May 2014

• Chair’s message
• Consultation
• Accreditation
• News and alerts
• Panel, court and tribunal decisions

Chair's message

Australia's health ministers have announced the terms of reference for the review of the National Registration and Accreditation Scheme. In March 2008, when Commonwealth and state and territory governments all signed the agreement which underpins the scheme, they agreed that it should be reviewed after three years of operation. The review will be conducted independently of AHPRA and the National Boards. It will examine whether the scheme is meeting the objectives set out in the National Law and will consider benefits and costs.

There are few projects that deliver a key achievement on the day they commence. National registration for doctors, nurses and midwives, dentists, pharmacists and six other health professions became a reality from day one. Other aspects of the scheme took longer to establish and some are still developing and improving. In addition to workforce mobility, the two major objectives are to protect the public by ensuring that only practitioners who are suitably trained are registered and to facilitate access to health services in the public interest. The scheme is funded by practitioners' annual registration fees.

Accountability is one of the guiding principles in the legislation governing the scheme. We welcome this opportunity to reflect on what has been delivered, what is working well, what needs further work and whether the benefits are proportionate to the costs of the scheme.  

Dr Joanna Flynn AM
Chair, Medical Board of Australia

Consultation

Give us your feedback on core registration standards

The Medical Board is consulting on revised draft registration standards that set requirements for:

• professional indemnity insurance arrangements for registered medical practitioners
• continuing professional development for registered medical practitioners, and
• recency of practice – the nature, extent, period and recency of any previous practice of the profession by applicants for registration.

The Board has not proposed major changes and the draft standards are broadly similar to the current registration standards. The proposed changes reflect feedback from stakeholders and what we have learned from the first four years of operating the National Scheme. The language in the revised registration standards has been simplified and the standards restructured to make them clearer.

Feedback

Please provide written submissions by email, marked ‘Consultation – Core registration standards’ to medboardconsultation@ahpra.gov.au by close of business on 30 June 2014.

In the interests of transparency, we will generally publish submissions on our website. You can read more about our consultation process here.

So we can publish your submission on our website, please attach it to your email as a Word document so we can meet international web accessibility guidelines.

Address submissions mailed by post to the Executive Officer, Medical, AHPRA, GPO Box 9958, Melbourne, VIC 3001.

Summary of the standards

The Board’s consultation paper can be found on the Current Consultations page.

It is helpful for us if you read the revised registration standards in their entirety, particularly if you are giving us feedback. We have provided brief summaries in this Update to give readers a sense of the content of the standards.

Professional indemnity insurance (PII)

The revised registration standard does not change the current requirements for professional indemnity insurance.

If you are a registered medical practitioner who is practising, make sure that you are insured or indemnified for each context in which you practise. This applies to all practice contexts, including private and public practice, self-employed practitioners, those employed by others or working in an unpaid or volunteer capacity.

The proposed registration standard lists exemptions. These include practitioners whose practice does not include providing health care or medical opinion about the physical or mental health of any person or when a practitioner is practising exclusively overseas.

Continuing professional development (CPD)

The requirements for CPD are different for different types of registration.

The revised registration standard does not change the CPD requirements for medical practitioners with general or specialist registration. It proposes to align the Board’s expectations of international medical graduates (IMGs) for CPD with its expectations of most other practitioners. Specifically, the draft standard proposes that IMGs with limited registration or provisional registration meet an equivalent CPD standard to medical practitioners with general registration.

Summary of the proposed CPD standard:

1. Medical practitioners who have specialist registration must meet the requirements for CPD set by the relevant specialist medical college for every specialty in which they hold specialist registration.
2. Medical practitioners who are Australian or New Zealand medical graduates and have provisional registration to undertake an accredited intern year must participate in the supervised training and education programs associated with their position.
3. Medical practitioners who are international medical graduates and have provisional registration must:
   • participate in the supervised training and education programs associated with their position, or
   • complete a minimum of 50 hours of CPD per year, if they are not in an accredited intern position.
4. Medical practitioners who have general registration and are college vocational trainees must participate in the supervised training and education programs associated with their position.
5. Medical practitioners who have limited registration for postgraduate training or supervised practice, limited registration for area of need, limited registration for teaching or research or limited registration in the public interest must:
   • complete CPD activities as agreed in their supervision plan, and
   • complete a minimum of 50 hours of CPD per year (i.e. if their CPD activities agreed in their supervision plan total less than 50 hours, additional CPD activities must be completed to reach a minimum of 50 hours).
6. Medical practitioners who have limited registration (public interest–occasional practice) must complete a minimum of 10 hours CPD per year focused on the particular nature of their practice; for example, therapeutics.
7. Medical practitioners who have general registration and do not have specialist registration:
   • must complete a minimum of 50 hours of CPD per year, and
   • may choose a self-directed program which must include practice-based reflective elements such as clinical audit, peer review or performance appraisal, as well as participation in activities to enhance knowledge, such as courses, conferences and online learning.

Recency of practice – the nature, extent, period and recency of any previous practice of the profession by applicants for registration

This proposed registration standard introduces a minimum number of hours of recent practice, with flexibility in how this is completed. The standard is otherwise unchanged.

The proposed registration standard requires medical practitioners to practise within their scope of practice at any time for a minimum total of:

• four weeks equivalent full-time (minimum 38-hour week) in one registration period, or
• 12 weeks equivalent full-time (minimum 38-hour week) over three consecutive registration periods.

The standard also provides information for medical practitioners with non-practising registration or who are not registered and wish to return to practice (including international medical graduates), and for medical practitioners who are changing their scope of practice.

Approval process

The Board will consider all submissions and then revise the proposed standards as needed. It will then submit the proposed standards to the Australian Health Workforce Ministerial Council (Ministerial Council). The new standards will take effect after the Ministerial Council approves them.

Give us your feedback on registration standards for limited registration

The Medical Board is consulting on revised draft registration standards for:

• limited registration for postgraduate training or supervised practice
• limited registration for area of need
• limited registration for teaching or research, and
• limited registration in public interest.

The Board can grant limited registration to international medical graduates (IMGs) who do not hold an approved qualification for general or specialist registration. Limited registration allows IMGs to practise for specific purposes under supervision in Board-approved positions.

These registration standards set out the Board’s requirements for an initial application for, and renewal of, each type of limited registration.

The Board has not proposed major changes and the draft registration standards are broadly similar to the current registration standards. The proposed changes reflect feedback from stakeholders and what we have learned from the first four years of operating the National Scheme. The language in the revised registration standards has been simplified and the standards restructured to make them clearer.

Feedback

Please provide written submissions by email, marked ‘Consultation – Limited registration standards and draft guidelines on short-term training in a medical specialty pathway’ to medboardconsultation@ahpra.gov.au by close of business on 30 June 2014.

In the interests of transparency, we will generally publish submissions on our website. You can read more about our consultation process here.

So we can publish your submission on our website, please attach it to your email it as a Word document so we can meet international web accessibility guidelines.

Address submissions mailed by post to the Executive Officer, Medical, AHPRA, GPO Box 9958, Melbourne, VIC 3001.

Give us your feedback on guidelines for short-term training in a medical specialty

Internationally qualified specialists or specialists-in-training who are not qualified for general or specialist registration can receive training in a specialty in Australia. This pathway to registration was set up as part of the 2006 Council of Australian Government initiative to establish a national assessment process for overseas-qualified doctors.

The Board has developed draft guidelines on short-term training in a medical specialty for international medical graduates who are not qualified for general or specialist registration. The draft guidelines aim to make clear:

• the requirements and processes for registration for applicants who are not qualified for general or specialist registration seeking to undertake short-term training in a medical specialty, and
• the roles and responsibilities of the Board and the specialist medical colleges in the assessment and registration of applicants seeking to undertake short-term training in a medical specialty.

Feedback

Please provide written submissions by email, marked ‘Consultation – Limited registration standards and draft guidelines on short-term training in a medical specialty pathway’ to medboardconsultation@ahpra.gov.au by close of business on 30 June 2014.

In the interests of transparency, we will generally publish submissions on our website. You can read more about our consultation process here.

So we can publish your submission on our website, please attach it to your email it as a Word document so we can meet international web accessibility guidelines.

Address submissions mailed by post to the Executive Officer, Medical, AHPRA, GPO Box 9958, Melbourne, VIC 3001.  

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Accreditation

Royal Australian College of General Practitioners

After receiving accreditation advice from the Australian Medical Council, the Board approved:

• the accredited quality improvement and continuing professional development program in the recognised specialty of general practice leading to fellowship of the Royal Australian College of General Practitioners (RACGP), and
• the following training programs in the recognised specialty of general practice leading to fellowship of the Royal Australian College of General Practitioners (RACGP) as providing a qualification for the purposes of specialist registration until 31 December 2019:
  • Vocational Training Pathway
  • General Practice Experience (Practice Eligible) Pathway, and
  • Specialist Pathway Program.

University of New South Wales

After receiving accreditation advice from the Australian Medical Council, the Board approved the following accredited programs of study as providing a qualification for the purpose of registration until 31 March 2020:

1. Bachelor of Medical Studies and Doctor of Medicine
2. Bachelor of Medicine/Bachelor of Surgery (four-year degree) 
3. Bachelor of Medicine/Bachelor of Surgery (six-year degree), and
4. Doctor of Medicine.

One of the objectives of the National Law is to facilitate the provision of high quality education and training of health practitioners. The accreditation function is the primary way of achieving this. More information is published on our Accreditation page.

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News and alerts

Ministers announce the review of the National Registration and Accreditation Scheme

Australia’s health ministers have announced the terms of reference for the scheduled review of the National Registration and Accreditation Scheme (the National Scheme). The review – to be led by independent reviewer, Mr Kim Snowball – was built into the intergovernmental agreement that set up the framework and governance arrangements for the National Scheme. The agreement stated that the Australian Health Workforce Ministerial Council (Ministerial Council) will initiate an independent review after three years of the National Scheme’s operation.

The terms of reference for the review are published at Australian Health Ministers’ Advisory Council website under ‘media releases’ on the right-hand tab.

The independent reviewer, Mr Snowball, has held a variety of senior leadership roles in both the public and private health sectors. He was previously the Director General of WA Health and has also served as the Chair of the Australian Health Ministers’ Advisory Council (AHMAC).

The Board will be participating actively in the review process and will keep stakeholders informed of opportunities to provide comment and consultation timelines.

Advertising guidelines updated

The Medical Board and other National Boards have acted on the feedback they received about the Guidelines for advertising regulated health services (Advertising guidelines) released in March, and published updated versions on their websites.

The guidelines were edited to make them clearer, particularly that:

• under the National Law, testimonials are not allowed when advertising a regulated health service
• the obligations of the National Law about advertising only apply when a regulated health service is being advertised, and
• the National Law is not intended to stop members of the community and patients from discussing their experiences online or in person.

For more information and a link to the guidelines, visit the News page on our website.

From the SA Coroner

On 14 February 2014, the South Australian Deputy State Coroner (DSC) delivered her findings into the deaths of John William Ryan and Patricia Dawn Walton. The DSC found that:

• Mr Ryan had died as a result of hypoxic-ischaemic encephalopathy following ventilator failure and cardiac arrest in the context of morbid obesity and opiate medication, complicating post-operative recovery from ankle arthrodesis.
• Ms Walton had died as a result of hypoxic-ischaemic encephalopathy following cardiac arrest after developing cardiac syndrome precipitated by myocardial ischaemia as a consequence of uncontrolled hypertension, fluid overload, ongoing pain and coronary artery disease following left total hip replacement.

The findings are available on the Courts Administration Authority of South Australia website.

The DSC made a number of recommendations, including the following that are directed at the Board and medical practitioners:

1. That the Medical Board of Australia, the Australian Medical Association, the Australian Medical Council, the Australian College of Nursing and Australian Nursing Schools attempt to raise awareness amongst medical practitioners and nurses about the inherent risks of post-operative respiratory depression occurring in obese patients in particular, who may or may not have a diagnosis of sleep apnoea and who are receiving, or have received, opioid analgesia; 
2. That the Medical Board of Australia consider formulating a code of conduct which stipulates that medical practitioners who practise preferentially in a facility in which they have a financial interest, should disclose that fact to the patient appropriately and specifically raise the issue concerning suitability of that facility with other specialists to whom they refer the patient for pre-admission assessment.

The Board has issued guidance in Good medical practice on how to manage conflicts of interest and financial and commercial dealings at 8.11 and 8.12 respectively. View the document on the Code of conduct page. 

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Panel, court and tribunal decisions

Panel, court and tribunal decisions published online

AHPRA on behalf of the 14 National Boards publishes a record of panel, court and tribunal decisions about registered health practitioners. Summaries are published when there is clinical and educational value.

Court and tribunal decisions

Under the National Law, the Board must refer a matter about a registered medical practitioner or student to a tribunal if the Board reasonably believes that the practitioner has behaved in a way that constitutes professional misconduct; or the practitioner’s registration was improperly obtained because the Board was given false or misleading information. The Board must also refer the matter to a tribunal if a panel established by the Board requires the Board to do so.

Medical practitioners may also appeal certain decisions of the Board to a tribunal, or court.

AHPRA publishes summaries of selected tribunal or court cases from time to time. These can be sourced at Publications>Tribunal decisions on the AHPRA website. A full library of published hearing decisions from tribunals or courts relating to complaints and notifications made about health practitioners or students is available on the Austlii website.

Panel hearings

When investigating a notification, state and territory committees of the Medical Board of Australia 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. Summaries have been provided when there is educational and clinical value. These summaries are accessible from hyperlinks within the table. Practitioners' names are not published, consistent with the requirements of the National Law. This table does not include summaries of panel decisions made under previous legislation, even if these were held after July 2010.

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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 Joanna Flynn AM, 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.

Comment on the Board newsletter is welcome and should be sent 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).

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