Dr Pickering and Dr Repin visited the State branches and Territory groups to pursue the idea of structural change. Their discussions convinced them that an internal review of the structure would not succeed; an external review was the only way to obtain the kind of solution that would be accepted by the profession as unbiased. In September, Federal Council decided that an approach be made to “an eminent well respected, non-medically qualified person” to conduct a dispassionate review of the structure, function and constitution of the AMA. Dr Pickering and Dr Repin met Sir Robert Cotton – experienced in business before becoming a Federal Cabinet Minister and, later, Ambassador to the United States – to ask him to take on the task. He accepted. In November, Federal Council formally invited Sir Robert to undertake the review. The Cotton Task Force operated out of federal headquarters (then in Sydney), with staff from the Federal Secretariat. Federal Council later decided to enlarge the Task Force, adding three eminent members of the profession and one lay person. They were Dr Rod McEwin (physician, formerly head of the NSW Health Department), Dr Brian Shea (psychiatrist, past Chairman of the South Australian Health Commission), Dr John Clareborough (past president of the Royal Australasian College of Surgeons) and, at Sir Robert’s request, Mr Leonard Hinde (actuary and former adviser to the Board of the Reserve Bank).
The Task Force report was delivered – a more accurate word would be ‘exploded’ – three months early, in March 1987. Among the core recommendations of A Review of the Alternatives for the Reorganisation of the Australian Medical Association was Recommendation 2: that “the AMA becomes a national association and that the autonomy of the Branches be removed”. As Dr Pickering says, “it was a brave, bald statement and I believe was made as such to gain maximum emphasis. Such a recommendation could never have originated from within the AMA. It screamed out ‘This is what is wrong with the AMA’ and was to be the major debating point of the whole Report.”
Before that could happen, Federal Council had to decide how the report should be released. Since it had commissioned the report, Federal Council thought it should have the chance to discuss it first. It realised that its decision would create some angst within the branches, who would prefer that they and their secretariats should see it before the general membership and the public. Federal Council had some sympathy with this, Dr Pickering says. But it decided that a general release would allow rank-and-file members - ie, those who would have the final say - to see it at the same time as branch councils and so become immediately involved in the review process. Dr Pickering released the report at a media conference on the day that the full report was published as a supplement in the MJA.
The Cotton proposals were essentially that authority in the organisation should be shared – that the constitution should reflect that, while the branches continued to have authority over state matters, the federal AMA should have sole authority over those relating to the Commonwealth. In other words, a true federation, in which the federal AMA would have powers to act that the NSW doctors’ dispute and other incidents showed that it did not then have. Apart from any other consideration, this would replace the existing time-consuming, laborious and basically inefficient process in which the federal AMA needed to gather the advice of branch councils before it could act or react to events for which there was often no AMA policy to guide it. Apart from Rec. 2, which was radical enough, another courageous recommendation was that Federal Council should be replaced by a General Council, with members directly elected and including delegates of craft groups, thus representing more accurately the current state of the profession. And it proposed that, if there was one organisation, its assets should be available to the whole membership. These were highly contentious ideas and Dr Pickering appreciated that some would be vigorously opposed. Nevertheless, he set out on a national round of discussions about them with the branches, individual members of the AMA and the colleges.
He saw his role in these discussions as conveyor of information, not opinions, he says. “My aim was to stimulate sufficient interest in the report to get people thinking and to receive feedback on what was perceived to be its good and bad features. I felt it most inappropriate for me to take a fixed position. If I could be seen to be neutral, I was more likely to gain the confidence of the membership and more likely to receive constructive feedback. I sought full and informed discussion that would lead to the development of a new constitution that the majority of the membership would comfortably accept and even welcome.”