP’s actions have raised serous concerns in my mind and I have major difficulties in trusting them to do right by the community. I now have great difficulty in accepting Medicare Locals as the right mechanism for closing the gap in local health care needs.

  5. Fran Baum

    The NAML Board which was removed on 20th December 2012 had an impressive membership with a wide range of skills and experience in both primary medical care and the broader concept of primary health care. I know this because I have worked with most of them and have great respect for them. The former Board has guided the new Medicare Local from a zero base to an organisation that has effectively engaged with key stakeholders (including Aboriginal and mental health service providers) and is leading South Australia regarding improved access to After Hours services from GPs. It has commenced engagement with GPs re eHealth and other programs, and has had a range of other programs approved by DoHA.
    There are a lot of unanswered questions from the new CEO and Board about why they took the action they did and why they treated the CEO and Board so poorly.
    The issues also raises lots of issues for the provision or effective Primary health Care in the northern suburbs of Adelaide which are the site of some of the most disadvantaged communities in Australia
    The “old” NAML has instituted very effective relationships with the Aboriginal community in the northern region. These relationships rest on the personal skills of the CEO and her staff, and cannot simply be picked up and continued by a new cast of players. Almost certainly the changes at NAML will affect the trust and faith of key Aboriginal leaders in the NAML. This is most unfortunate and is an important reason for re-instating the staff and the former Board.

    Collaboration and the ability to work in partnership, is fundamental to the success of Medicare Locals and the delivery of DoHA priorities and funded programs. The behaviour of the ANDGP Board and CEO has demonstrated a lack of understanding about the significance of relationships and the requirement to operate on the basis of trust and transparency. This does not give one confidence in the ability of the new CEO and the Board to undertake the careful and respectful work required to forge effective and productive partnerships.
    While they may have had the legal right to do what they did they certainly did not have the moral right and their actions will be damaging to PHC. It really seems to be a case of professional politics overruling community interest.

  6. WhoIs DrWhom

    Yes, this has happened. The old northern division has undertaken a hostile take over and the CEO has been sacked.

    Happy times in the land of Medicare Locals it would seem.

  7. Doctor Whom

    This is surprising – most MLs have managed to write their constitution in a way that means only the original well paid board and extraordinarily well paid senior staff have any power. In most MLs there is no real capacity for “members” to change the board or staff.

    If it is anything like most MLs the “potential implication for services in the North Adelaide area?”. will be that services will improve as make-work paperwork flowing to Canberra will slow down.

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