November 2017

Update Medical Board of Australia

Chair’s message

This week the Medical Board has released a Professional Performance Framework, designed for patient safety. We believe it is a fair and practical approach to ensure that all doctors in Australia practise safely. Surveys in Australia repeatedly show that patients trust their doctors. Trust is precious and each medical practitioner has a role in building and preserving it. This trust is based on community confidence that doctors will keep their knowledge and skills up to date and practise ethically and safely throughout their working lives. The Professional Performance Framework will support doctors to take responsibility for their own performance and encourage the profession collectively to raise professional standards and build a positive, respectful culture in medicine that benefits patients and doctors. We look forward to working with the profession and the community as we build and implement it.

Dr Joanna Flynn AM
Chair, Medical Board of Australia

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Professional Performance Framework

New Professional Performance Framework released by the Board

The community in Australia has high levels of trust in doctors and expects medical practitioners to provide safe care to patients. The Medical Board of Australia has designed a Professional Performance Framework to ensure that all registered medical practitioners practise competently and ethically throughout their working lives. The Professional Performance Framework is the term that the Board is using to describe the process that it had previously called ‘revalidation’.

The Professional Performance Framework will support doctors to take responsibility for their own performance and encourage the profession collectively to raise professional standards and build a positive, respectful culture in medicine that benefits patients and doctors.

The Professional Performance Framework has five pillars:

  1. Strengthened continuing professional development (CPD) requirements.
  2. Active assurance of safe practice.
  3. Strengthened assessment and management of medical practitioners with multiple substantiated complaints.
  4. Regularly updated professional standards that support good medical practice.
  5. Collaborations to foster a positive culture of medicine that is focused on patient safety, based on respect and encourages doctors to take care of their own health and wellbeing.

The Professional Performance Framework will be implemented progressively and over time. The Board will consult with stakeholders about the components of the framework.

The final report of the Expert Advisory Group on revalidation

The Board has previously announced that it is committed to developing a process that supports medical practitioners to maintain and enhance their professional skills and knowledge and remain fit to practise medicine. It used the term ‘revalidation’ for this process and appointed an Expert Advisory Group (EAG) to provide it with expert advice.

The EAG, chaired by Professor Elizabeth Farmer, has delivered its final report. The Professional Performance Framework is the Board’s response to that report.

The EAG’s recommendations are designed to improve public safety. Their approach recommends:

  • maintaining and enhancing the performance of all doctors practising in Australia through efficient, effective, contemporary, evidence-based CPD relevant to their scope of practice, and
  • proactively identifying doctors who are either performing poorly or are at risk of performing poorly, assessing their performance and if necessary, supporting their remediation. The EAG identified that age, professional isolation and multiple complaints are all risk factors for poor performance.

The Board has accepted the evidence provided by the EAG and its recommendations, including to not adopt the term ‘revalidation’, as this does not accurately describe the Board’s approach.

The Professional Performance Framework

The Board’s Professional Performance Framework is evidence-based, integrated and builds on existing initiatives. It will be implemented progressively, with some elements already in place and others requiring significant planning, consultation and development.

Under the five pillars of the Professional Performance Framework:

  1. Strengthened CPD includes practitioners having a ‘CPD home’, participating in its CPD program and completing at least 50 hours of CPD per year relevant to their scope of practice that includes reviewing their performance, measuring their outcomes and educational activities.

  2. Active assurance of safe practice involves identifying practitioners at risk of poor performance and managing that risk.
    The EAG has identified increasing age and professional isolation as risk factors for poor performance.

    The Board is proposing to require practitioners who provide clinical care to have peer reviews and health checks at the age of 70 and three yearly thereafter. The outcome of health checks and peer reviews will not be reported to the Board unless there is serious risk to patients.

    The EAG also identified professional isolation as a risk factor. The Board plans to provide guidance to help practitioners identify the hallmarks of professional isolation and manage the risk from it, including by increasing peer review in their CPD.

  3. Strengthened assessment and management of medical practitioners with multiple substantiated complaints includes formal peer review of performance for practitioners with multiple substantiated complaints.

  4. Regularly updated professional standards that support good medical practice includes a revised Code of conduct, as well as revised and new registration standards.

  5. Collaborations to foster a positive culture of medicine that is focused on patient safety, based on respect and encourages doctors to take care of their own health and wellbeing. This includes the Board working with the profession and others to reshape the culture of medicine and build a culture of respect. It also includes encouraging doctors to take care of their own health and wellbeing and to support their colleagues; and urging governments and other holders of large data to make it accessible to individual practitioners to support practice improvements.

Implementation

There is a lot of work to be done before the Professional Performance Framework is implemented. While many of the elements are in place already or only require fine tuning, others will require more substantial work. The Board is committed to working in partnership with the medical profession and others in the health sector to implement the Professional Performance Framework. It is also committed to ongoing consultation about the various elements.

We will keep the profession informed of the next steps.

More information

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Revised registration standards for specialists and AMC certificate holders

Revised registration standards take effect in February 2018

Two revised registration standards take effect on 15 February 2018. One applies to applicants for specialist registration and the other to AMC certificate holders seeking general registration.

Revised standard for specialist registration

The revised registration standard for specialist registration takes effect from 15 February 2018.

The revised standard applies to everyone who is applying for specialist registration. It does not change the current requirements for specialist registration but has been reformatted and reworded to make it clearer.

The Australian Health Workforce Ministerial Council approved the revised standard on 1 September 2017.

Revised standard for granting general registration to medical practitioners who hold an Australian Medical Council certificate

The revised standard for Granting general registration to medical practitioners who hold an Australian Medical Council certificate takes effect from 15 February 2018.

It applies to international medical graduates who hold an Australian Medical Council (AMC) certificate and have successfully completed the required supervised practice in Australia to be eligible for general registration.

The revised standard does not change the current requirements for general registration for AMC certificate holders. Applicants for general registration are expected to demonstrate that they are performing at least at the standard of an Australian intern at the end of intern training. The revised standard makes this clearer by requiring that AMC certificate holders demonstrate they have achieved the learning outcomes defined in the AMC’s guidance Intern training – Intern outcome statements.

The revised standard has also been reformatted and reworded to make it clearer.

The Australian Health Workforce Ministerial Council approved the revised standard on 1 September 2017.

The revised registration standards are available on the Board’s website.

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Annual report published

2016/17 annual report now available

The 2016/17 annual report of AHPRA and the national health practitioner boards has been published.

The annual report is a comprehensive record of the National Registration and Accreditation Scheme for the 12 months ending 30 June 2017.

During the year, the Medical Board re-examined how it triages and responds to complaints so regulatory effort is targeted and proportionate. It also investigated ways to make sure that all doctors in Australia keep their knowledge and skills up to date.

These changes are being progressively applied to improve our work.

Other highlights include:

  • More registered doctors: Medical practitioners made up 16.4% of all health practitioners registered nationally (111,166 individual registered medical practitioners in 2016/17; up from 107,179 in 2015/16).
  • Medical students on the register: On 30 June 2017, there were 20,057 medical students, an increase of 1.5% from 2015/16.
  • Complaints received about medical practitioners: There were 3,617 notifications (complaints or concerns) lodged with AHPRA about medical practitioners in 2016/17, an increase of 14.9% (from 3,147) in the previous year.
  • Of 3,557 matters closed in 2016/17, less than 25% led to further regulatory action. 7.3% of matters closed resulted in the Board accepting an undertaking or conditions being imposed on the practitioners’ registration; 11% resulted in a caution or reprimand; 0.6% resulted in cancellation or suspension of registration.
  • In 76.3% of matters, no further regulatory action was taken: The Board takes no further action when, based on the available information, there is no risk to the public that needs to be managed.
  • Statutory offences by medical practitioners: 273 new complaints were made this year relating to possible statutory offences by medical practitioners. More than half of these (164) related to advertising breaches, while misuse of a protected title was alleged 97 times. AHPRA and the Board closed 283 statutory offence matters in 2016/17.
  • Immediate action was taken 102 times: The Board takes immediate action to restrict or suspend the registration of a medical practitioner as an interim measure to protect the public while notifications are being investigated.
  • Active monitoring cases on 30 June 2017: The health, performance and/or conduct of 1,000 medical practitioners was monitored during the year.

The 2016/17 annual report, along with supplementary tables that provide data about registrations, notifications, statutory offences, tribunals and appeals, and monitoring and compliance, is available on the annual report page of the AHPRA website.

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Compounded medicines

Joint Medical and Pharmacy Boards' statement on compounded medicines

The Pharmacy Board of Australia and Medical Board of Australia have released a joint statement describing good practice when prescribing and dispensing compounded medicines.

A compounded medicine may be a suitable treatment option for some patients if, for example, they have an allergy or sensitivity to an excipient (such as a preservative) in a ready-prepared commercial product or they require a different dose due to difficulty in swallowing.

Compounded medicines are not subject to the same rigorous assessment for product efficacy, quality and safety by the Therapeutic Goods Administration (TGA) as medicines listed on the Australian Register of Therapeutic Goods (ARTG). It is therefore important that practitioners exercise good practice when prescribing and dispensing compounded medicines.

Medical practitioners who prescribe these medicines and pharmacists who dispense these medicines should review the joint statement and consider their responsibility to keep patients safe.

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Latest tribunal decisions

Recent decisions have been published online

There are important lessons for registered medical practitioners from tribunal decisions. The Medical Board of Australia (the Board) refers the most serious concerns about medical practitioners to tribunals in each state and territory. Cases published recently have included:

  • a psychiatrist has been permanently disqualified from applying for registration for engaging in sexual relations with three vulnerable patients (Medical Board of Australia v Kent

  • a medical practitioner has been reprimanded and suspended after conviction for unlawful and indecent assault (Medical Board of Australia v Mir)  

Publication of panel, court and tribunal decisions

The Australian Health Practitioner Regulation Agency (AHPRA), on behalf of the 14 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 Law1, 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 requirements of the National Law.

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

In NSW and Queensland, different arrangements are in place. More information is available on AHPRA’s website on the Make a complaint page.


1The Health Practitioner Regulation National Law, as in force in each state and territory

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Alerts

New RACGP guide on prescribing opioids

The Royal Australian College of General Practitioners (RACGP) has released a new guide for general practitioners on prescribing opioids.

This guide is the third in a series by RACGP about prescribing drugs of dependence in general practice. The first was a clinical governance framework for prescribing drugs of dependence in general practice which provides practices with principles, strategies and tools in relation to prescribing drugs of dependence. The second was a guide on prescribing benzodiazepines.

The guides are available on the RACGP website.

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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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Page reviewed 22/05/2018