TRANSCRIPT OF PROCEEDINGS
Fair Work Act 2009 1035105-2
VICE PRESIDENT WATSON
B2011/3940
Section: s.242 - Application for a low-paid authorisation
Application by Australian Nursing Federation
Melbourne
11.01AM, THURSDAY, 22 NOVEMBER 2012
Continued from 21/11/2012
PN7106
THE VICE PRESIDENT: Mr Dowling.
PN7107
MR DOWLING: Thank you, your Honour. Just three short preliminary matters for the record. Your Honour will recall that the applicant called for a contractual document (indistinct) Schroeder. I reminded my learned friend Mr McDonald of that last night and we've still not received that. We also call for a position description from the witness Ms Cartwright yesterday and we have not received that and we are yet to receive the list of documents in respect of Mr Killam. I ask my learned friend to provide those as soon as possible so that we can resolve any issue that might be outstanding during this witness hearing. Thank you, your Honour.
PN7108
MR MCDONALD: Thank you, your Honour. I can indicate that we do have the document from Ms Cartwright and will be in a position to circulate that today. Also we will be in a position to circulate the listing (indistinct) in relation to MrKillam today. We are still waiting on Dr Schroeder to forward that document to us, we will certainly follow him up about it. If we could call our first witness for today Dr John Menzies, who appears by video.
PN7109
THE VICE PRESIDENT: Dr Menzies.
STANLEY JOHN MENZIES, SWORN [11.03AM]
<EXAMINATION-IN-CHIEF BY MR MCDONALD [11.03AM]
PN7110
MR MCDONALD: Could you state your name and business address for the record please?---Yes, my full name is Stanley John Menzies and I conduct a general practice at 7 Robinson Street Camperdown and also a satellite practice at Lismore.
PN7111
Dr Menzies, have you made a statement for these proceedings?---Yes, I have.
PN7112
Is that a three page statement dated 15 May 2012?---Yes, it is, I have it here.
PN7113
Were there any aspects of that statement that you wish to alter?---No, I think that's - as I say I conduct a satellite practice three days a week at Lismore, 20 minutes to the north of Camperdown and they employ a part time doctor to do that.
PN7114
Dr Menzies, is that statement true and correct to the best of your knowledge and belief?---Yes.
PN7115
I tender that statement.
EXHIBIT #M21 WITNESS STATEMENT OF STANLEY JOHN MENZIES
PN7116
MR MCDONALD: Dr Menzies, could you give us an overview of the Robinson Street Medical Centre, please?---Yes, this is a general medical practice conducted on the campus of the Camperdown Hospital. It was formerly a nurses home but it's been modified by the hospital for a medical practice that myself - usually there have been two full time GPs and in addition general practice registrars, but for the last seven years I've not been able to have a full time colleague so at the moment there is myself as a GP, a GP registrar. I have a lady doctor who comes two days a week and at our Lismore practice a GP comes up from Geelong to provide (indistinct) clinic twice a week. I'm in the hospital grounds and it's a small hospital. With my other colleagues in Camperdown we provide the medical services to the hospital so I find it very convenient being on site for attendances at casualty or problems that crop up in the ward or delivering in the labour ward and so it's a mixed - it's a typical country practice, it has both hospital and clinic responsibilities and the clinic as I say, the doctors are described - I have one full time practice nurse and one part time practice nurse and one relieving or casual nurse. The rooms are also used by visiting specialists from Geelong, Ballarat and Warrnambool as well as Allied Health, a dietician, psychologist, audiologist et cetera also you know have a visit on a visiting basis.
**** Stanley john menzies Xn mr mcdonald
PN7117
Is it an area where there are a lot of other doctors available to treat patients?---No, we've - I mean I've had an unfilled vacancy for seven years. My colleague - perhaps if I go back a step. Initially when I came 30-odd years ago all the GPs in Camperdown practised from facilities provided by the hospital. About 20 years ago some of my colleagues chose to buy their own building in the shopping part of town and move their practice to there. I chose to stay on the hospital site. But we continue a very cooperative arrangement. Unfortunately a husband and wife team left earlier in the year so that our numbers are down. There is one principal in that practice who is approaching 70 and works part time and they are desperately trying to find more doctors. Does that answer that question?
PN7118
Yes, thank you. Can I ask you what the nurses do at the Robinson Street Medical Centre please?---Well, two things. My full time practice nurse is like an assistant clinical director I would say. Certainly she takes full responsibility for our chronic disease management, that is adherence to treatment plans and recalls and what not and that's a large part of her job. Secondly she certainly attends to triaging patients who present on the day with an acute presentation and assists in the preparation of those patients before they are seen by a doctor. Certainly does a lot of wound care. Thirdly or fourthly we conduct a number of what I'll call patient education programs, we also participate in a number of I suppose you'd call them external activities. We had a - still have a loose engagement with various universities and we conduct a number of practice based projects. We also participate in - I'm not sure if you're aware of a program relating to collaborative programs. We're presently one of a part of group on patient health electronic records so that our participation in the e-collaborative for example is wholly managed by this practice nurse really, and I suppose in amongst all that she is a social worker in the sense of an early detection system for problems that are not always apparent to the doctor, provides what you might say a lot of oil between the cogs for the smooth running of the clinic with both clerical or administrative staff. The medical students and nursing students that come through the practice and as I say a great support to myself.
**** Stanley john menzies Xn mr mcdonald
PN7119
You indicated there was also a part time nurse?---Yes, and equally she participates in many of those things that I've mentioned at a delegated level and in addition she has - I find it hard to talk in the third person when I think of these people as individuals, also the second person is fully credentialed for women's health and conducts pap smears and women's health services, so she runs that program entirely - I won't say independently but at her own direction and discretion really. So our number two nurse does most of what number one does at a delegated level as well as conducting the women's health program and she participates in all the public health bits that we do, she comes from the - I mentioned that Lismore was an area of our activity. I mean we provide the GP services up there since the doctor left about 15 years ago. But Lismore has a very strong community health program. Previously this lass conducted that as the community health manager and she continues - well, there's a bit of a blurred distinction between what is our clinic and the sort of community needs so she perhaps does a lot more up there.
PN7120
Dr Menzies, when you do work in the hospital is it these nurses who you employ in the Robinson Street Medical Centre who assist you?---No, no, and there's 30 yards between the clinic and the hospital and the hospital is a conventional public hospital, it's a small 28 cube bed type hospital and has its own nursing staff.
PN7121
Dr Menzies, you refer in your statement to the practice nurses receiving 5 per cent of income generated from nurse associated medical benefits, could you explain how that process works?---Yes, it's possible obviously with our software in the clinic to identify the income earned by nurses through the development of chronic management plans, pap smears and what not, and I had that up at the end of the year and these are the MBS items and allocate 5 per cent to the nurses and we choose - work out the proportion each receives in proportion to what they have done really. As I say it's feasible to itemise what everybody does in the clinic at least in terms of MBS items.
**** Stanley john menzies Xn mr mcdonald
<CROSS-EXAMINATION BY MR DOWLING [11.16AM]
PN7122
MR DOWLING: Dr Menzies, I take it from your evidence and the way you describe the duties your nurses carry out that you hold them in high regard?---Yes.
PN7123
They are highly skilled?---Yes.
PN7124
They are of great value to your practice?---Correct.
PN7125
One of the things you say in your statement is they are essential for triage of acute presentations, partly because of a shortage of doctors in the local area, is that correct?---Partly. Perhaps I could have explained that better. I mean people ring up for an appointment saying generally - appointments are allocated to the times available by the reception staff. If someone, for example, comes through the door and says I've got a pain in the belly or I don't feel well and there are difficulty sort of allocating them an appointment they will be popped in a treatment room and the practice nurse will attend to them first and take pulse, blood pressure, et cetera and then myself or the other doctor in the clinic will attend to them. So that's how it happens.
PN7126
Do I take it then that one of the relevant factors in terms of there being a shortage of doctors in the local area is that you might expect a more acute presentation at your clinic than you might in an area where there's a large number of clinics and a large number of doctors?---Possibly, I mean the only equivocation I have is you know we're across the driveway from the hospital so generally what you might call acute cases will often present to casualty at the hospital but equally - no not equally but to a lesser extent they appear at the clinic, yes, so they are general practice presentations rather than hospital presentation.
PN7127
**** Stanley john menzies Xxn mr dowling
Certainly you understand that the triage is one of the important responsibilities of the duties of the nurses in your practice?---Yes.
PN7128
In your statement - - - ?---Sorry, if I can just clarify that.
PN7129
Please?---If there's a demand over the phone the reception staff will either - depending on the situation, pain in the chest or someone has collapsed you know that will go through to myself for advice, but in trying to fit in people who feel that they must be seen on the day, for example, that often goes in that medium ground through the nursing activity.
PN7130
Thank you, Dr Menzies. In your statement you have set out the nurse remuneration of the three nurses, two of whom you have described their duties today. If we can deal firstly with nurse one who is the full time nurse and works ordinary hours of 38 hours per week, should we take it that she is the nurse that you described as being in a position somewhat like an assistant clinical director?
---Yes, it sounds a fancy title but yes.
PN7131
She's the one amongst her duties you described chronic disease management for which she has full responsibility, triage, wound care and amongst other things patient education programs, that's nurse one?---Yes.
PN7132
You have next to her name you have categorised her in accordance with the level of nurses that are set out in the Nurses Award 2010, do you see that?---Yes, that's level 4 principal nurse manager grade 3, is that - - -
PN7133
Yes, those words?---Yes.
PN7134
Should we understand from that that you have had a look at the Nurses Award and the various levels and responsibilities of the nurses under that award and you have made a decision that this nurse properly fits within the classification of level 4, principal nurse manager grade 3?---Yes, that's what I thought fit it best.
**** Stanley john menzies Xxn mr dowling
PN7135
You have set out there also her hourly rate of pay being $31.08?---It's been updated since then, it's $33.07.
PN7136
So nurse one, the level 4, principal nurse manager is what, sorry, $33?---And seven cents an hour.
PN7137
Thank you. When you examined the award for the categories did you also examine the relevant pay rates for the nurses at each of those levels?---I think so, I mean I just - - -
PN7138
Would it surprise you to hear that the pay rate for a registered nurse level 4 grade3 is now presently under the Nurses Award $35.06?---I'd have to take advice from my practice manager about those sort of specifics.
PN7139
I can tell you that that is the rates presently for a registered nurse level 4, grade3, it's now $35.06 and you are paying that nurse $33.07, is that something that is of concern to you?---I would like to research it because I believe that we were paying the correct rate, so that is news to me and I will certainly go back and look into it why I'm not paying that.