President’s Report 2015

Legal expenses

Genesis medical scheme launched an application in the Cape High Court to have Regulation 8 declared illegaand to be abolished. Regulation 8 relates to PMB’smade in terms of the Medical Schemes Act, 131 of 1998. SAPPF applied to join as a respondent in the Genesis Case upon which Genesis appealed to the Constitutional Court to have the ruling reversed, which application SAPPF will have to contest.

In addition, BHF earlier asked the North Gauteng High Court to rule on the meaning of a clause in Regulation 8 instructing funders to reimburse PMB’s in full, which was eventually dismissed with cost due to technical errors in the application. The Superior Court of Appeal in Bloemfontein subsequently upheld the North Gauteng High Court’s decision.

SAPPF also succeeded in preventing the HPCSA to set a benchmark ethical tariff based on the 2006 NHRPL which bears no relation to the real cost of providing and sustaining a private medical service.

The continuing Inquiry in to Private Sector Costs conducted by the Competition Commission , which might eventually impact on the setting of benchmark fees, requires support related services to ensure that the correct information and factual data is presented to the Commission.

Why does all these issues need to be contested?

The Department of Health recently published in the Government Gazette a proposed amendment to the PMB regulations that will enable schemes to cap their PMB exposure to the scheme rate. This may also possibly require legal contention.

SAPPF explained the issue eloquently, in contending that, “the whole ethos of the PMB regulations, which [was established]to compel all schemes to provide a minimum set of benefits for a range of conditions prescribed by law, [will be turned] from a minimum benefit into a maximum benefit determined by the rules of each scheme. This will protect schemes from exposure to unbudgeted expenses but will transfer the risk to their members. Furthermore the proposals seek to prevent practitioners from adding a co-payment to their fee in excess of the scheme benefit, thus enabling schemes to determine the maximum fee chargeable by practitioners, without due regard for the costs of providing the service.” – SAPPF newsletter 16 September 2015

This understandably not only affect PMBs at the present time, but will eventually impact on all fees in general, stripping the autonomy of each and every individual medical practitioner to sensibly decide in how he or she will provide a proficient medical service in a sustainable and acceptable monetary fashion.

Ethical practice

Ethical practice in medicine should always be adhered to and stands above any concomitant decision that may adversely influence the patient’s management. We learned about a practice in a specific section of the cochlear implant fraternity where a company not only provide global quotes which include the fees of the implant, surgeon’s fees, anaesthetic fees and the hospital fees, but where the CI-program is operated by the same company owning the exclusive rights to the distribution of the implant in South Africa. In addition, employees of the same company coordinate this specific CI-program. Regardless of the structuring of the company, this emulates in an inappropriate situation where an outside entity with a profit incentive, recruit patients and decisions on the patient’s management are hence made by individuals employed by the company, decisions that will eventually only benefit the company in question.

This clearly contravenes the unspoken rules of ethical practice. The EXCO discourages such practice and should members involved reconsider their alliance to such companies.

In addition, it needs to be restated that no qualified ENT surgeon aspiring to be trained in a specific field of Otolaryngology should be excluded from training by colleagues in this specific field, if the colleagues feel their survival in the field is threatened.

Congresses

The Society will be hosting exciting congresses in the upcoming three years, the first being in Sandton in 2016 in collaboration with the German ENT Society. The year following the congress will be moving to Port Elizabeth at the new Boardwalk Convention Centre where we will be joined by the Nordic ENT Society. In 2018 the 54th annual ENT congress will be linked to the World Audiology Congress that will be staged at the Cape Town International Convention Centre.

Congress organisers are increasingly confronted by dwindling sponsorships prompting the need to find alternative ways to finance the cost of presenting high quality meetings addressed by international leaders in their respective fields. Invariably visiting international speakers and delegates to the annual SA national ENT Congress are astounded by the quality and efficacy of our meetings, which underlines the value of our congresses. Considering the significant expense of attending congresses abroad, our national congress still provides excellent value for money.

It goes without saying that the effortless operation of our congresses wouldn’t have been possible without the tremendous effort of Ms Denise Kemp and her wonderful team at Eastern Sun Events.

Status of Academic Institutions

Discussions with the committee for Heads of Departments disseminate a growing sense of optimism in the academic milieu. This is not only evident in evaluating the results from the recent College examinations, but also observing the quality of the presentations at the annual Congress.

The ability to render a quality service in the teaching units at the bureaucratic state funded provincial academic hospitals will always be subject to frustration verging on despondency, but observing the dedication and commitment of the leadership in the academic ENT Departments is certainly invigorating.

The appointment of Dr Yougan Saman as Head of the ENT Department at the University of Kwazulu-Natal fulfills a long-term need in providing structure and direction with in the department.

Awards for registrars submitting paper and oral presentations at congresses are increased to R2000 per congress and articles published in peer – reviewed journals to R2500 per article to the department.

It is similarly most gratifying and encouraging to notice the SA ENT Registrar’s Association going from strength to strength!

Remunerated Work Outside the Public Service (RWOPS)

The inadmissible level of ethical and legal adherence by a few individuals to RWOPS regulations and requirements at specific academic institutions, remains of concern. The abusive and detrimental effect this has on the committed treatment and management of State patients, the teaching of undergraduate students and the training of registrars have long-term consequences, contributing to the gradual destruction of the public healthcare system.

Fellowships

Ongoing discussions are under way with private institutions working towards the establishment of fellowships. Following inceptive meetings with Discovery the EXCO appointed a working group to continue further negotiations with the Discovery Foundation Board.

History Book

The writing of the history book on the Society is reaching the final stages of completion upon which editing, graphic design and printing will follow. The culmination of the tremendous effort Stefaan Bouwer and Tamara Lombard invested in this project will hopefully realise at the next Congress when the book will be launched.

Future Leadership of the Society

The EXCO had for a long time encouraged the exploitation and development of young and upcoming leaders in the Society. It remains vitally important however that our young members are groomed in the e thos, proud tradition and professional conduct of the ENT Society, something that they can only achieve and learn through involvement in the regional activities of the Society.

Facebook page

An ENT Society Facebook page has recently been launched under the guidance of Dr Carl Van Wyk. We would like to encourage members to optimally utilize this facility in pasting contributions and photographs that is what builds a history.

AND A REMINDER….

From time to time we should pause and ask ourselves why we should become, or continue to be a member of the Society.

I would like to remind members and non-members why belonging to the Society is to your advantage:

1. The South African Society of Otorhinolaryngology Head and Neck Surgery:
   • Speaks as a collective voice for the Otolaryngology fraternity all issues pertaining to Otolaryngology practitioners.
   • Protects the boundaries of the specialty.
   • Protects individual members of the Society who are unfairly treated or discriminated against by funders or any third party.
   • Engages proactively with all important role players on affairs specifically pertaining to the specialty.
   • Assists in maintaining excellent academic standards.
   • Encourages and supports the formation of special interest groups within the specialty.
   • Defending issues that are threatening the sustainability of the private sector.

1. Academic subcommittee:
   • Supports interaction, dialogue, planning and improvement of curricula as well as promoting the introduction of new technology and techniques, all serving to improve registrar training.
   • Encourages research projects and allocates solicited research grants to credible projects.

1. ENT Congress subcommittee (Local organizing committee):
   • Arranges for a subcommittee to organize and convene the Annual ENT Congress.
   • Provides a platform for registrars to present papers or posters to an international audience.
   • Provides substantially reduced Congress registration fees to paid – up members.

1. Continued Medical Education:
   • Supports a healthy academic environment, enables private otolaryngolog ists to benefit from journal discussions as well as courses.
   • Provides a platform for securing CPD points through Journal Club discussions.
   • Endorses and promotes support to individual Journal Clubs.
   • Provides access to selected online journals.

1. Funding:
   • Provides financial support to registrars who present papers or posters of quality at Congresses.
   • Provides financial awards to registrars who presented papers/posters of excellence at the Congress that qualify for the registrars’ prizes.
   • Provides funds for the John Hamilton Training Grant.
   • Allocates grants to the individual Academic Departments of Otolaryngology for use at their own discretion.
   • Provides financial support to Journal Clubs to subscribe to journals.
   • Funds the maintenance of the ENT website.

1. Peer Review:
   • Provides peer review on issues submitted by patients, funders, the legal fraternity and colleagues.

1. Tariff subcommittee:
   • Negotiates with relevant institutions to secure fair and equitable recognition of and remuneration for services provided.

1. Practice management:
   • Supports and encourages negotiation by the ENT management subcommittee (MANCO) for arrangements, contracts and benefits advantageous to otolaryngologists.
   • Offers through MANCO a group function for collecting and processing of otolaryngology practice related data and research information to facilitate negotiations with funders, the Department of Health, educational bodies and other relevant institutions.

1. Member interaction:
   • Provides a forum for all ENT practitioners to interact with one another.

THANK YOU!

I would like to express my sincere gratitude to the members of Society for the privilege being able to serve as president over the past three years. It has been a wonderful experience, during which many friends were made, but an experience that wouldn’t have been possible without the incredible support and friendship of the members of the EXCO. To Janette, our administrative officer, I simply fail words to thank you, you really enriched and eased my life.

Congratulations to Shanil Ramjettan who will serve as a worthy president for the next three years.

To each and every one of you, A BIG THANK YOU!