June 2024

In this month's issue:

• Chair’s message
• Medical Board of Australia news
  • Consultation open on standard to unlock SIMG reforms
  • Medical, Nursing and Midwifery and Pharmacy Boards’ joint statement on professional responsibilities for prescribing and dispensing
  • Got a CPD home for your 2024 CPD? If not, you need to get one soon
  • Avoid treating family and friends
  • Latest registration data published
• News and alerts
  • Myths and misconceptions about notifications – getting the help you need
  • Greater protections for patients in Western Australia as National Law changes are enacted
• Medical regulation at work
  • Latest tribunal decisions published
• Contacting the Board

Chair’s message

Reforms are underway to streamline pathways to specialist registration and help ease Australia’s medical workforce pressures. The specialist registration standard is a key lever for reforms and the revised specialist registration standard is open for comment. Governments have set ambitious timelines for these reforms. If you’re interested, please join our public consultation and share your thoughts by 3 July.

Dr Anne Tonkin AO
Chair, Medical Board of Australia

Medical Board of Australia news

Consultation open on standard to unlock SIMG reforms

Tell us what you think about proposed regulatory changes designed to unlock reforms to get more internationally qualified medical specialists practising safely in Australia.

The Board has launched a consultation on a draft revised Registration standard for specialist registration.

Consultation timelines are compressed to meet reform deadlines set by Australia’s health ministers, so please share your feedback by 3 July 2024.

The registration standard is the regulatory tool that paves the way for the reforms, which include a fast-track pathway to specialist registration that aims to get more internationally qualified medical specialists seeing patients in Australia more quickly.

The fast-track pathway uses an existing provision in the National Law and will sit alongside the existing specialist medical college assessment system, which will remain in place for SIMGs who are not eligible for the expedited pathway.

The expedited pathway will recognise specific overseas specialist medical qualifications and grant upfront specialist registration to eligible doctors. Initial conditions on their registration will be imposed as a safeguard to protect patients while the new recruits are inducted into Australia’s healthcare system.

GPs, anaesthetists, obstetricians and gynaecologists, and psychiatrists are the priority specialties, with the fast-track pathway targeted to start in October 2024 for GPs and December 2024 for other priority medical specialties.

Proposed changes to the registration standard aim to maintain standards while making the pathways to specialist registration clearer, establishing the expedited pathway, removing outdated regulatory barriers and improving workforce flexibility.

Setting up the fast-track pathway is a key component in work by the Board and Ahpra to implement relevant recommendations flowing from the Overseas Health Practitioner Regulatory Settings Review - Final Report, 2023 by Ms Robyn Kruk AO (the Kruk Review).

Ahpra and the Board have set up a taskforce to develop the new expedited pathway and the Board is consulting with the specialist colleges for the priority medical specialities to finalise the list of qualifications that will be the gateway to fast-track registration.

We encourage all agencies and individuals involved in recruiting and employing SIMGs to take part in the consultation.

The consultation paper supporting the draft revised Registration standard for specialist registration is published on the Board’s consultation page.

Medical, Nursing and Midwifery and Pharmacy Boards’ joint statement on professional responsibilities for prescribing and dispensing

We are concerned about practitioners practising in health services designed to provide customers with access to a predetermined medicine, which raises concerns that some may be putting profit ahead of patient welfare.

This statement reminds practitioners about their existing obligations and highlights how these responsibilities apply in the context of new models of care.

New models of healthcare, including the use of telehealth are important enablers of greater access to health services. Our concern is that some new models of care may take advantage of consumer demand for certain treatments and compromise good patient care.

It doesn’t matter what model of care is used to prescribe or dispense. The health practitioner prescribing or dispensing medicines remains responsible to deliver safe and appropriate care and for ensuring that their own practice meets the standard expected by their registration board and the community.

We urge health practitioners to think carefully before practising in any business, whether that be via a technology platform or in-person, that may not reflect the professional obligations in their respective codes of conduct.

The issue

Some emerging health service models that are disrupting the traditional therapeutic relationship between a patient and their practitioner have enabled the rapid rise in the prescription and use of specific medicines or products. Examples include businesses focusing on treatment for obesity, chronic pain and sleep disorders. Some of these models are focused on delivering a single treatment solely in response to patient demand. They often have a high volume of telemedicine consultations and/or computer or algorithm-based prescribing of medicines, and some businesses also offer direct supply of unapproved medicines to patients.

It is of concern that in some circumstances, practitioners delivering health services within these models of healthcare may be failing to meet the standards of good practice, with risks to patient safety that have the potential to cause significant harm.

These models present challenges to health practitioners including:

• a lack of evidence and clinical guidance to support safe prescribing of new medicines (for example, medicinal cannabis products)
• a lack of access to information about a patient to support safe prescribing, supply and usage of medicines (for example, in some states and territories real-time prescription monitoring that could alert a practitioner to patient history complexity, comorbidities or contraindicated medicines already prescribed), and
• practice frameworks set up to offer a single treatment or outcome (such as weight loss medication) in response to patient demand rather than clinical need, which may potentially compromise quality and continuity of care.

The Medical, Nursing and Midwifery and Pharmacy Boards of Australia and Ahpra are also aware of reports of potentially vulnerable practitioners, particularly inexperienced or early career practitioners, who are being misled that their practice is acceptable when it is not.

We urge health practitioners working in businesses with any of these problematic features to ensure that the framework for practice is consistent with their professional obligations.

Professional obligations when prescribing, compounding and dispensing

1. For prescribers, good care includes:
   
   1. Assessing the patient in a real-time interaction, taking into account the history, the patient’s views, an appropriate physical examination and any necessary investigations.
   2. Formulating and implementing a suitable management plan.
   3. Only recommending treatments when there is an identified therapeutic need and a reasonable expectation of clinical efficacy and benefit for the patient.


2. All practitioners have professional obligations to communicate effectively with patients and other treating practitioners to facilitate coordination and continuity of care. Working in collaboration requires authorised prescribers to be available when pharmacists need to discuss a patient’s therapy (including any issues in relation to prescription requirements).


3. A pharmacist can refuse to dispense and supply a prescribed medicine if they believe that it is not safe to do so, however, they must communicate their concerns to the prescriber and patient so that alternative options can be considered.


4. All health practitioners involved in prescribing and dispensing have individual legal and professional responsibilities when a compounded medicine is prescribed and subsequently dispensed.


5. A compounded medicine should only be prescribed by a medical or nurse practitioner and prepared by a pharmacist where it is clinically indicated and if:
   
   • an appropriate commercial product is unavailable, or
   • a commercial product is unsuitable, and
   • it is not prohibited by law.


6. As is the case for any commercial product, before a prescription for a compounded medicine is provided and the medicine is compounded and supplied, all practitioners must know and comply with the requirements of their state or territory drugs and poisons (or equivalent) legislation, and consider any relevant practice standards and guidelines.


7. Good care includes recognising and respecting the rights of patients or clients to make their own decisions which includes the right to know all the available options and choose where they wish to access prescribed medicines. Health practitioners must not enter into arrangements for exclusive supply of prescriptions from a health practitioner/prescriber or other third party, although pharmacists may offer to retain prescriptions for subsequent dispensing with the patient’s or client’s consent.


8. The Boards’ codes of conduct, standards of practice and guidelines also contain important guidance in relation to conflicts of interest. Patients rely on the independence and trustworthiness of their health practitioners for any advice or treatment. In the case of ‘closed loop prescribing’ where the prescriber and supplier of medication are not independent, there is an onus of responsibility on all health practitioners involved in care to ensure that they are working in the best interests of the patient.

Regardless of what model of care they use to prescribe or dispense, all health practitioners should be prepared to be able to explain to their Board how their practice meets their professional obligations to provide safe and appropriate health care.

Got a CPD home for your 2024 CPD? If not, you need to get one soon

You need a CPD home to log your 2024 CPD.

As we said in our email to all doctors last month, time is running out if you don’t yet have a CPD home.

There are 20 AMC-accredited CPD homes, including all specialist medical colleges and four non-college homes.

If you are doing a specialist college CPD program or have already joined one of the other AMC-accredited CPD homes and are doing CPD, you can ignore this reminder.

The list of CPD homes is published on the Medical Board's website – choose one that suits your scope of practice.

And to answer your questions about CPD:

• When you next renew your medical registration, you will need to tell us the name of your CPD home. You don’t need to log into the Ahpra practitioner portal to do this now.
• CPD requirements apply to the calendar year. You will need to complete 50 hours CPD between 1 January 2024 to 31 December 2024. You don’t have to finish your annual CPD by September when you renew. You just need to have joined a CPD home by then and started logging the CPD you’ve done so far.
• You can do your CPD with a specialist college or one of the other four approved and accredited homes, which are AMA’s Doctorportal learning, Osler, HETI, Skin Cancer College Australasia. Links to all the accredited homes are on our website. Contact the CPD home to join.
• If you’ve been doing your college CPD for years and intend to keep doing it, just tell us that your college is your CPD home when you renew your registration.
• You don’t have to do extra CPD, on top of your college CPD. Just do what the college requires and tell us which college is your CPD home when you renew your registration.
• Specialist trainees will be doing CPD through their college – just tell us when you renew your registration in September which college is your CPD home.
• If you have retired and are no longer working but still have your practising registration, you will have received our CPD reminder. You can choose whether to let your registration lapse or opt for non-practising registration when you get your renewal reminder in August. Either way, CPD requirements do not apply. But if you choose to renew your practising registration, like all practising doctors, you will need to meet all registration requirements and standards, including CPD.
• If you have retired from full-time practice but are continuing to provide patient care such as prescribing or referring, or occasional sessional/locum work, then you must retain full practising registration, have a CPD home and meet the CPD standard (and the recency of practice standard).
• If you are working overseas but still hold any type of practising registration in Australia (general, specialist, limited), you will need to meet the Medical Board of Australia's CPD requirements. You will need an accredited CPD home in Australia and to complete 50 hours of CPD. Ask your CPD home about which CPD you are doing overseas meets and counts towards Australian requirements. If you do not intend to practise in Australia, you can change to non-practising registration which does not require CPD.
• If you hold limited registration (for post-graduate training or supervised practice, area of need, teaching or research, or public interest (for more than four weeks)) you need to do CPD and have a CPD home. If you are a specialist IMG (working towards specialist registration), your home will be your specialist college. IMGs working towards general registration can join any home.

CPD exemptions:

• Interns (PGY1 doctors)
• PGY2 doctors participating in a PGY2 training program accredited by their state or territory postgraduate medical council (or equivalent), and/or working in supervised clinical practice positions in a hospital or general practice setting.
• IMGs with limited registration in the public interest, or limited registration for teaching or research (to demonstrate a procedure or participate in a workshop), who have been granted registration for four weeks or less, do NOT need to do CPD.
• If you are taking time off from practice (parental leave, illness, exceptional circumstances), you need to apply to your CPD home for an exemption. Your home will decide to exempt you or vary your CPD requirements.
• If you are taking time off from your specialist training, your college will let you know what CPD you need to do.

In case it helps, our recent email included a checklist for your 2024 CPD. See What do I need to do? on our website.

All CPD homes will report on whether or not you complied with CPD requirements to the Board each year. You also have to make a declaration about CPD when you renew your medical registration.

Avoid treating family and friends

The Board regularly receives notifications related to medical practitioners providing medical care to family members and to those close to them. We have received feedback, particularly from some older practitioners, that they have always done this and cannot see why it is a problem. However, treating family and those close to you is not considered good practice and is fraught with problems.

The Board’s code of conduct, Good medical practice: a code of conduct for doctors in Australia, sets out clear professional standards:

Whenever possible, doctors should avoid providing care to anyone with whom they have a close personal relationship (and) must not prescribe Schedule 8, psychotropic medication and/or drugs of dependence or perform elective surgery, such as cosmetic surgery, on anyone with whom they have a close personal relationship.

Here are some recent examples of treating family members:

• a GP prescribing benzodiazepines for their partner without the knowledge of the partner’s treating psychiatrist
• a GP prescribing oxycodone, diazepam and temazepam for their partner for years with no notes/medical record
• a GP treating their partner, children and parents for a range of acute and chronic conditions over a period of years
• a junior doctor (with general registration) prescribing codeine for a friend with chronic pain
• a paediatrician prescribing Ritalin for their son
• doctors prescribing Schedule 8 medication multiple times for a partner, child or parent.

In a recent case, a tribunal noted the risk of poor medical outcomes due to bias in treatment and investigation, and the practitioner being influenced by factors other than medical facts.

Tribunals have heard cases involving doctors providing medical care to their family and friends when it was not an emergency, and the patient could have accessed care from an independent practitioner.

There are risks when medical care does not include the usual checks, for example, when a comprehensive history is not taken or a physical assessment is not performed. Ad hoc prescriptions are often not documented or monitored, and continuity of care is missed.

Medical practitioners should not be their family member’s primary practitioner, must never prescribe Schedule 8 medications to family and should avoid treating family members except in an emergency.

Of course, doctors are free to advocate for and support family members with their healthcare needs.

Latest registration data published

The Board publishes data each quarter on the medical profession. Data are broken down by state and territory and registration type, and for specialists by specialty and field of specialty practice. Visit our Statistics page to view the latest report.

News and alerts

Myths and misconceptions about notifications – getting the help you need

This is the first article in a series of three on myths and misconceptions about notifications.

Too often, doctors struggle in silence when they are dealing with a physical health, mental health or drug and alcohol issue – or even just the day-to-day challenges of being a medical practitioner.

The best thing you can do – for yourself, for your family, and for your patients – is to seek help early and to actively engage in recommended treatments. This might be from your own GP, another health practitioner or from one of the independent support services available for medical practitioners that are funded by the Board via Drs4Drs.

There is a common misconception that if you seek help, your treating practitioner will automatically be required to report it to Ahpra and your registration may be affected. This is not the case.

The threshold for when treating practitioners need to make a mandatory notification about health is very high and only necessary when the public is at substantial risk of harm. The need for a mandatory notification to be made is not often met.

If you are managing your health and getting the help you need, you can usually continue to practise. The Board wants you to be healthy and safe to practise and encourages you to seek help early when you need support.

Greater protections for patients in Western Australia as National Law changes are enacted

Recent changes to the National Law have now been enacted in WA. The changes include protecting the title ‘surgeon’ and allowing Ahpra and the Board to issue a statement warning the public about individual practitioners, when there is a serious, unmanaged risk to public health and safety.

The Act brings Western Australia into greater alignment with the other states and territories.

There is more detail in the news item on the Ahpra website.

Medical regulation at work

Latest tribunal decisions published

There are important lessons in tribunal decisions about registered medical practitioners. The Medical Board of Australia refers the most serious concerns about medical practitioners to tribunals in each state and territory. Here are recently published decisions:

• a Victorian general practitioner has had his registration cancelled and has been disqualified from applying for registration until 2025 for his social media posts (Medical Board of Australia v Ellis)
• a Victorian medical practitioner has had his registration cancelled and has been disqualified from applying for registration for eight years for unnecessary and inappropriate physical contact with female patients (Medical Board of Australia v Hmood).

Publication of panel, court and tribunal decisions

Ahpra, on behalf of the 15 National Boards, publishes a record of panel, court and tribunal decisions about registered health practitioners.

When investigating a notification, the Medical Board may refer a medical practitioner to a health panel hearing, or a performance and professional standards panel hearing. Under the National Law, panel hearings are not open to the public. Ahpra publishes a record of panel hearing decisions made since July 2010. Practitioners’ names are not published, consistent with the National Law.

Summaries of tribunal and court cases are published on the Court and tribunal decisions page of the Ahpra website. The Board and Ahpra sometimes choose not to publish summaries, for example about cases involving practitioners with impairment.

In New South Wales and Queensland, different arrangements are in place. More information is available on Ahpra’s website on the How to raise a concern about a health practitioner page.

Contacting the Board

The Medical Board of Australia and Ahpra can be contacted by phone on 1300 419 495.

For more information, see the Medical Board of Australia website and the Ahpra website.

Lodge an enquiry form through the website under Contact us at the bottom of every web page.

Mail correspondence can be addressed to: Dr Anne Tonkin AO, Chair, Medical Board of Australia, GPO Box 9958, Melbourne, VIC 3001.

More information

Please note: Practitioners are responsible for keeping up to date with the Board’s expectations about their professional obligations. The Board publishes standards, codes and guidelines as well as alerts in its newsletter. If you unsubscribe from this newsletter you are still required to keep up to date with information published on the Board’s website.

Comments on the Board newsletter are welcome, send your feedback and suggestions to newsletters@ahpra.gov.au.

For registration enquiries or contact detail changes, call the Ahpra customer service team on 1300 419 495 (from within Australia).