This article could get all three current RACGP presidential nominees disqualified

15 minute read

The RACGP needs to think a lot more carefully about the role of the president and take it more seriously moving forward, because as things stand today it is hit and miss, to put it politely.

The messy nature of the RACGP presidential election process goes some way to explaining how the college has gotten itself stuck in the mud in the manner it has over the past decade, and why it might stay there if it doesn’t actually change something more systemic, like its constitution.

As an example, I’m not writing this column with the intention of getting all three current nominees for upcoming RACGP presidential election disqualified per the college’s Elections PolicyAppendix 4, Campaign Rules, Clause 2.1 Candidates Conduct, Part b, but it could happen.

Candidates are each responsible for their own campaigns, including controlling (where possible) the materials written about them by third parties.

I guess they might each be able to pull the “where possible” defence on me, especially as I haven’t been able to talk to any of them yet – they are all playing a very straight bat so far in terms of talking to the media (i.e., they aren’t, until the campaign period is official).

But I do know some of the candidates much better than the others, so I’m thinking I could get at least one or two of them into some trouble if I tried hard enough. After all, surely after talking to me so much over the preceding few years they should have predicted how I’d behave and headed me off at the pass, as their college seems to require of them under this particular election rule.

This clause is just one of a few offbeat ones that make up the policy governing RACGP elections and which in the end point to a bigger issue for the college around the role of the president.

Some other interesting other ones include but aren’t limited to:

Appendix 4. Section 2.1 Candidate Conduct, Part e:

[Candidates] should discuss with the Chair of the RACGP Board and/or President prior to any Campaigning being undertaken … the Candidate’s expected behaviours during the Election Period

If I were the RACGP I would have added to this clause “expected… and unexpected behaviours”. You can’t be too careful these days and if you are requiring your candidate to maintain control over what a third party is going to write about them or the election, they should at least let the executive know just how erratic they might actually turn out to be if things don’t go their way.

Appendix 4, Section 3.1 Communications

Candidates must make the text and format of any election advertising, publicity or campaign material available to the Returning Officer, ideally before, but in any event promptly after, any such material is printed, published, distributed, emailed or broadcast.

This rule could be saying that we, the college, want to make sure you, the nominee, are doing the right thing. Or it could be a little bit more Big Brother than that.

The RACGP rules around campaign material, like most elections, are a very clear. If you break them you break them right? And get into trouble, I suppose. Why does the college feel it needs to see every piece of campaign communication? Do the candidates have to submit tweets, Facebook posts, Instagram selfies with voters, etc. to the RACGP returning officer as a part of this rule? If they do I think some current candidates are already in trouble.

This may seem pedantic but this sort of control of communication is not a returning officer requirement in state or federal elections in Australia. It has the whiff of the “command and control” culture that was a trademark of the old RACGP executive. It is also expending more effort and time on things that in the bigger scheme of the presidential position and election, are a waste of time.

What constitutes campaigning and when you actually start it is grey if you read all the RACGP election rules. But all the candidates are being extremely careful to stay within the guidelines the college policy sets on elections, even when some of those guidelines, like what constitutes campaigning prior to the officially endorsed “campaign period”, aren’t entirely clear.

Candidates do not want to rock any boats in this election, that much is clear. Which means GPs have just two weeks to decide who their next president is between August 4 and August 19.

Two weeks?

For the most important position in the college in the most important election in the last two decades?

During COVID-19?

When two of the three candidates so far are Victorian?

Does that feel sensible? Does it indicate to anyone that perhaps the RACGP doesn’t really consider the position of the president to be a critical component of membership engagement and the running of the college?

It’s not like all the candidates (those nominating so far anyway) are on the same starting line in this race. Some, for innocent and obvious reasons, already have much bigger networks and connections than others and are starting way out in front.

Dr Karen Price, as founder and key moderator of the largest GP social network in the country, GPDU, may have a head start in terms of recognition, access to membership and understood policy positions compared with someone like Dr Chris Irwin, who is relatively new to college politics.

I’m just wondering what an official start date for campaigning actually achieves in this case when some candidates may be said to have been informally campaigning for years.

At this point all nominees are from Victoria and NSW (Associate Professor Ayman Shenouda practises near Wagga Wagga), but if we get one from Queensland or WA, I’m guessing they’re going to have a distinct advantage in their two weeks of official campaigning for the two GP candidates stuck in the middle of a Victorian COVID second spike.

Appendix 1. Section 3.6 Preferential Voting
In the case of two or more Candidates receiving an equal number of votes, the Candidate who had the higher standing in the previous round of the voting count will prevail, but if the equality exists in the previous round the Returning Officer may decide by random lot which Candidate prevails.

It isn’t entirely clear if this clause applies to presidential or council candidates, but if it does apply to the president, it says that in a tie it’ll come down to short straws. That’s democracy these days for you. Or perhaps another indication that the president’s role isn’t really taken seriously enough.

Not trying to be pernickety here but one candidate’s statement published on their own website is 1227 words long, as counted on MS Word, and the RACGP Election Policy rule states that a statement should be “1000 words or less” as determined by a “computer generated count” (Appendix 4, Section 3. Candidate Statements)

The same candidate has asserted on the same website that this is “the most important election of the millennia for General Practice”.

Certainly the RACGP is at a crossroads, and certainly, the next president could make or break the college given that:

  • A long-tenured CEO, who many believe had led the college into lots of commercial
    dead ends and lost the faith of the majority of members, has recently departed
  • The college is set to lose near-monopoly control of CPD, which could lead to a large drop in membership and base revenue
  • The college will also be charged with starting to manage all the training of registrars across the country in the period of the next president, which will likely more than double the responsibility and management complexity of the organisation
  • The new president will arrive at nearly the same time as a new CEO, who no one inside or outside the college, excepting the executive and board, has any clue about so far
  • COVID-19 has introduced a range of new challenges for GPs and the college and likely will result in significant ongoing business paradigm changes such as telehealth and electronic scripts
  • GPs, though now back to having their pay more or less indexed with CPI via the MBS, are still a long way behind where they should be
  • GPs are facing the fastest changes in digital health technology we have seen to date
  • With the failure of Healthcare Homes reform and minor adjustment to the MBS after a long-term review, GPs face an ongoing funding system that is not fit for purpose and failing to transform to meet the future needs of Australian healthcare
  • Overall, GPs are underpaid and overworked as more burden falls to chronic health management, and the funding system isn’t changing to meet their needs

One way to think about this list of challenges is, what sort of crazy person would nominate to be the president of the RACGP in this election?
You’re almost certain to fail at several or all of these challenges given how many there are and how little time you have to get around the job as well as the agenda and politics of the RACGP executive. But they are all vital issues for members – so what do you do?

Another way of thinking about it might be: is the RACGP crazy to think that a popularly elected GP, who may or may not:

  • have any experience in advocacy, Canberra politics, business, association administration, CPD, education, training, governance, events, and more
  • be confident, smart, charismatic, bull headed and wise
  • have a practice that is in fantastic financial shape so they can take their mind off things
  • for two years, or be financially independent, so they can be wholly devoted to their president’s role on only $130,000 per year
  • know how to work on a medical college board and with an executive and have a great grasp of company and organisational governance rules and procedures

make any real difference, in just two years in office?

Or does the RACGP executive understand, as its past CEO clearly did, that while a president is elected with such a short single term, with no formal screening for experience or skillset, they have virtually no chance of changing anything meaningfully in the long term?

If a president strays too far from the line and momentum of the existing executive then most will find themselves in very deep and stressful waters, fighting internally as well as externally.

If you haven’t looked at the candidate statements of the current nominees yet they are all here

  1. Dr Karen Price
  2. Dr Ayman Shenouda
  3. Dr Chris Irwin

For some points of reference here also is the original candidate statement of Dr Harry Nespolon, the current RACGP president.

4. Dr Harry Nespolon

You can’t really fault any of these statements for their alignment with most of the key issues facing GPs and the college. There are even some great ideas that no one seems to be thinking about openly, like fixing up the relationship between GPs and PHNs or rebranding GPs to the public.

Given the performance history of presidents, good and bad, are these realistic agendas from our nominees?

Dr Nespolon may have some good experience and ideas to pass on to these aspirants.

He has probably done more to rescue the trajectory of the college since Dr Michael Kidd saved it from bankruptcy many years ago. The MBS freeze was brought forward again after sustained campaigning by him in Canberra at the last election. He oversaw the departure of a CEO whose lack of engagement with members, empire building and spending on non-core initiatives had caused many to despair. He also played a significant role in delivering telehealth to GPs during COVID-19, something that looks like it could end up as an ongoing transformational leap for the profession.

But Dr Nespolon is moving on, and if you ask him, as TMR did a few weeks back, he did not have the time or continuity in his term to do even half of what he thought needed to be done. He now leaves passionate about some of the things he has put in place, but virtually powerless to affect continuity on any of the things he started.

A new CEO and a new president can reset everything. Nothing systemic has actually changed and everything can go back to the way it was with an executive that had failed to negotiate any decent deal with Canberra for GPs in 10 years.

Dr Nespolon, who spent every spare moment he could afford to in Canberra, in the ear of politicians and senior health bureaucrats, believes this is the only role that matters for the next president: advocating with the people in power to secure the destiny of GPs for the long term.

If you examine the NPS scores of the college before Dr Nespolon’s term, and now (results and article HERE), the improvement in member attitude towards the college is nothing short of amazing. If it were the equivalent of a Newspoll (if we still trusted them) and Dr Nespolon was running for a second term, I can’t see how he wouldn’t win a second term and get to finish what he started.

But that is not going to happen. He will be disconnected from internal processes by the end of November, and possibly earlier, depending on the politics of the changeover and the executive.

This situation more than anything exposes the president’s role at the RACGP for what it mostly is: neat on the CV for an aspiring career GP, hit and miss for the members, but always nearly impossible for even the smartest and most politically savvy and motivated candidate to effect meaningful permanent change. The brevity of the term says the RACGP executive doesn’t really take the position seriously. This set up hasn’t ever really worked for the members. The whole purpose of the president and his or her election is meant to be that members get to vote for someone who they think will do what they think is best for the college. That’s in part democracy, but more importantly it’s the key connection between members and the executive in having a meaningful input into how the college is run and moves forward.

Can you imagine if we voted in the federal election every two years for a prime minister and party, that could only have one two-year term? We’ve witnessed just how effective that might be by default over the last 10 years in Australia with our prime-ministerial musical chairs. It’s a hopeless regime in which to get stuff done.

Presidents can disrupt, poke and tip, as Dr Nespolon has done, at best. They can’t be the sort of transformational catalyst and implementation genius that each candidate is hinting at in their statements, as clever and noble as they all are.

Whatever their statements say, the smart nominees will be  thinking carefully about a strategy once elected that’s far more pointed, practical and achievable.

For Dr Nespolon, the answer was simple: win in Canberra, shake up the executive.

But if the new CEO isn’t up to snuff then things may drift back to the way they were, or worse. Nothing in terms of governance or constitutional set up has changed from the bad old days, so the bad old days could quite easily come back.

Perhaps the most meaningful thing the next president could do, alongside the Canberra challenge set by Dr Nespolon, is engineer a change to the constitution that allows for a term ofthree years, and a president to be able to serve two terms if elected.

If it could be done, there’d be a lot more connection between members’ needs and the executive, and potentially, much more continuity in this relationship in moving the college forward.

The main problem is that coalface working GPs don’t have the time, inclination or money to serve longer.

It’s precisely the argument why you increase the term and allow for two terms. You will start selecting for candidates who aren’t there for CV or ceremony, and who are highly motivated, committed, and understand what the role is really about.

The RACGP is too big (and getting much bigger) and too important these days to the future viability GPs and the healthcare system overall for the president’s position to be part-time, underpaid and two years only.

If it was a properly paid full time position, with the chance of six years in the job if they were doing it well enough to be re-elected, the nominee profile is going to be better fit.

If things stay the way they are then a non-GP executive will always have the upper hand.

The RACGP needs a president role that makes the members’ representative a serious and stable check on the executive so that both sides have a proper stake in the direction and positioning of the college.

Error and Apology:

The original version of this article implied that all three current candidates were from Victoria (which is in the grip of a second wave of COVID-19). That was inaccurate. Dr Ayman Shenouda, current vice president of the College is from NSW. I apologise to Dr Shenouda for the error and to readers, for any different emphasis or meaning the error may have conveyed – Jeremy Knibbs


First published 10/07/20 The Medical Republic

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