Introduction
Most SASOG members by now are aware of the recent events affecting the
relationship between SASOG and GMG. The issues behind these events have been
discussed at the recent general meeting of SASOG at the SASOG Congress at Sun
City on 30 August 2024. This communication aims to provide a historic perspective of
the association between SASOG and GMG. The information presented here has been
derived from documentation that has been accumulated from the inception of the
SASOG/GMG association, as well as by individuals who were involved in the
establishment of GMG and in the initial agreement between SASOG and GMG as well
as the most recent developments.
It is important to reflect on the history of events to understand why and how current
events have arisen and see the way forward.
SASOG
SASOG has been in existence as a voluntary association since 1946, representing
the interests of O&G specialists in South Africa and advancing women’s health, like
all other specialties in the country who have societies looking after their members’
interests. Through the years, several daughter societies representing different
subspecialties and interest groups have become part of SASOG, and the society has
developed strong associations with relevant other stakeholders such as the HPCSA
and College of O&G. For many years SASOG leadership were mainly involved in
public and academic medicine. Over time, it became quite apparent that the needs of
O&G specialists in private practice, especially those related to issues such as remuneration,
and relationships with medical aids needed attention, analysis, and support.
GMG
The Gynaecology Management Group (GMG) was established in 1996 with the
blessing of SASOG. There were two main drivers leading to the formation of GMG.
Firstly, SASOG at the time did not sufficiently address private practice matters, and
secondly, it was necessary to respond to efforts from large corporate companies that
were planning to establish managed healthcare systems in private practice,
threatening to compromise the independence of private practitioners.
GMG, a separate legal entity with membership, for many years outsourced the bulk of
its services to Health Management and Networking Services (Proprietary) Limited
(Healthman), managed to negotiate some benefits with funders. These benefits could
not be limited to GMG members only, and as a result, all private practitioners in O&G
benefited from the work done by GMG, with only a small proportion of those
practitioners being paid-up GMG members, and as a result GMG did not have
sufficient membership numbers to financially sustain itself in the long term.
In 2004, the then chairman of GMG concluded in a report that “the continued survival
of GMG has made a new dispensation imperative”. The proposed new dispensation
was some form of amalgamation or co-operation agreement between SASOG and
GMG.
SASOG and GMG co-operation
During the triennium of 2006 – 2008, SASOG and GMG, as two separate legal entities,
decided to work together. A formal agreement between the two parties were signed
on 7 May 2008, and according to this agreement, SASOG approved GMG as the
service provider responsible for private practice matters of the Society. This
arrangement meant that all private practice SASOG members paid dual membership
to SASOG and GMG, and SASOG members not in private practice only paid SASOG
membership fees. When the agreement between SASOG and GMG was finalised,
GMG, as a service provider, would be responsible for numerous administrative and
consulting functions which were mostly performed via Healthman and represented
coding, funding, and private practice business related matters on behalf of SASOG
members in private practice. GMG was also responsible for collecting membership
fees. Consequently, most SASOG members also had to become members of GMG
and virtually all GMG members were members of SASOG. The liaison between
SASOG and GMG were regulated by occasionally updated service level agreements
(SLAs), defining the relationship and clearly states what the different responsibilities
of the two parties were.
In essence, the co-operation agreement between SASOG and GMG came about
because the increasing demands to support private practice practitioners could
be rendered by GMG. At the same time, the agreement assisted with the
increasing administrative burden of SASOG, and ensured the continued
survival of GMG through increased membership and financial support, as GMG
was unable to sustain itself financially.
The SASOG GMG relationship
The healthcare landscape SASOG operates in has evolved significantly during the
past 15 years. Amongst others, the SASOG constitution was adapted to allow fair
regional representation on Council and membership, and the number of different
daughter societies and interest groups increased. In 2014 SASOG appointed a
secretariat, and in 2023 SASOG appointed a chief operating officer (COO). More than
75% of SASOG members are in private practice, and this is reflected in the SASOG
leadership and in the elected SASOG Council members. Basically, the initial drivers
and needs that lead to the establishment of GMG and the collaboration between the
two organisations disappeared over time, as the managed health care threat did not
materialise or were avoided.
In recent months the relationship between SASOG and GMG management teams
deteriorated, and disagreement mounted about the different roles, responsibilities,
and the legal agreement between the two organisations. Despite honest efforts to
resolve the conflict, the relationship of trust was damaged, and consensus could not
be reached about a continued service level agreement between the two parties.
Considering all the above, SASOG Council concluded in July 2024 that a continued
agreement with GMG as a separate legal entity is not necessary or beneficial to
SASOG and its members. Recognising the skills, institutional knowledge and
valuable work GMG has done, SASOG requested GMG to continue its work not
as a separate legal entity, but as a committee or business unit under the
auspices of SASOG. SASOG Council is of the opinion that the continued existence
of GMG as a legal entity separate from SASOG is not to the advantage of the
discipline, as SASOG strives for unity and would prefer to integrate the functions of
GMG into SASOG.
Regrettably, on 3 October 2024, GMG formally communicated the GMG board of
directors’ (BoD) decision to not accept the request from SASOG to become part of
SASOG in a different format. GMG decided to continue functioning as a separate legal
entity.
The end of the formal SASOG GMG agreement
Although this development is unfortunate and disappointing, SASOG respects the
GMG BoD decision, and wishes GMG well in their future endeavours.
The decision of GMG to remain a separate legal entity, not becoming part of
SASOG in a new format as offered by SASOG Council, and not having a valid
legal agreement with SASOG, has now resulted in a formal separation between
SASOG and GMG.
The way forward for SASOG
SASOG council is confident and satisfied that sufficient provisions and systems are in
place to ensure these recent events will not adversely affect the Society or any of its
members. Some of the initiatives already in place, such as the SASOG Private
Practice Business Unit (PPBU), has been communicated to members. SASOG will
continue to restructure and innovate, to remain relevant and provide real and tangible
benefits to its members. SASOG will keep its members informed of the progress of
restructuring within the Society.
SASOG has an unwavering commitment to both advance the interests of women’s
health in South Africa and protect the interests of all its members; be it in private,
academic, or public sector practice.
SASOG and GMG membership and fees will be separated, and GMG no longer
represents the private practice or any other interests of SASOG members.
Disclosure and acknowledgements
This communication has been drafted by the current Honorary Secretary of SASOG and a
member of SASOG Council uninterrupted since 2008 and represents the SASOG version of
these events as accurately as possible.
Information on the historic events have been verified by Dr Fred Hayward, past SASOG President
and past GMG chairman at the time of the SASOG GMG amalgamation, as well as by
Prof Franco Guidozzi, previous president of SASOG at the time of the amalgamation.
Information on recent events have been verified by past Presidents of SASOG, Prof Bash Goolab,
Dr Johannes van Waart, Prof Greta Dreyer and Dr Haynes van der Merwe and the current
President Prof Ismail Bhorat.
Documents: A copy of the SASOG GMG agreement signed on 7 May as well as the
2004 GMG report to SASOG Council.
Prof Leon C Snyman
SASOG Honorary Secretary
14 October 2024
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