AMA joint submission on National Registration and Accreditation

The AMA supports the principle of nationally consistent registration arrangements that ensure that those doctors who are qualified and safe can work anywhere in Australia.  We want a system that makes it easy for doctors to work across state and territory boundaries without having to re-register.

The National Registration and Accreditation Scheme for the Health Professions proposed by the Council of Australian Governments introduces new national arrangements for:

• registration of medical practitioners;
• accreditation of medical education and training; and
• complaints and disciplinary processes.

Throughout the consultation process conducted over the past two years, the AMA made clear its broad and specific objections to the many elements of the scheme through a number of comprehensive submissions to Government.  These submissions highlighted our key concerns that:

• the proposed framework would allow politicians to put workforce or budgetary shortages ahead of patient safety and quality of care with little scrutiny of their decisions;
• the scheme would not secure high standards of registration for the medical profession;
• accreditation of medical education and training would not be independent of government, putting international recognition of Australian accredited medical courses, and Australian trained doctors, at risk; and
• the scheme is complex, cumbersome, bureaucratic and expensive, and will result in significant increases in registration fees for the profession.

The AMA has lobbied very strongly to secure a number of important changes to the scheme.  Since the exposure draft of the enabling legislation that was released in June 2009, many of the AMA’s concerns about elements of the scheme have been addressed (click here to view a list of those concerns). 

However we remained concerned about the reserve powers of Health Ministers in respect of accreditation standards. 

It is proposed that Health Ministers will be able to issue policy directions to the national medical board in relation to new or amended accreditation standards for medical education and training when they consider the standard will have a substantive and negative impact on the recruitment and supply of the workforce.  While the Health Ministers will have to first consider the potential impact on quality and safety of health care, the AMA believes this is not robust enough to protect the public interest in terms of accreditation standards for medical education and training.

While we would prefer that the Ministers had no involvement in accreditation standards, the Bill must be amended to require Health Ministers to apply a public interest test when exercising their reserve power. 

The AMA intends to lobby state and territory parliamentarians to amend the Bill when it comes before their respective parliaments to include a public interest test. 

This amendment would insert a specific provision requiring Health Ministers to apply a formal public interest test that considers, amongst other things, the potential impact on the quality and safety of patient care, before issuing a direction on accreditation standards.  This is an essential process to ensure that quality and safety is not compromised in an effort to achieve short-term solutions to workforce supply constraints.

We must have an iron-clad guarantee that medical training standards would not be compromised by the new arrangements.  The community must have confidence that the new scheme will ensure safety, quality, and the highest standards in medical training, and ultimately the services themselves.

The medical profession wants no part of a scheme that fails to protect the interests of patients and the community and which compromises the future training of doctors in Australia.

Mandatory reporting
The AMA has sought further consultation on the definition of reportable conduct.  In effect, the relevant provisions in the draft Bill represent new mandatory reporting requirements across the health professions, as well as for the medical profession.  The draft definitions in the Bill could be interpreted very broadly and there are considerable risks that health professionals will over-report, or not know when to report.  This will require education for registrants so they have some certainty of what would be considered in scope as reportable conduct, before case law is established.

The AMA is also lobbying state parliamentarians to have additional exemptions from mandatory reporting for spouses, treating doctors and other professionals providing support to doctors with health issues, such as the doctors’ advisory health service.  We also believe that medical practitioners who participate in quality assurance activities in accordance with the Commonwealth Health Insurance Act 1973 from any requirement to report reportable conduct identified during those activities. 

AMA Joint Submissions

Senate Community Affairs Committee inquiry

The Senate Community Affairs Committee is conducting an inquiry on the National Registration and Accreditation Scheme for Doctors and other Health Workers, and will report to the Senate by 18 June 2009.

The AMA made two submissions to the Committee:

First Submission

This submission provides a comprehensive explanation of the AMA's concerns with the proposed national registration and accreditation scheme. It outlines the AMA's alternative model to retain the autonomy of the accreditation process in order to protect patients by only accepting high quality doctors while at the same time providing a system for a national registration arrangement which will deliver consistency of standards for the medical profession across Australia.

Submission on Exposure Draft

This submission notes that the Ministerial Council has forfeited the power to approve accreditation standards, but has retained a power to give the national board policy directions on accreditation standards. The submission calls for additional provisions to be added to the legislation that:

• Defines the circumstances when the Ministerial Council can issue policy directions on accreditation standards; and
• Provides mechanisms for transparency and accountability of these directions.

The submission also outlines a range of other important functional, operational, and administrative issues with the scheme that need to be clarified and reflected, where necessary, in revisions to the Bill.

AMA Joint Submission to Government

The AMA has also made a joint submission on the exposure draft to the Project Implementation Team.

Proposed arrangements for specialists

The AMA Joint Submission on the proposed arrangements for specialists highlights concerns that the proposed scheme will be a vehicle for governments to respond to workforce challenges by:

• permitting people to be registered as medical practitioners even though they do not meet the requirements for general medical registration; and
• allowing other health providers to inappropriately undertake competencies beyond their training and scope of practice.

Further, there is no guarantee the proposed scheme will incorporate the the role of medical colleges in:

• determining specialist qualifications for, and conferring them on, medical practitioners;
• continuing professional development for the medical profession; and
• assessment of overseas medical graduates who are applying for Australian specialist qualifications.

Proposed arrangements for accreditation

The AMA Joint Submission on the proposed accreditation arrangements highlights concerns that, under the proposed scheme, accreditation of medical education and training will not be independent of government, providing the potential to lower standards and therefore compromise patient safety and health outcomes.

Proposed arrangements for information sharing and privacy

The AMA Joint Submission highlights concerns that the proposed arrangements will impose additional requirements on registrants to provide information, including workforce data, to the relevant board as a condition of registration, and extend existing arrangements for information sharing about registered medical practitioners between various government agencies.

Proposed arrangements for handling complaints, and dealing with performance, health and conduct matters

The overarching concern of the AMA and the co-signatories is that the proposed complaints handling process, where the ‘front end’ is run through national administration in accordance with a national law and the ‘back end’ is dealt with through state-based tribunals in accordance with varying state based laws, is contrary to the objective of having a national scheme.  In this context, as individual cases are considered and handled by different entities within the scheme operating variously under commonwealth and state laws, there is a risk that decisions on their outcomes will be unduly delayed because of lack of clarity about the application of the appropriate laws.

The assessment of the “best” system must consider the confidence that patients and registrants will have in an externally imposed system.

Proposed registration arrangements

The AMA Joint submission highlights the real risk that the new scheme will erode the medical board’s ability to protect patient safety, and addresses four major concerns with the proposed registration arrangements:

1. There is no recognition or guarantee of the continued role of medical colleges in determining specialist qualifications for, and conferring them on, medical practitioners;
2. The scope of practice for the other health professions will be able to be expanded without any obligation for one health profession board to consult with other boards, particularly the medical profession board;
3. The scheme seeks to introduce new onerous continuing competence/CPD requirements, which will effectively create a new scheme for the medical profession, and does not recognise the role of the colleges in continuing competence and professional development for the medical profession;
4. The medical board will be able to register a person who does not meet the requirements for registration in certain circumstances.

Issues supplementary to the IGA for the first bill

The AMA Joint Submission identifies seven major areas of concern about the overarching structure of the IGA:

1. Accreditation of medical education and training will not be independent of government, providing the potential to lower standards and therefore compromise patient safety and health outcomes.
2. Loss of the independence of accreditation of medical education and training will mean that Australia will no longer meet international guidelines.
3. The scheme will provide a vehicle to implement an unacceptable policy agenda of workforce reform, without scrutiny, evidence or public debate on changes to the roles and responsibilities of health professionals. Our fundamental concern is the potential impact on patient safety and health outcomes.
4. There is considerable risk that registration requirements and professional standards and competencies will be changed inappropriately and without public and professional scrutiny.
5. There is insufficient accountability for Ministerial decisions and policy directions, particularly when those decisions are inconsistent with advice provided by the professional board or the independent accrediting body.
6. There is a risk that the new national health professional boards will not be sufficiently resourced to adequately carry out their functions.
7. The scheme will result in significant increases in registration fees.