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Flood matters: information for the recovery phase

Thank you very much for coming in tonight. And I would like to welcome you to the second in our Flood Mattes: Information for the recovery phase webinar. This one is about people matters. And the webinar will focus on the mental health of your practice staff, HR considerations in a time of acute distress, and localised disruptions. But I will start this evening with an Acknowledgement of Country. Now, I am working tonight on the Country of the Wangal Clan of the Eora Nation, and I would like to recognise on everybody’s behalf, the traditional custodians of the land and sea on which we live and work, and pay our respects to Elders past, present and emerging.
I would like to introduce tonight, Dr Penny Burns as our facilitator. Penny is a disaster medicine specialist. And she is also a general practitioner in Sydney, based in Sydney, and she has personal and professional experience of disaster. Penny has been in the field of disaster medicine for over a decade now, working with disaster affected GPs and other disaster responders. She works tirelessly to improve the recognition of the invisible work that GPs do when disasters strike their local communities. She also advocates to see GPs included as a crucial first responder health professional in disaster response, and also seeks recognition of their integral role in the recovery phase, where they provide a continuity of care in the medium to long term. She is particularly interested in disaster mental health, and disaster recovery. Welcome, Dr Burns. Over to you.
Welcome everyone. I think as GPs we often think that we are bullet proof and the time, you know, when disasters strike is the time when really no one is, and when I sort of hear the stress in some of the GPs that I have been involved with over the last 10 years, while they are trying to sort of rescue their community from disaster, I am just reminded of the true altruism that we show as GPs, and the need that we have as GPs to also sort of think about taking care of ourselves. We are just as affected by disasters as other people. And I think this is probably the most important part of disaster management, this is looking after GPs first, so that we can then go on to manage our community and help our community through the long phase of recovery. GPs are the only members of the disaster response who remain with the community for the long run.
So I am very pleased to introduce our two speakers tonight. So we have Kathryn Hutt, who is the Medical Director at the Doctors’ Health Advisory Service New South Wales, and is a part time general practitioner in Mona Vale in Sydney. She provides regular fly-in GP services to remote New South Wales, and she has also got qualifications in public health and applied ethics. She is an active clinical member on the Sydney University Human Research Ethics Committee. And in her role as an on-call doctor with the Doctors’ Health Advisory Service New South Wales, Kathryn has spoken to hundreds of doctors and medical students about their personal experiences. In a previous experience, she worked with the New South Wales Medical Council, and she has witnessed the impacts on doctors of receiving a complaint or having involvement in the suspension system. And the importance of ensuring that they can find adequate support at these times. Kathryn is passionate about the wellbeing of her colleagues and is committed to ensuring that all doctors and medical students have access to support whenever they need it.
And then our second speaker, Felicity Buckley. So, she is part of the Workplace Relations team at AMA New South Wales, and she provides doctors in private practice with assistance and advice on a wide range of matters including practice management, award interpretation, staff contracts, people management, long service leave, entitlements and terminations. So we look forward to hearing from both of them, but we are going to start with Kathryn. So, welcome, Kathryn.
Thank you very much, Penny. It is an absolute privilege to be here. I would just like to acknowledge all of you out there who are going through and have been going through for some time now, very difficult, difficult times, and I would like to encourage anyone, if this does bring up a bit of distress or concern, to please make use of some of the services we are going to discuss this evening, even if it is just for a quick chat, it is always a good thing.
So, why am I here tonight to talk to you? Who am I? I am a GP in Mona Vale, but I am also the Medical Director at Doctors’ Health Advisory Service. Now I am hoping you have all heard about this already, but if you have not, here is a chance to learn about it this evening. You will see us morph into Doctors’ Health New South Wales over the next little while, because Doctors’ Health Advisory Service is a bit of a mouthful. But we have been around for almost 50 years. Doctor to doctor, 24/7 on phone, there is always another doctor to talk to. And we are here for any doctor, medical student, family of a doctor, family of a medical student, dentists, vets, to talk about whatever is going on. So, certainly we talk to hundreds and hundreds of doctors every year and medical students, and that is where I am coming from to give you a little bit of a perspective. So, this evening, I am going to give you a little bit of a challenge. I am going to be talking to you about your staff, certainly, perhaps registrars, perhaps you have got medical students, perhaps you have got other GPs in your practice, so going ahead and looking at some of the HR things, but I am also going to challenge you to think about yourselves as GPs, which is very hard for us to do. Doctors are very good at putting up a front that everything is okay and looking after everybody else. I think we can all perhaps relate to the sad apple there at some time in our careers, and in fact we are almost trained to do that, to be okay no matter what. And I am here to challenge you a little bit to say that in fact, it is really important to try and work out what is really going on. Now, the same goes for your registrars, medical students and other colleagues. They will all be going through exactly the same thing, they are not going to have a little sign on their forehead saying, actually, I am not okay. The one thing to talk about is really trying to get behind that façade and see what is really going on for people. And that sometimes requires some really sensitive questioning. It sometimes requires some role modelling around not just saying, are you okay? But saying, I am feeling like this, how are you going? Or, are you okay, and then actually waiting a bit for an answer. Or saying, are you okay, and then saying it again the next day and the next day. Things like that can really make a difference, because often we are very used to you know, denying that there is anything going on. A
After a disaster like this, there are a lot of things that can go on above and beyond the day to day things that happen in anyone’s health and mental health. So certainly if you look at the literature after the disasters, we will see in health workers, increased rates of depression and anxiety, PTSD certainly. Okay? And as GPs we are probably all very used to those labels and diagnoses. Of course, there are often other things going on as well, other mental health conditions can be triggered. We have got disrupted sleep patterns, things like that that are going on and can certainly trigger other things. Substance use can become a bigger issue, lots of stress going on, you know, financial things, family stress, anything at all really, relationship difficulties, do not forget domestic abuse here. So, looking at all these things that could be happening in your own world, or for your colleagues and staff.
I did want to particularly perhaps talk about burnout, because that is a fairly newish concept, perhaps it is not something that we have thought a lot about in general practice or learnt a lot about, and I thought it is worth spending a little bit of time looking at that this evening to see whether that is something that perhaps you might not have sort of thought about for yourself, or recognised in your colleagues.
So, what is burnout? Burnout happens, and certainly studies have shown there is a very strong link with PTSD and burnout after a disaster. So, a combination of emotional exhaustion, negativity and a reduced sense of personal accomplishment. Well, cannot imagine that happening in a disaster. So, a disaster is the perfect storm for burnout. It is not an illness as such, it is an occupational or environmental condition really. It can occur after persistent and unrelenting stress. So, I commend to you the Black Dog Institute website, and we will talk about that in a minute, that goes into some detail around the concept of burnout and some things you can do to navigate that.
So, here is our burnt out GP practice manager, medical student, registrar, you name it, we all experience these same symptoms. And I guess the thing for all of us to do is actually think about ourselves and what this might look like for us. So, for example for me, when I look at this and I am getting a bit burnt out, the irritability comes out with a little bit of frustration on the road. Suddenly I am not as tolerant for example of that person in front of me who is on their phone when the light goes green. But it is going to look different for everybody. And it is really just looking at this list, and trying to put yourself in that picture. It may not be hard at the moment. There may well be things there that you can very much relate to. And these are all warning signs that you are developing you know, burnout.
Now, with our calls to the call line, one of the common things that people say is, why am I not okay? Why is everyone else coping and I am not? That is probably the most common thing people are saying, to which I can say, I have probably just spoken to all your colleagues, you know, yesterday or the day before. The next thing they often say is, oh, I was going so well, and then there was just that one little thing and suddenly I am a mess. And it is like, well let us just talk through what has been going on and when you really talk through it, actually things were not going that great, but they were just holding on by the skin of their teeth, and then something came along. And that can be a patient complaint, that can be you know, something going wrong with an, I do not know, the electricity going off again. It can be anything, right? But it can be the thing that just triggers that perfect storm of burnout.
Now, I know you have probably all had enough of disaster services at the moment, and I hope this does not trigger anyone, but I actually think the disaster teams do very well at some things, and I think this is one of them. Alright. So, if you go onto that Black Dog website, you will find a whole lot of monitoring things that you can check in and check your score, and that is great if you have got time. Okay? I use this one. I drive past it every day. And I think, oh, where am I on this? Okay? Am I sitting at green? That is okay. Or are things perhaps moving up a little bit? Because I do not want them to get to catastrophic. Catastrophic is catastrophic by definition. So, I want to think, where am I? Because what you can do if you are very organised, or even in your mind, is think well, what am I going to do if that little indicator starts moving up? Maybe I start bringing in some of my preparedness things. Maybe I you know, stop having that, stop thinking about having that extra drink, because I realise I am getting to very high. Maybe I bring in some strategies. Maybe I make sure I get to bed on time. Maybe I ring a friend and talk to them. If that indicator is moving up. So I think this is a very simple but very effective way, if you drive past one that is great, but even if you can just have one in your head, and think, I am just going to check in with myself, around how I really am. Okay? Not just push on without even giving it any thought.
Okay. What are we going to do? If we do start, the indicator does start moving, and I imagine for most people at the moment, no one is on green. Right? I do not know, maybe you are, that is great. But these things change and can change on a daily basis. So, as you move up, what are you going to do? What are the evidence based things that might actually make a difference at the moment? Some of them are easier than others. So, if we start looking at these, certainly you can do your mindfulness and relaxation exercises that most people know about but do not do. It might be a time to actually start doing them, even if that feels like it is not doing any good, the evidence shows that certainly it does with regular practice. Set boundaries, take control of your time. Impossible, I hear you say, do not tell me to set boundaries and take control of my time, you are annoying. Of course. Okay. It does feel often impossible and it feels like everything is out of control. And that is part of burnout. But there may be little things you could do. It may be that you have to say, please do not squeeze in anyone else in my lunch break, I really need that lunch break. I know that there is this huge demand, but if I do not get half an hour, an hour, in that lunch time, I am not going to be okay by the end of the week. So there are perhaps areas that you could wrestle back some of those boundaries a little bit, bearing in mind that if you do not do that, things can fall in a heap and then you know, there will not be anyone around.
I am going to now talk a little bit about two of these things, one is the social connectedness, and the other one is asking for help. Because these are two big areas that can make a really big difference, and sometimes it is not as hard as people might think to do that. Okay? But if you want more information about any of those others, or some more detailed you know, advice, or you want to have a look at managing burnout or particularly burnout as a manager, I highly commend this website. It is set up for health professionals across Australia, so it is not New South Wales, Queensland, anywhere can access this. Quite a lot of resources for you, and also resources as managers. So leading a team through burnout. This is a very new module, I do not think it has been released, but I would commend that to you, and it has certainly got some very powerful messages around how you might start to look at burnout in your own practice with your own team.
So thinking about that social connectedness. Here are some of my lovely colleagues at Mona Vale, alright? And one of the things we did in the beginning of the pandemic, is we all moved to scrubs. Now, you would think, well, you do not need scrubs, what are you, some American, you know medical show? But actually, this was a very powerful thing that we did that brought us together as a team. So there is a receptionist there in scrubs along with a GP. In fact, not having to make the decision about what to wear in the morning and not having to work out if it is ironed or not, has actually made a big difference to my life as well. And we will never be going back out of scrubs again now, because it actually has brought us all together. We all look the same, and it has been a really fun thing but also taken away a bit of pressure. So, that is a very simple strategy to do, that gives you that sense of cohesion in the team and also decreased, one fewer decision in the day and that cannot be a bad thing.
It does not have to be an expensive strategy. You know, you can just have a team meeting at the end of the day and get a pizza. Okay? The power of a peer meeting with your colleagues or maybe some GPs from a local practice and getting together for pizza. Or even just the team in your practice. It is a different dynamic. So, you do not just go into work, get the work done and all go home, you spend some time together, and that is the time that people start talking about what is going on for me, you know, and really being able to have some of those very real conversations about how they really are. And maybe even debriefing a bit, letting off some steam. And it does not have to be a fancy French restaurant, okay? We do do this, and it is just lovely.
Okay, culture. Here is lovely Tina, GP Tina. On the left finding out that one of her colleagues is taking another sick day. Alright, or maybe she is on your right. I do not know, but you can see where she is, she is rolling her eyes, because she is thinking, oh no, that means I am going to have to take the load, and, and, and. And she is just completely burnt out herself, and this is the reaction when she finds out. This might be the reaction to the practice manager let us just say, or to another colleague. Oh, I cannot believe it. If we all start reacting like that, or if this is our attitude when other people need a bit of time off or some leave, unfortunately it does two things. Number one, it means that people feel really awful about taking leave and they tend not to, and they leave it until it is too late. But the other thing I have noticed, is that if that is the reaction, when you need to take leave, you actually cannot because you feel like everyone is going to do that about you. So in fact, we need to be GP Tina on the other side, who is saying, you need some time off, absolutely. We will manage. Back when you are ready, because everybody does this. And sometimes we are ready to step up a bit, sometimes we have to step back, and if we let ourselves, if we let each other do that, we might actually let ourselves do it, and it protects us in the long term. So, really important in terms of the culture of your practice and all your staff, that even if we are not saying it, messages like this about when people might need to take some leave.
Now, what help is around? Lots of it, actually, but it is a question of finding the right help. Not surprisingly, the best help often for any of your staff including yourself, is your own GP. Now, I know that all the GPs are stretched at the moment, but there are also other GPs around, telehealth-wise, and it might be that people do not have their own GP, and that is a problem, and I would encourage all doctors to find and meet a GP, interview them, make sure that they are a good fit, so that you have got your own GP if you might need them. It might be for your staff, I mean, you probably are not the best GP for your staff. I would say you are definitely not the best GP for your staff, you know, they are your staff. But you might be able to help them find a GP you know, in a close by practice or something like that, or let them know that having a GP is a really good idea. And also letting them know how they might approach that, that they do not need, and this is particularly true for our medical, you know, GP registrars for example, or our colleagues, because they feel like they have to have a diagnosis to go and see a GP, and really you can just go for a check-up. As we know as GPs, people come in for a check-up all the time. And encouraging your practice manager, your nurses to go and have a check-up, is a really good thing to do, because often, that can be the best support that they can have at this sort of time.
Now, with a lot of your registered clinical staff, they are going to be terrified to seek healthcare, because of mandatory notifications in New South Wales and Queensland. Not a problem in Western Australia, but we cannot all move there. So, they are going to be worried that if they admit that they are struggling, or that they are vulnerable, or that they have anything going on, or they are having an extra glass of wine, or they are feeling depressed, or any of these things, that that person they have been to see is going to report them to AHPRA and they will lose their registration. So, really important that everyone understands when mandatory notification comes into play. It is very, very rare. The threshold for needing to notify one of your patients is so high, it is almost never met, okay? It is only patients that have an illness that impairs them to the extent that they are going to cause substantial harm, that there is a substantial risk that they are going to cause harm to the patients. And that is a very high threshold. So, if they come and see you and you tell them to stop working and they stop working, even if they got a terrible illness, that is not an impairment. But the best way if you are thinking about do I need to notify, is to talk to your medical defence organisation, your medical indemnity provider. But certainly if you are seeking care, please feel reassured that that threshold is very, very, very high and it is very unlikely. And really the most important thing is that you get help, get some treatment. If you are worried about that, you can call the Doctors’ Health Service and we can talk you through it before you access treatment with a treatment provider. It is certainly something we talk about all the time if people are worried, because it is a very real fear.
Now, here we go. So here is another service, which is anonymous, non-Medicare. This is the TEN Group again, they have got sessions that you can book with a clinical psychologist or psychiatrist through the essential network. Now this is available to nurses, it is available to your registered health care staff, and it has recently been opened up for practice managers as well. Unfortunately not for receptionists at the moment, but it certainly is available for your clinical team, and you can, other than the online resources that are there for everyone to use 24/7 and sort of DIY, there is actually a talk to someone free of charge without the Medicare trace if they are worried.
For your reception staff and non-clinicians, Beyond Blue offer a service there for them, and that might be an appropriate one that they can call the support line there around the disaster, and they can get immediate support again 24/7. And often that can be a good way to introduce people into some longer term support if they need it.
Now, there will be many, many other employee assistance programs available to all of you and probably some of your staff. So, certainly the RACGP have got an EAP available for GPs and registrars. These provide some short term psychology type counselling. ACRRM as well. And each medical indemnity provider have their own program. But the Primary Health Network EAPs often go a little bit further, okay, so they will often include practice staff and it will be a question of accessing your own area to find out exactly what is provided. I have put a couple of examples up here. But certainly these are free and confidential. There is always a fear about people accessing things when they think things might go back to the employer. So, very important when you are talking to your staff about this, to make it very, very clear, that if they access these services, you will never find out. Otherwise, they may not feel comfortable doing that.
And here for our GP registrars, also if people have, particular in the corporate practices, they will often have an EAP if you have got any affiliations with the Local Health District, and for your GP registrars, GP Synergy are offering a few services as well for them. So perhaps worthwhile them getting in touch to make sure that they are aware of that.
Now, this is an interesting service. So, this is for those of you, and I think most of you will be in more regional areas, the Bush Support Line. Again, this is a highly professional service with experienced psychologists. And this is available to health workforce and their families. So this is a very good one to know about. Again, 24/7. And sometimes it is just really important to know that there is someone on the end of a phone, somewhere, that is relevant to speak to. Because often, you know, we wobble, often it is the middle of the night and it is really nice to know that there are lots of services out there, just waiting to get a call.
This is the Bush Support Line through CRANA. Again, I commend that to you for yourselves, but also for your staff.
There is another service, Doctors for Doctors. This is a psychology based service, or counsellor service. But again, it is 24/7, offering three sessions for any doctor or medical student across Australia, confidential and free of charge.
There is also a section on Doctors for Doctors around how to stay well, but there is also a help another doctor section, with some training modules, because one of the things about being a GP is that when other GPs come to see you, sometimes that can feel a little bit confronting or threatening, and there is some training on there, and we will talk about that again in a minute, around helping you to help other clinicians.
Peer support, very, very important. I was talking to someone recently about some peer learning groups, and just how important they are, getting together with a group of peers and talking about your work, in a very safe sort of way. Hand ‘n’ Hand is a more, I guess formal way of doing that, where you can actually register and join peer support groups if you do not have one in your local area. But I would also commend the idea of setting one up with people that really will understand the surroundings, that you can meet. Often you can meet in a private room in a restaurant or you can meet in someone’s practice or something like that. You can get that pizza, and it is a really good time to really connect to people with that sort of shared experience. It is often very valuable to do that together. You can talk about things that other people just may not understand, things that you may not be able to say to other audiences, because they just will not get it, and it is just, the social connectedness aspect of this and the peer connectedness is just so important, and so helpful.
This is lovely. Pandemic Kindness Movement. Again, some great resources, some clinical experts have come together and put together some resources for the pandemic. But I think equally applicable, okay, to the flood. Anything really, we can all spread only kindness. Alright? Sometimes that gets forgotten. But certainly have a look at that. There are some excellent resources there as well.
The Medical Benevolent Association. Again, been around a long time, doctors looking after doctors, okay, and they have just had a big program for flood affected doctors to help them with some financial assistance. But they do so much more than that. They have some very experienced social workers working there. They can link people in with financial people, they can help them navigate, you know, the evils of Centrelink forms, whatever, it is a very, very helpful organisation, and there is a little bit of financial support available for some things, so it is definitely worth asking whether they are able to help if you need.
Doctors for Doctors training. So there is a training on Saturday August 6th. I am having a little plug. Any of you watching this before, any of you here tonight or watching this before August 6th, there is a training day about looking after other doctors, but also looking after ourselves at the same time. That might be a good one to have a look at. These run frequently. So if it is after August 6th, that is okay, you have not missed out. But if you contact any of our Doctors’ Health Services, we will be able to put you in touch.
Now, this is the New South Wales Service. That is the phone number to call, 24/7. So what happens is, you will get through to an answering person, a real person, who will take your details and you do not need to leave a name, you do not need to leave any more than a contact number, because we will need a number for one of our GPs to call you back. And you can expect a call back from a GP usually within four hours. And really it goes from there. And we talk all sorts of things. There is nothing too big, nothing too small. And people certainly do find sometimes it is just helpful to know that there is someone else to talk to. You do not need to need anything to ring. You can just ring any time and we can talk through whatever is happening for you.
So, really my message, and I think that is my time up, but we are all very conscious that we are all in this together. Safety is important, your own safety is paramount. So look after yourself first, but then look to your team. The others in your team, particularly the doctors, will not tell you when they are not okay, so it is very much about sensitively asking that. But role modelling. Role modelling looking after yourself, role modelling taking your own temperature or doing your own kind of catastrophic rating every day, and really do reach out early rather than waiting until things do hit that catastrophic. Thank you very much. I would very much welcome any questions, and I look forward to meeting you all in the Q and A session.
Thanks, Kathryn, that has been really fantastic. Lots of really, really useful information in that, and I think, I mean the two really key things I take are that safety first and we were talking about this before we started the webinar, but I have just been doing some disaster training and all the other disaster responders are all taught that it is about safety itself first, and then safety of immediate group or immediate environment and then safety of the broader community. And I think as GPs, it is really important, and that is what the message you have given is, you need to make sure you are safe and you are feeling okay first, before you are able to go in and help others. So help your staff, and then help your family, help your community. And we have seen this in disasters, some of the most I guess enduring, and the most wonderful GPs who have gone through bushfires, floods, have been those who have gone, okay, am I ready to go in? No? I am going to wait a week because I need to sort this out first, and then this particular GP I am thinking of then went into the Victorian bushfires, and she was there for two years supporting the community. And really strong and really safe, and you know, I think those that rush in sometimes, it is useful to just step back for a minute and say, am I ready to go in? I need to keep myself safe. Because again, as GPs, we are there for the really long haul. And then the other really key message that I really, really, really love, is that social connectedness, you know? And we learn about that in psychological first aid. So GPs in the early days of particularly the Victorian bushfires, I am sounding a bit old here, but in other events as well, the practices were flooded with patients coming in. They were in distress, they wanted to be where they knew they were safe, where they knew they had a local trusted health professional, and as part of psychological first aid, some of the female GPs in particular, were saying that every single patient that I saw, I needed to go through this decreasing of distress, which is basically psychological first aid, where you look, listen and link. So you look at the patient, you see that distress, you listen to what they are saying, and then you link them, you connect them. You do not leave them unconnected. It does not matter who you connect them to, their dog, to their home, to their set of golf clubs, whatever is really important to that person, or to health services. And we also you know, there are more and more studies coming out now showing that if you get social support during a disaster, or even if you just think you did, you are more likely to recover better. And that is a really important thing to remember. And the other thing that we are learning, I do a lot of work with children in mental health, we are learning with teenagers in particular, that giving of support to other people is also very protective, and so I think it as GPs, we have got a really strong role to play, not only looking after ourselves, but helping our patients going through this also looking after themselves.
So, now I would like to introduce or invite our second speaker, Felicity to come and talk to us about workplace relations. Thank you, Felicity.
Okay. Thank you so much for having me tonight. Thank you for joining us. That was wonderful, Kathryn, some great resources and lots of really great information. There we go, okay I am up.
So this evening, I am going to talk to you about some of the common HR issues that GP practices may face in flood affected areas. Or actually, I guess as we are talking about you know, all natural disasters and emergencies for areas and periods. So first up, in terms of your practice, when a practice has to temporarily close its doors as a result of a natural disaster or emergency, when this is beyond their control, they may be able to stand down their employees. So when I talk about employees, I am talking about health professionals, support services, so practice managers, receptionists, nurses. Not referring to doctors who are engaged through a service agreement. So, just employees in this case. As an employer in this situation, you need to consider all the options that area available to you and your employees. These situations can be things like flood, bushfires, tropical cyclones, severe storms, I guess even earthquakes.
So, the two awards that apply to GP private practices are Health Professionals and Support Services Award, and the Nurses Award. Now, neither of these awards contain a stand down provision for natural disasters and emergencies. So what this means is that the Fair Work Act employee stand down provisions apply. So this provision allows an employer, such as a GP practice, to stand down their employees when they cannot be usefully employed because of stoppage of work for which the employer cannot be reasonably held responsible. And this would include times when flooding or severe storms, caused a practice to close. As an employer, you are not required to pay your employees during a period of stand down, but you may choose to pay them if you wish. The stand down provision does not apply, or would not apply, if an employee is already not attending work. So that includes if they are on annual leave or any other type of paid leave or unpaid leave even, or if it is a public holiday.
Though when you are standing down your employees, you need to make sure that you inform them, preferably in writing of first up, start date of the stand down, make it clear if they will be paid or not be paid, and what the effect on their other entitlements may be. So it is always a good idea to also keep them updated and informed about when you think they might be able to return to work.
But, before you stand down your employees, there are some other options that you may wish to look into. So, a couple of suggestions could be, you can ask your employees if they would like to take a period of paid leave, such as annual leave or long service leave if they have an entitlement owing to them. Under the Health Professionals and Support Services Award and the Nurses Award, you can direct an employee in certain circumstances, to take annual leave when they reach a certain significant accrual. It is usually about eight weeks or more. So, it might be worth in these situations checking how much leave your employees have, and seeing if this is an option to direct them to take that leave. You do need to do it in line with what the award says. If you have more than one practice, and the other site is not closed, you may consider offering some shifts at the other site. So, asking your employees if they would like to work at a different site. And you can also look into other flexible options, such as getting employees to work some of their hours from home. So it is important to remember that the employee needs to agree to most of these other options. And if they would prefer to take unpaid leave while the practice is shut down for that period, you cannot force them to take these other options or take their paid leave.
So, moving on to staff entitlements when the employee is absent from work due to these natural disasters and emergency situations. So, you may come across a situation where the practice is still open and functioning normally, but your employee is unable to attend work. Natural disaster, like a storm and the resultant flood, can throw out multiple reasons why an employee needs to take some time off. In cases like this, it is important to keep in mind the health and wellbeing of your staff when looking at what options may be available to them. Usually it will depend on the specifics of the reason as to what is available to the employee when they take this time off. First up, I guess we can look at personal leave. So that includes sick leave and carer’s leave. You probably know that permanent full time employees accrue 10 days of personal leave a year and for part time employees it is pro rata based on their ordinary hours work. This can be accessed if they are unable to work due to an illness or injury to themselves or if they need to provide care or support to an immediate family member or a household member due to illness, injury and also in the event of an emergency. So being able to take personal leave in a natural disaster or emergency situation will depend on the specific circumstances. A few examples might include if the employee is injured during this emergency. But even including things such as their child’s school or day-care is temporarily closed or shut down, then they would take carer’s leave for that period.
Once an employee has used all their paid personal leave, they are still entitled to take two days of unpaid personal leave per occasion. And this two days of unpaid personal leave also applies to casual employees, because I know that there are often a lot of support services staff in private practice who are employed on casual contracts.
Next up, annual leave. This one is fairly simple. But if an employee is dealing with issues at home due to a natural disaster or emergency, they may need to take some time off and they may request to take a period of annual leave. You might have a leave policy in place I your practice that deals with the process of applying for annual leave and you know, giving notice and having it approved and things, but this may need to be relaxed in circumstances like this. Given the often unexpected nature of these situations, you may need to sort of take it as is rather than enforcing the policy. Employees may have a period of long service leave that they have accrued and that is owing to them, and they may wish to use this to deal with situations at home relating to storms or flooding. And while this might not be a convenient time for the practice for the employee to take that leave, situations like this often require extra understanding. It may even be as simple as the roads have flooded and your staff members are unable to safely travel to the practice. You are not obligated to pay them if they are unable to work, but letting them access their paid leave entitlement would be more than reasonable.
Other options that can also come up, may include community service leave. This allows employees who are members of, it needs to be a recognised emergency management body such as the SES or the RFS, to take unpaid leave to fulfil duties associated with a natural disaster. There is no limit specifically on how much leave they can take, as long as they are still being engaged in that emergency management with that registered body then they are allowed to take unpaid leave for that service. And of course, in addition to all of this, you may approve other periods of unpaid leave for employees when their absence is reasonable.
Moving out of the initial emergency stage with a natural disaster, you may find that you need to make some changes to your practice and the hours you work, the hours your doctors in your practice work, and then this will flow on to the hours that you know, you require the staff in your practice to be working. These might be temporary for a couple of weeks while the clean-up progresses, or they may make you rethink how you are running things, and prompt permanent changes. If you are staying open, but you have some staff taking leave, you may require existing staff to work additional hours or shifts. Be aware what might attract overtime penalty rates under the awards. So this may include when a permanent part time employee works outside their agreed ordinary hours. And then for any permanent employee, so full time or part time, when they work more than a 10 hour shift, more than 38 hours in a week, or outside the standard ordinary hours as detailed by the awards.
We have covered a lot of the leave options available to staff in these situations, and for short term changes to working hours, this can often be really helpful. Another option that you might want to consider is, and that is available again under the same awards is the use of TOIL or time off in lieu. This can allow staff to work additional hours and then bank that time to take it at a later date. It is outlined quite specifically in our Professionals and Support Services Award, but also in the Nurses Award. So, there is further information about going about this process, but you just need to make sure that you record all the additional hours in writing and that you both agree to that time, not to be paid out as wages, but to be taken as time off in lieu at a later date.
Now we are going to have a look at what is involved when you wish to vary an employees working hours by agreement. So, this might come up. Sometimes it might be an increase to hours if you have lost staff. Sometimes it might be a decrease to hours if you are changing how you structure the practice. So generally speaking, employers are not able to unilaterally change an employee’s contract without undertaking a consultation process. And that consultation process is part of the award, and it is really important that you follow that when you make these changes. So in accordance with your consultation obligations, under the modern awards, when a decision has been made to introduce a major workplace change, and this includes reduction of hours, the employer has an obligation to notify employees that may be affected, discuss the proposed changes, and provide relevant information in writing. We always recommend that you issue documentation to your staff during this process and this can be used later as evidence of your geniusness to consult with them, and your obligation to provide the relevant information in writing.
So the Fair Work Ombudsman website talks about consultation and what that requires. And basically, you need to discuss the changes with your employees and consider their views, so yes, the views from staff and get their input into the decision before making a final decision. What this does not mean is that you have to give staff the right to veto or ask for their approval in relation to the changes. These variations to hours may be temporary or they may be permanent changes, and once you have agreed on your working hours, you need to make sure that you record those in writing. So, you do not need to necessarily create a whole new employment contract, although you can if you want to. There is a helpful form on the Fair Work website that you can use to record the variation. Or you could just create, you know, a short letter outlining the changes. And look, in the event that the employee does not agree to reduce working hours, or to the proposed changes, this may result in their current role being made redundant. It may also be the case that the consulting hours in your practice have changed and you need to restructure your current staff to suit. If you find that an employee’s role is being made redundant, you may wish to seek further advice and you can get assistance with that process. So, AMA members are able to speak with the workplace relations team, and we can talk you through matters like this.
On that same note, you may find that you can continue to run your practice with the same staff and the same hours, with a portion of all of the work being done from home for a period of time. I guess one of the unexpected positives to come out of the last years of COVID is the developments in telehealth and the ability of people to perform work remotely. I am not suggesting that this will work in all circumstances or that you make it a long term solution, but thinking ahead and being prepared and will be really helpful in times of natural disasters and emergencies. It is important to remember your privacy obligations to patient medical information and records when you have staff working remotely. So this includes support staff, and also doctors. You will need to make your own decisions on a case by case basis when assessing how your practice can continue to meet these obligations when you are working from home and other locations. So, the office of the Australian Information Commissioner has some really helpful guides on their website that can help talk you through this process. You may need to look at your practice privacy and confidentiality policy, the one that you had staff sign, usually with their offer letter. It may need to be amended to include other factors that are now relevant. Something else you can potentially look at is additional training for employees on privacy and also data breaches can be very important and really useful.
So the changes to telehealth over the last two years have made it much more accessible to all doctors and while this is still a changing environment, you do need to make sure you are up to date on all the current Medicare rules and requirements for billing each item number. It is something that you may want to consider offering to patients if you cannot get to the practice or on the flip side, they are unable to travel to the practice because of severe weather or flooding. Then on the practical side, and these are things that you may already have had to consider with COVID lockdowns, but it is much easier if staff and doctors are prepared from a resourcing point of view. So, questions you could ask your team are, who will answer the main reception line, and how? Will you divert the numbers to mobiles? Do you need to provide staff with mobiles? How will you access the server and the systems? Do they have laptops? Do they have secure computers at home that they can use? I mean, you know, to the point where do they have electricity, do they have Wi-Fi, do they have power? How will you run your telehealth consults? So will be there be phone or video? Do you have a secure system to use, you know a Zoom accounts or Teams accounts? Are they password protected? What is your process of letting patients know how to access the appointment, because you know, obviously they need an email, and you need to send them all those details. It is a bit different to just having them come in. So I guess these are just a couple of things you might want to consider in advance, and have as a plan before the emergency occurs. So, you can continue the smooth running of your practice.
Okay. Where are we? So that wraps up my part of the presentation for tonight. I hope the content has been helpful for you and your situation in particular. And I am very happy to stick around and answer more questions on the HR side of things.
Thank you very much, Felicity, and I think this is absolutely crucial there. Following hurricane Katrina, there was a study done that showed that 25% of those who did not return and continue to practice in the area, was due to damage to infrastructure in the business and inability to get financial support and to get the business back and running. And things like, we are seeing you know, in recent disasters, how you know, accommodation, even being able to have shelves up to put computer equipment on is absolutely crucial. And I think one of the things that really struck home to me when I was talking to the GPs following the Christchurch earthquakes, was that issue around staff and how to keep staff employed. There were doctors there who just went all out and paid staff, and then had major issues later on trying to keep the business going. And so a lot of the things you have mentioned there are really useful to know in advance and to consider in advance, I think, and lots of options. I think it is about being adaptable and it is good to know that we have got people that we can ring and ask questions about, because it is not easy.
Look, thank you so much, both of you for those wonderful presentations. I am just going to go through and might ask a few questions, there is an initial question here that is actually one that I might answer. It is from one of the participants. So, who is available to do a technical debrief, and I am really pleased you used that term, we do not want to be doing personal debriefs after disasters, a technical debrief for GPs involved in disaster relief? And now unfortunately, that is a huge number of people, and some people have been very involved and done an amazing amount of work, and also uncovered issues. So, for example, this person was involved in setting up and coordinating a health clinic, a recovery centre, who can I talk to about technical things which could have been improved and how could we improve next time? There is a huge amount of work going on at the moment amongst doctors and GP groups, the College included, I think the AMA, the PHNs, and there is a lot of meetings, there is a lot of sort of, I guess, disaster strategy being undertaken. In July we are having an emergency disaster planning strategy meeting with about 20 people, trying to work out what is the best way forward, what are our roles. I know numbers of PHNs are also doing that and we are trying to make that streamlined. So I would love you to contact me or to feed it back to the College, because we are really keen to get the lessons learnt. And this is the thing with disasters, every disaster is different, and so every disaster, we learn something. There has never been a disaster where we have not learnt something. So, one of the groups that has been missing and silent is the GPs. So you look back at past disasters, and there is no record that GPs were even present in some of these. And it is absolutely devastating to see that, because we know GPs by default were included, we do not have the lessons they have learnt. And so we have now got a historian in the College who is recording these as well, and the more we can document the experience and the learnings from GPs who have provided such wonderful care to the community, the less those future GPs who are going to face disasters are going to have to struggle to try and work things out. So, I would be really grateful if you could maybe through Mia or I am happy for you to contact directly, my email does seem to be out there, but it would be really wonderful to hear about those sorts of things.
So, I wanted to go back to the issue of talking about the fact that GPs are there in the very acute event, and I do not know if anyone has ever seen, there is a wonderful community adaptation on following a disaster, so I am going to draw it here, because I have not got it, I am going the wrong way. But you sort of go along, normal community equilibrium, and then you get hit by the disaster. So it goes down. The disaster strikes. And you sort of go down. And then you have this wonderful period where you come up, and it is a period of energy and where everybody comes together, and it is called the honeymoon period, and everybody is helping everyone, community, social support, everyone is coming together. Strangers are helping strangers. Media is coming in. You know, all sorts of resources are flooding in. Everybody is focussed, everyone wants to help. And then in the weeks afterwards, you start to get this dip, where some people are getting more than others. People are starting to realise that what they were expecting is not happening. The pain of what has actually happened and the destruction and the loss is being felt. And you go back down to this sort of, sorry, not doing this very well, level, and then the anger and the grief also starts. And then you start to rise up and there are different levels of recovery after that. And you know, there are those communities that do not recover very well, there are those that bounce back really strongly, and there are those that sort of just come back in the middle. And it is a really, I found it a really useful way when I first experienced a disaster personally, and I found that really useful. They handed that out actually during the disaster, and I found it a really useful way of sort of just, helping me work out that what I was going through was normal, and it was not abnormal. And I think that that sort of highlights the fact that this is a long term response. So I wanted to ask Kathryn about you know, we have talked about acute resources, but what about that long term time? You know, a number of GPs I know through disasters said, look I did not want help early on, I wanted to be there, I was okay, I was monitoring myself. But at three months, or two months, I was really tired, and that is when I needed help. And I guess I want to know what sort of advice you would have for that group of people?
I think, and it is very true, I mean, this thing does not end. It is not like it is all over and you get to bounce back to normal, is it? I think, and again, that is around burnout, is that perpetual out of control, it is ongoing. It is enduring. It is one thing after another. I think really, normalising it is really important. And in fact, a lot of our callers, a lot of it is about really just saying, but you are just like everybody else. There is this expectation that in fact everyone, as we talked about, everyone else is okay, why am I struggling? Well, it is normal right now to be struggling. You know, I am surprised that you have not been wobbly all the way along, but the fact that you are here now, now is what is important. And all of those services really that I put up there, are there all the time. There are very few there that were just here for the floods, gone tomorrow. I mean, this organisation here where you can ring and talk to a doctor 24/7 has been here for 50 years now almost. Almost 50 years. But something like that. Because there is always someone. And it is a very strong message to say that none of us out there, as clinicians, as doctors, are ever alone. There are always other doctors that are with you in spirit. They are on the end of the phone. It is around just not trying to go through this on your own, and really reaching out, whether that is to that peer group, whether it is to a professional, in some way reaching out to make sure you are not trying to just manage it all on your own. Really important.
Thanks, Kathryn. And I actually realise we do not have a lot of time for discussion, unfortunately. So, look, I think that is really important. And one of the things that I also think that raises, is that just in terms of getting back to the debrief, is all the other groups have an opportunity where they come together and they discuss what has happened and go through it. And hopefully again as GPs we can create that, and in the future moving forward, that is one of the lessons learned that I think we would like to bring into play. And whether that is through the PHNs or the College, or through different groups or both groups, I think that is going to be something that we are going to be discussing for the future.
There is one last question that I am going to answer here. It is, are there services or mechanisms to facilitate inter-specialty cooperation in disaster settings, e.g., GPs, surgeons, physicians, counsellors etc.? Can telehealth allow doctors in other locations to assist in service provision? Two really, really crucial points, and I think you know, Felicity raised telehealth, and I think that is something now through the pandemic that we have now got as a tool. And absolutely, I think again that is a really good suggestion, and we will take it to this meeting in July, because previously people have actually flooded in, and that has not always actually been that useful. I remember one of the teachers following a huge bushfire, standing where 23 children had died during this bushfire, and she was standing there trying to work out, you know, she had children missing, and there were all these extra people standing in the room that the children did not know, and she did not know, and all she wanted to do was be with her kids. And so this was, you know, having the option to have help from outside that is not physically there and that can be monitored, controlled, through telehealth, is a really good idea. We do not need extra people on the ground. We can have that you know, telehealth environment. In terms of facilitating specialty cooperation in disaster settings, this already happens across disaster responders, and this is where we are working to link GPs in through the local health districts and the PHNs. That is the way we are going to have to link in. There is no other way to link in, and we are trying to make that a much better process and a much clearer transparent sort of procedure, but there is no harm in having extra connections from the GPs themselves out to these groups before the disaster. And in New Zealand in fact, they do that. They have a thing called LEGS and so they get each little local area to have the GPs connect with the radiologists, connect with the pathologists, connect with the pharmacists, connect with the surgeons beforehand, and if you know, say if there is going to be a disaster, then we will contact you. And so that is about disaster preparedness. But I will wind up there, and I want to thanks Kathryn and Felicity very much for some wonderful presentations. Over to you, Sue.
Alrighty. Well, just want to wrap everything up and say thank you very much everybody for attending. It has been wonderful to have you here, and this will be available as a recording in the very near future. If you found this information session useful, then as you can see on the slide, you can choose to self-record the CPD points by your My CPD portal on the RACGP website.
And finally, a special offer from our guests last week at the Financial Matters seminar. Howden Insurance Experts are offering a one hour flood support and guidance session, and William Buck Health is also offering a one hour complimentary consultation. If you would like to know more about that, please do not hesitate to get in touch with us at the New South Wales and ACT Faculty.
So in closing, thank you again. It has been great to have you all here. I really trust that you have learnt some fabulous things from our wonderful speaker tonight and I would like now to return you to your evening. Good night.
Thanks, Sue.

Other RACGP online events

Originally recorded:

17 May 2022

Learning outcomes

  1. Discuss human resource issues that may be relevant for practices that amend operations due to disasters.
  2. Be aware of human resource issues when requiring staff to work from home.
  3. Discuss the mental health concerns affecting clinicians responding to disasters

This event is part of . Events in this series are:


Kathryn Hutt
Medical Director Doctor's Health Advisory Service

Dr Kathryn Hutt is the Medical Director at the Doctors’ Health Advisory Service (NSW), and is a part-time general practitioner in Mona Vale, Sydney. She also provides regular fly-in GP services to remote NSW. Kathryn has additional qualifications in Public Health and Applied Ethics and is an active clinical member on a Sydney University Human Research Ethics Committee. In her role as an on-call doctor with the Doctors’ Health Advisory Service (NSW), Kathryn has spoken to hundreds of doctors and medical students about their personal experiences. In her previous experience working with the NSW Medical Council, she has also witnessed the impacts on doctors of receiving a complaint or having an involvement with the regulatory system, and the importance of ensuring they can find adequate support at these times. Kathryn is passionate about the wellbeing of her colleagues and is committed to ensuring that all doctors and medical students have access to support whenever they need it.

Felicity Buckley

As part of the Workplace Relations team at AMA (NSW), Felicity provides doctors in private practice with assistance and advice on a wide range of matters, including practice management, award interpretation, staff contracts, people management, long service leave entitlements and termination.”


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