The critical question is not the source of the body's funds but whether its activities are so controlled by government, or are so closely associated with the implementation of its policy, that it should be properly characterised as carrying out the work or function of government. To answer this question in respect of the Division, it is necessary to examine, amongst other matters, its constitution, the control over appointment of its board, how it is funded and its relationship with the Commonwealth government in that regard.
Structure and activities of the Division
12 The legal structure of the Division, as is evident from its constitution that was adopted on 13 November 2001, is described in some detail by Byrne, A.J.A. and there is no need to repeat it here. Similarly, his Honour set out in his reasons, with some particularity, the Division's goals as they are reflected in its Annual Report of 2002, and its principal activities and source of funding. Moreover, it is plain that the government plays no part in the appointment of its board members. It is necessary, however, to examine the context in which the Division came into existence and its relationship with the Commonwealth government.
Establishment and development of Division
13 It is apparent from the materials that have been provided to us that the circumstances in which the Division came to be established can be traced back to the late 1960's when there existed considerable dissatisfaction by a significant body of general practitioners about their role in the provision of health services. As a consequence, a number of bodies of general practitioners were established in the mid-1970's. These bodies were relatively unstructured and informal and were concerned primarily with attempts to resolve these problems. Over the course of the next three decades, these groups expanded in the manner described below and eventually became, under the aegis of the Commonwealth government, part of a national scheme, which is directed and organised by it and is aimed at improving the ability of general practitioners, and other health care professionals, to provide local health care services to a standard determined by government. As will be described more fully later, the work of this and other divisions is relevantly controlled by government, which has assumed responsibility for the nation-wide provision of local health care services and uses the divisions as the vehicle through which it seeks to achieve its national policy objectives.
14 As General Practice in Australia: 2000[26] explains, in the late 1960's there was considerable dissatisfaction and disillusionment amongst general practitioners concerning their role in the overall provision of health care to the community, including, no doubt, dissatisfaction with their working conditions and level of remuneration. In response to this dissatisfaction, the forerunners of the present divisions were established and appear to have been comprised of hospital-based practitioner associations that were concerned primarily with ameliorating practitioner isolation and providing members with professional support and greater inclusion in the overall health care system. Gradually, such bodies became more formalised and grew in number, so that by 1984 the Royal Australian College of General Practitioners had adopted a set of policy guidelines for establishing and operating such divisions. In summary terms, the guidelines described the essential work of the divisions as: "representing GPs in the local hospital and community; negotiated credentials for GP access to hospitals; organising continuing medical education for GPs; implementing peer review and quality assurance; facilitating undergraduate teaching and vocational training; and participating in primary research, health promotion and education ...". The guidelines make it apparent that the early divisions probably existed primarily for the benefit and advancement of their members - in terms of their work, further education and greater organisation - although no doubt an incidental, but important, purpose was the delivery of better health care services to the general community. But, as noted in General Practice in Australia: 2000, lack of infrastructure funding restricted the growth of the divisions in terms of size and number and limited their role and activities. Eventually, most likely due to lobbying by the medical profession, in recognition of this limitation on the work and growth of divisions, the Commonwealth government began to fund them in 1991-92 under its "Divisions and Project Grants Program" on the stated basis that such funds were provided to support "local groupings of GPs in the formation of trial Divisions of general practice ... .".
15 By 1993, as a result of this "injection" of funds by government, the number of divisions had grown from 31 (in 1991) to 100 and divisions "covered" approximately 80 per cent of Australia. By 1994, approximately 60 per cent of general practitioners were members of a division and this number has increased since. Thus, by 2000, there were 123 divisions covering Australia's entire geographic area.
16 The establishment of the divisions' grants program was part of the government's wider policy to reform general practice in Australia and was the result of recommendations made in a number of reviews of general practitioners' practices by bodies that were either part of the government or were closely associated with the implementation of its health care policy, such as the National Centre For Epidemiology And Population Health (NCEPH) and the General Practice Consultative Group. Over the period 1992 to 1997, numerous reviews of divisional operation were conducted by various bodies. This included a review by the General Practice Consultative Group, which recommended in its 1992 publication, entitled "The Future of General Practice", that greater funding be made available "to establish divisions and to support their activities". Also, the Divisions Strategic Group recommended in its 1995 report the establishment of State and Territory support structures for divisions. The Department itself,[27] which in 1992 published an issues paper (also entitled "The Future of General Practice"), put forward a blueprint for the development of general practice in Australia.
17 In the context of this process of ongoing review by government and associated entities of the operations of the divisions, and in order to achieve its policy objective of assisting general practitioners to deliver more efficient and higher quality health care and improved health care outcomes for the community, the government introduced in 1996-97 the "Divisions of General Practice Program". Under this program, the method by which government funded divisions changed materially - moving away from infrastructure and project-based funding (as was provided from 1991 under the "Divisions and Projects Grants Program") to "outcomes-based funding agreements" ("OBF agreements") that were "based on agreed priorities" and "reflected the growing maturity of divisions, both from the perspective of governmental and divisional members." The shift from infrastructure and project-based grants to outcomes-based funding appears to have been made in an attempt to reduce delays in funds being paid to divisions and, importantly, in order to introduce greater accountability for divisions' use of government funds.[28] In short, OBF agreements enabled the Department to exercise more effective control over divisions' operations, albeit generally leaving them to determine how to achieve the aims set out in the agreements. Thus, by 1998, one year after the implementation of this change in the funding mechanism, the Department stated[29] that "Divisions are now more realistically fulfilling the original aim of the Divisions of General Practice Program, that is: 'to improve health outcomes for patients by encouraging general practitioners to work together and link with other health professionals to upgrade the quality of health service delivery at the local level.' " That this was the result of the change in funding policy is unsurprising, given that funding pursuant to OBF agreements is made available only for the purposes of enabling divisions to meet aims that have been "vetted" or approved by the Department and which are set out in specific financial, business and strategic plans that are annexed to the funding agreement. Continued funding by government under such agreements is linked to the satisfactory achievement by the divisions of the objectives stated therein. Put another way, OBF agreements are executed by the government only if a division's indicated "outcomes" are "in keeping with the Current Aims of the DGPP."[30] Thus, as Steven Sant, the Division's Chief Executive Officer, said in his evidence before the Tribunal, in providing block grants to divisions the government stipulates broad "outcome indicators" and tells them, effectively, "You will do a variety of things that will meet these outcomes." In short, divisions are funded by government in order to give effect to government policy.
Government relationship with Central Bayside
18 The Division was established in 1993, by which time divisions were clearly within the purview of the Commonwealth government's health policy and in receipt of infrastructure and project-based grants from the Department of Health and Ageing. Indeed, it is reasonable to assume that the appellant was established using Commonwealth funding. Since the shift in government funding policy in 1996-97, as outlined above, the Division has received nearly all its funds by way of government grants. Approximately 43 per cent of the funds came to it pursuant to the OBF agreements that it executed with the Department. The bulk of the remaining funds also came from the government. Through the OBF agreements (in combination with project-specific grants), the government exercises effective control over the Division's operation and activities in a number of ways, importantly, as part of its national health strategy. As I have said, funding is provided on the basis that the Division will meet objectives set by government policy. Furthermore, under the OBF agreement, the Division is accountable to the Department for the use of grant moneys and is required to report to it every six months, in a prescribed manner, regarding its progress towards achieving stated "outcomes" and concerning its financial position. The agreement also contemplates that the Department's officers will monitor and supervise the operation of the Division and requires it to provide to such officers access to its premises and to permit them to inspect and copy materials pertaining to its operations in relation to the approved budget and business plan. If the Department concludes, on a reasonable basis, that the Division has spent the funds otherwise than in accordance with the agreement it has the right to require the Division to repay them. The Division is also prohibited from sub-contracting any of the work for which the government provides funding without the Department's approval and the government has the right to terminate the agreement before its expiration or to reduce the scope of the Division's funded activities.
19 That the government has assumed responsibility for the establishment and operation of this and other divisions is also reflected in the statement in General Practice: 2000 that in 1997 there was a "devolution of contract management of [Divisions] to State Offices of the [Department]", presumably consequent upon the establishment of State/Territory based "support structures" and the change to outcomes based funding arrangements. The assumption of such responsibility is also evidenced by the letter dated 14 September 2001 from the Department's Director of Health Strategies to the divisions stating that, in contemplation of the renewal of a three-year OBF agreement with the divisions, the Department was conducting an internal review of "the outcomes it would like to see Divisions focus on". The letter notes that "first quarterly payment ... will be contingent upon State/Territory Office approval of draft strategic business plan and a draft budget and the subsequent signing of a new Funding Agreement." Most strikingly perhaps, in October 2002, the Government announced a five month review of the divisions' operations, with the then Minister for Health and Ageing stating that the review would make recommendations to government as to the size, number, governance arrangements, future role and future funding of divisions across Australia. Although not determinative of the issue, it seems clear enough that the Department considers that it has the ultimate control over the direction and continued operation of divisions.
20 Despite the Division's objects being of public benefit, it is apparent from the material that it carries out its functions in order to discharge the responsibility assumed by government to support and ensure the provision of efficient, integrated, quality local health care. The functions performed by divisions fall clearly within the purview of governmental functions, albeit not solely performed by government and, moreover, the government has assumed responsibility for the establishment, direction, funding and control of divisions, not through statute, but through policy and its choice of funding mechanism.
Division not a charity
21 Although, on the face of things, and in light of the Tribunal's relevant finding to which reference has been made, the purposes and objects of the Division can be regarded as falling within the fourth head of Pemsel's case_,_ and whilst the government does not control the Division in terms of determining the composition of its governing body or controlling its day-to-day operations, it is plain enough, as I have said, that it has assumed responsibility, on the national level, for developing the role of general practitioners in providing health care services through the divisions. It has also been noted that, through the use of OBF agreements, the government has relevantly controlled the critical standards and outcomes that must be achieved by the divisions. It is true that, in theory, the Division can decline to accept Commonwealth funds and, thus, be free to pursue its objects independently of Commonwealth control or influence - other than being subjected to laws and regulations as all bodies are - but the reality is that each division is now part of a national operation, such that the lack of Commonwealth funds would, at best, result in a reversion back to the pre-1992 situation. This would clearly be a retrograde step in terms of health care delivery and is not one that any division is likely to take in the interests of its members or the public. To my mind, looking at the facts applicable to this situation, the circumstances are relevantly removed from one where the government provides funding to a non-profit institution, such as an aged care facility operated by a church, and, in return, requires that it meet certain regulatory and accountability standards laid down by it. Similarly, the Division is relevantly unlike public universities, notwithstanding that they are heavily funded by the Commonwealth government on condition that they comply with its many strict guidelines relating to their governance, financial and academic activities. Despite the fact that the government is able to dictate to public universities on such important matters, they conduct their core activities "untainted" by government control so that one could not properly say that they perform the work or function of government. In the case of the Division, however, its core activities are performed pursuant to the dictates of government, as has been explained. Its situation is, therefore, materially different from that of a government-funded aged care facility or public university or a body such as the corporations which were considered in Alice Springs Town Council.
22 As Barwick, C.J. said in The Incorporated Council of Law Reporting of the State of Queensland v. The Commissioner of Taxation of the Commonwealth of Australia[31] "... in the long run ... it is a matter of judgment whether the trust or purpose fairly falls within the equity, or as it is sometimes said, 'within the spirit and intendment' of the preamble to the Charitable Uses Act 1601 ...". I consider that it is also a matter of judgment whether, on a proper characterisation of the facts and circumstances in this
case, the Division performs the work or function of government. For reasons I have given, I consider that the learned judge below did not err in exercising his judgment in that regard. In the circumstances, I would dismiss the appeal.