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In this month's issue:
Real time doctor–patient consultations hold the key to safe prescribing. The Board’s updated telehealth guidelines embed telehealth as an ongoing feature of healthcare in Australia but close the gap that has emerged between online prescribing models and good medical practice. As well, the building blocks of our reforms to the cosmetic surgery industry are now in place. Higher standards and tougher advertising rules apply from July.
Dr Anne Tonkin AO Chair, Medical Board of Australia
Updated telehealth guidelines will close the gap that’s sprung up between online prescribing business models and good medical practice.
After consulting the community and the profession, we have issued revised telehealth guidelines that will take effect on 1 September 2023.
Under the updated guidelines:
Telehealth is here to stay. It plays an important role in healthcare in Australia and has opened up great opportunities to improve access to and delivery of care, including to rural and remote patients and people living with disadvantage.
The interaction between a doctor and their patient is an important element in all consultations, including telehealth consultations.
The standard of care provided in a telehealth consultation must be safe and as far as possible meet the same standards of care as provided in an in-person consultation.
But prescribing or providing healthcare for a patient without a real-time direct consultation, whether in-person, via video or telephone, is not good practice and is not supported by the Board.
The guidelines specify that:
This includes asynchronous requests for medication communicated by text, email, live-chat or online that do not take place in the context of a real-time continuous consultation and are based on the patient completing a health questionnaire, when the practitioner has never spoken with the patient.
Any practitioner who prescribes for patients in these circumstances must be able to explain how the prescribing and the management of the patient was appropriate and necessary in the circumstances.
A doctor who has not consulted directly with the patient and does not have access to their medical records is unable to exercise good, safe clinical judgement.
Under the guidelines, a patient’s usual medical practitioner, or another health practitioner with access to the patient’s record, can prescribe without a consultation in certain circumstances.
The guidelines allow a patient to consult a doctor for the first time using telehealth and for a doctor to issue new and repeat scripts as part of a telehealth consultation. The Board does not expect a patient to have had an in-person appointment with a doctor before they have a telehealth appointment.
Prescribing medication is not a tick and flick exercise. It relies on a doctor’s skill and judgement, having consulted a patient and recognises that prescription medication can cause harm when not used properly.
The Board carefully considered the feedback from customers of asynchronous prescribing companies who argued that these services were convenient, including when they couldn’t get GP appointments.
But the Board believes that prescribing medication should not occur in isolation. Consultations enable a doctor to ask follow-up questions that help identify the best treatment for a patient, including when they have previously been given a script by another doctor.
The updated telehealth guidelines and submissions to the Board’s consultation are published on the Board’s website. There were approximately 770 submissions – more than 650 of them from customers of two asynchronous prescribing companies, at least one of which offered consumers the chance of a $500 prize for completing a survey about their service.
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Most cosmetic surgery reforms are now in place, to start 1 July 2023, including higher professional standards, tough new advertising rules, facilities licensing requirements, title protection commitments and a solid platform for registration endorsement.
With the building blocks set, our focus is turning to smooth implementation and helping doctors and patients navigate a safer cosmetic surgery landscape.
Changes coming under the industry-wide reforms include:
Cosmetic surgery (except certain types of blepharoplasty) must be performed in an accredited facility. The Board is sequencing the start date for this, to give facilities working towards accreditation more time to meet the required standards.
Cosmetic surgery can be performed in a facility that is not yet accredited until 1 July 2024 if, by 1 July 2023, the practitioner can provide evidence:
All facilities in which cosmetic surgery is performed must be fully accredited against ACSQHC National Safety and Quality Health Service (NSQHS) Standards by 1 July 2024.
New Accredited facility FAQs are published.
From 1 July 2023, a GP referral is required for cosmetic surgery, under updated cosmetic surgery guidelines. After helpful feedback from doctors, the Board has confirmed that:
Updated GP referral FAQs are published.
Health ministers are working towards protecting the title ‘surgeon’ to stop anyone without specialist registration in surgery, obstetrics and gynaecology or ophthalmology from calling themselves a surgeon.
Legislation to enable this is now in the Queensland Parliament. We have advocated for this recognition of the expertise of specialist surgeons. Practitioners with an endorsement for cosmetic surgery will only be able to use the title ‘surgeon’ when they also have specialist registration in one of these specialties.
Accreditation standards for cosmetic surgery endorsement are in place, and education providers can now apply to have their programs of study assessed against the standards. The standards will determine which qualifications will be recognised for endorsement. Only when cosmetic surgery training programs meet these new rigorous cosmetic surgery training standards, will their graduates be qualified for endorsement.
Demand for cosmetic surgery already outstrips supply by surgeons. The cosmetic surgery endorsement provides a safe alternative for patients who will continue to seek procedures by doctors who are not surgeons and creates a standard where there has been none. Patients can still choose a surgeon for cosmetic procedures. An endorsement will provide important information for those who don’t.
The accreditation standards – developed by the Australian Medical Council (AMC) using the same process to accredit specialist college training programs – are published on the Medical Board’s Accreditation page.
Higher professional standards for cosmetic surgery and tough new advertising requirements that apply across the cosmetic industry take effect from 1 July 2023.
Advance copies of the Guidelines for registered medical practitioners who perform cosmetic surgery and procedures and Guidelines for registered medical practitioners who advertise cosmetic surgery are published on the Board’s guidelines page.
The Council of Presidents of Medical Colleges (CPMC) has alerted the Medical Board to a problem in which referring medical practitioners sometimes fail to provide contact numbers for after-hours reporting of urgent/critical pathology tests.
The following is a fictitious case study that illustrates the importance of providing contact details.
A practitioner in private practice orders blood tests for a 59-year-old patient with a history of renal disease after she reports feeling increasingly tired. The blood is drawn in the late afternoon and the results become available in the evening. They confirm that the patient has deteriorating renal function and a potassium of 8.1 mmol/L.
The referring practitioner has not included a contact telephone number and the pathologist who has been alerted to the results cannot find contact details for the practitioner.
The pathologist calls the patient using the number on the request form, but the patient does not pick up as they don’t recognise the number.
Eventually, the pathologist calls the ambulance service that dispatches paramedics to go to the patient’s home.
Good medical practice, the Medical Board’s code of conduct, states that:
Good medical practice involves ensuring there are arrangements in place for continuing care of patients when you are not available. These arrangements should be made in advance when possible, and communicated to the patient, other treating practitioners and any relevant facilities or hospitals. (6.3.1)
While no one expects doctors to be working 24 hours a day, practitioners who refer patients for tests should have arrangements in place for a medical practitioner to receive and if necessary, action any critical test results, and to make those arrangements clear to other practitioners and patients. The phone number for that practitioner should be included on the request form so that abnormal results that represent a potential serious threat to the patient’s wellbeing can be communicated and appropriate timely action taken.
With COVID-19 mandatory isolation rules relaxed across Australia and fewer interns requiring access to COVID-19 flexibility, the Board has reduced its previous COVID-19 flexibility for 2023 interns, while acknowledging that interns may need to take leave for COVID-19 related illness or to isolate.
The Board expects that interns will complete the core terms and 47 weeks full-time equivalent (FTE) accredited supervised practice unless they had to take genuine COVID-19 related leave (for COVID-19 illness or to isolate).
This applies to interns who started their internship from 1 November 2022:
The intern will need to provide details of the leave including dates and the reason for leave.
For information on requirements for 2022 interns who started their intern year before 31 October 2022 please read the Board’s news item.
For interns starting their internship from November 2023 onwards, the Board expects intern training to return to business as usual and interns to meet the requirements of the Board’s registration standard.
The revised requirements are published in a news item on the Board’s website and there are also FAQs on the COVID-19 updates page.
The Medical Board will now accept a wider range of English language tests, giving greater choice to applicants for registration.
Passes in the following additional English language tests are now accepted:
The OET CBT is delivered on a computer in a testing venue with one element of the test delivered by a human interlocutor via video conferencing software.
The IELTS OSR allows eligible test takers to re-sit one component of the test within a 60-day period if all other components and certain requirements are met.
Applicants for registration should visit the test provider’s website directly to find out more about these tests, to find out more about these tests read Ahpra’s Accepted English language tests.
Increasing the range of approved tests aims to increase flexibility for applicants, while still protecting the public.
All other requirements in the Board’s English language skills registration standard still apply.
National Boards are currently reviewing the English language skills standards, having consulted widely on proposed changes.
As part of the review, National Boards will be carefully considering the approaches of other similar regulators, available evidence, and test security arrangements in place.
The Board publishes data each quarter on the medical profession. Data are broken down by state and territory, registration type and for specialists, by specialty and field of specialty practice. The latest report is available on our website under Statistics on the News page.
The Board has approved the following:
Ahpra’s Accreditation Committee is now consulting on a draft glossary of accreditation terms. The committee provides independent and expert advice on accreditation reform and other National Scheme accreditation matters to National Boards, accreditation authorities and Ahpra.
The proposed glossary of terms aims to introduce consistent accreditation-related terminology across professions, replacing the current wide variation.
For example, student learning in the workplace is now variably referred to as clinical placement, rotation or attachment, work-integrated learning and professional experience or professional experience placements. A range of terms is also used for the people responsible for students in these settings, including clinical supervisor, clinical educator, preceptor, etc. This variation is creating confusion for education providers delivering programs across multiple professions and for workplaces providing placements across multiple providers and professions.
The committee believes that establishing a common language through a glossary of agreed terms is critical and useful. The consultation is open until 23 June 2023 and the consultation paper is available on the Ahpra website.
Public protection is at the forefront in the latest round of reforms to the Health Practitioner Regulation National Law.
The changes started on 15 May, in all states and territories except Western Australia.
One significant change gives Ahpra and the National Boards a new power to issue a public statement to warn the public about a serious risk from an individual – either a registered health practitioner or a person who does not hold registration but is providing a health service. Issuing a public statement means we can warn the public about a serious risk at an early stage, while we continue to investigate. There is a high threshold that must be met to use the power, which we anticipate will be used sparingly and only in exceptional cases to better protect the public.
Read more in the public statements warnings FAQs.
Other changes will help us improve the effectiveness and efficiency of the National Scheme and help create a fairer system. These changes include:
Some of the changes do not apply in NSW, because of differences in how concerns are managed in that state. For example, the power to issue a public statement and the power to require information at an earlier point in the assessment process are already held by the Health Care Complaints Commission. Read more about the NSW regulators.
The changes are the latest in a wide range of reforms outlined in the Health Practitioner Regulation National Law and Other Legislation Amendment Act 2022, which came into law last October.
For more information, read the news item and see the resources on the Ahpra National Law amendments webpage.
To address health workforce shortages, the Australian Government appointed Ms Robyn Kruk AO in December 2022 to lead an independent review of Australia’s health regulatory settings. The review’s interim report is now published and recommends:
Ahpra and the National Boards welcome moves to safely introduce more trained practitioners into the nation’s health system sooner, as recommended by the interim report of the independent review.
Ahpra and the National Boards recognise that the severe shortage of healthcare professionals across Australia’s health systems is a real and significant risk to patient safety.
While a system-wide overhaul is needed to better align the qualifications recognised by Australian medical colleges and cut duplication of processes across authorities, we welcome the opportunity to steward changes that will strengthen the nation’s health system immediately and in the long-term.
Patient safety will always be our priority in registering any practitioner. By eliminating needless duplication, easing bureaucratic delays and better recognising the experience of overseas health professionals, we can attract the best and most suited to Australia, sooner.
As the nation’s health workforce faces increased pressure from the COVID-19 pandemic and an ageing population, the Australian Government appointed Ms Kruk to lead an independent review of the regulatory settings and qualification recognitions for overseas-trained health professionals and international students who have studied in Australia.
The interim findings of the Kruk review endorse measures we put forward to cut the red tape and costs faced by qualified internationally trained practitioners keen to work in Australia’s health system. The report recommends immediate actions including:
Overcoming many of the bottlenecks that prevent overseas-trained practitioners relocating to Australia will require system-wide coordination, such as better recognition of international qualifications by colleges and simplified visa requirements by governments.
A move to a single Ahpra-hosted portal for international applicants to lodge all their paperwork (covering migration, registration and employment) will remove many of the duplications currently faced. The ‘tell us once’ approach will significantly cut the time and expense of navigating the current system.
Australia’s health regulation system is one of the safest in the world. This isn’t an accident. We have a rigorous process to ensure those registered to care for the community are adequately trained and qualified.
We know that registration and migration processes are not easy to navigate, and we have been working closely with other agencies to streamline this. We are already seeing a positive impact with overseas-based practitioner registration back to pre-pandemic levels.
The National Registration and Accreditation Scheme has allowed Australia’s registered health workforce to increase every year through both domestic graduates and international recruits.
Ahpra has started streamlining its registration process to make it simpler for registrants, including through changes to English language requirements that allow applicants to re-sit specific parts of a test rather than restarting the entire process. Additional test options are also allowing applicants to be assessed sooner.
The Therapeutic Goods Administration (TGA) has published a fact sheet – Medical Device Patient Information Materials: a fact sheet for health professionals.
All implantable and Active Implantable Medical Devices (AIMD) are required to have patient information materials available in the form of both Patient Information Leaflets (PILs) and Patient Implant Cards (PICs). The TGA’s fact sheet provides information for health practitioners about PICs and PILs, detailing when they should be given to patients and who is responsible for providing them to patients.
The fact sheet is available on the TGA website.
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. Recently published decisions include:
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 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 Concerned about a health practitioner? page.
More information
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