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13 Feb 2018

BY PROFESSOR ROBYN LANGHAM, MEDICAL PRACTICE COMMITTEE

Should doctors be tested for their fitness to practise on a regular basis? What factors increase the risk of poor clinical performance? How should doctors with multiple substantiated complaints be managed in the long term?

These are just some of the thorny questions the Medical Board of Australia and, as a consequence, the AMA have been grappling with over the last two years as part of an investigation into whether Australia should adopt a system of ‘revalidation’ similar to that currently operating in the United Kingdom.

The AMA has argued strongly against introduction of the UK model, a model which has proven to be onerous, costly and complex, and undertaken by every single registered medical practitioner on a five yearly basis. The AMA has also advocated strongly against the Medical Board’s original revalidation proposal which we considered was too heavy handed and problematic.

While recognising the value of introducing extra measures to improve patient safety, the AMA has urged instead the adoption of an approach that builds on the many systems already in place that support doctors in delivering high quality care. Australian doctors already practise in a highly regulated environment.

Late last year, after a lengthy consultation process, the Medical Board announced it had designed a new Professional Performance Framework aimed at ensuring: “that all registered medical practitioners practise competently and ethically throughout their working lives”. The Framework replaces the Board’s original revalidation proposal.

This Framework is made up of five components. 

  • The current continuing professional development (CPD) system will be strengthened. This will require doctors to complete at least 50 hours of CPD per year relevant to their scope of practice, and nominating a CPD ‘home’ of one of the Specialty Colleges, which will then have responsibility to report to the Medical Board if CPD requirements are not met;
  • Doctors at most risk of poor performance will be identified and strategies put in place to manage them. For example, increasing age is a known risk factor, so three yearly peer review and health checks are proposed for doctors aged 70 and over who are still providing clinical care. Importantly, the Medical Board will not be party to any of the data from peer review and health checks unless there is a serious risk identified to patients;
  • Doctors with multiple substantiated complaints will be proactively managed including via the introduction of a formal peer review of performance;
  • The Board will revise and update registration standards and the code of conduct; and
  • The Board will work in partnership with the profession on strategies to further promote a positive culture focusing on patient safety, respect and ongoing improvement.

The Framework will be implemented progressively, with some components such as CPD already largely in place, and other components such as the regular review of doctors aged 70 and over needing further consultation and development.

The AMA recognises that doctors over the age of 70 make a strong contribution to clinical care in our community, but like other potentially high risk professions, it is an opportune time to establish a process to review a person’s continuing ability to provide care at that age.

However, the AMA, with the advice of the Medical Practice Committee, will be considering how health and screening checks of older doctors would be best implemented to ensure they are fair and consistent.

The AMA is also concerned about how the Medical Board will obtain data on an individual doctor’s performance in order to manage high risk individuals. For example, we oppose open data sharing between medical defence organisations and the Board.

We look forward to working with the Medical Board to ensure the implementation of this Framework is well considered and provides the best outcomes for doctors and their patients.

Full details of the new Professional Performance Framework and its consultation and implementation timeframe are on the Board’s website.

I encourage AMA members to provide their views on these issues to president@ama.com.au. Your comments will help inform AMA advice.


Published: 13 Feb 2018