National Registration and the Intern Year

Associate Professor Peter Procopis Member of the Medical Board of Australia

Chair, NSW Board of the Medical Board of Australia

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12 August 2011

Overview

• Establishment of the national registration and accreditation scheme

• The intern year – draft registration standard

• Framework for accreditation of the intern year

• Performance assessment

• Mandatory notifications

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Background to the National Scheme

• 2006 - COAG commissioned Productivity Commission report

• March 2008 - COAG decided to establish a national scheme for the registration and regulation of health professions and the accreditation of their education and training

• 1 July 2010 – National Registration and Accreditation Scheme - new legislation, new structures and new regulatory framework in place

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Before July ’10… Since July ’10…

• Eight States and Territories

• >85 health profession boards

• 66 Acts of Parliament

• One national scheme

• 10 health profession boards

• Nationally consistent legislation (largely)

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Health Professions in the Scheme

July 2010 1. chiropractors 2. dental care (including dentists,

dental hygienists, dental prosthetists & dental therapists),

3. medical practitioners 4. nurses and midwives 5. optometrists 6. osteopaths 7. pharmacists 8. physiotherapists 9. podiatrists 10.psychologists

July 2012 1. Aboriginal and Torres

Strait Islander health practitioners

2. Chinese medicine practitioners

3. medical radiation practitioners

4. occupational therapists

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Legislation

• The Health Practitioner Regulation (Administrative Arrangements) National Law Act 2008 (Queensland) (Act A) – Set up the various structures

• Health Practitioner Regulation National Law Act 2009

– Full provisions for operation of the scheme, commenced 1 July 2010 (Act B)

• Adoption and Consequential Bills (Bill C)

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NSW Legislation

Acts passed in New South Wales parliament

• 19 November 2009 - Health Practitioner Regulation Act 2009 - adopts the National Law as a law of New South Wales with the exception of: – Definitions of health assessment, performance assessment,

professional misconduct, unprofessional conduct and unsatisfactory professional performance, and

– Provisions dealing with complaints, investigations, health and performance assessments, disciplinary proceedings

• 18 May 2010 Health Practitioner Regulation Amendment Bill 2010

introduced provisions to deal with these residual matters

• 1 July 2010 Health Practitioner Regulation National Law (NSW) No. 86A commenced

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Structure

Accreditation Authorities Accreditation Authorities

National Committees National Committees

Advisory Council Health Workforce Advisory Council

National Boards

Agency Management Committee

National Office

State/Territory/Regional Boards Support

Contract

Ministerial Council

State and Territory Offices

Advice

NRAS administrative framework

• Australian Health Workforce Ministerial Council, • The independent Australian Health Workforce Advisory Council, • The Australian Health Practitioner Regulation Agency – AHPRA • an Agency Management Committee (AHPRA Board)

• National profession-specific boards (appointed on 31 August 2009)

• State Boards and Committees of the National Boards

• National office to support the operations of the scheme, and

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New South Wales structure

New South Wales structure

• National Law – Part 8 re Conduct, performance and impairment matters significantly different in NSW

• Councils established for each of the 10 professions, with a single NSW administrative support structure (Health Professional Councils Authority)

• Government continues to fund the Health Care Complaints Commission

• Decisions and any impacts on registration apply nationally

• AHPRA and National Board manage registration and accreditation

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Benefits of national registration

• Mobility: Register once and practise Australia-wide

• Consistency: National standards

• Efficiency: Reduced red tape (over time)

• Collaboration: Learning between professions

• Transparency: National registers online for all

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Some key features of the national scheme

• Criminal history and identity checks for all applicants

• Student registration

• Independent accreditation functions

• Mandatory continuing professional development for renewal of registration

• Mandatory professional indemnity insurance

• Mandatory notification

• National registration fee for each profession

Role of National Boards

• Approve national standards, codes and guidelines • Determine requirements for registration and register practitioners

who meet the requirements • Approve accredited programs of study • Oversee receipt and handling of notifications (complaints) on health,

performance and conduct – except for events in New South Wales

• Maintain registers (with AHPRA)

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The Medical Board of Australia

• 12 members – eight practitioners – four community members – appointed by the Ministerial Council

• Powers of the Board are defined by the National Law – Its role is to

“protect the public” but also has workforce responsibilities

• National Board deals with policy, standards, codes and accreditation

• State Boards deal with individual registrant issues eg registration and impairment

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Registration standards

Board has developed a number of registration standards: • Criminal history (common) • English language requirements (common) • Professional Indemnity Insurance arrangements • Continuing Professional Development • Recency of Practice • Specialist registration • Limited registration • General registration – AMC certificate holders in std p’way • General registration – interns (current consultation) Must be approved from MinCo after wide ranging consultation

The intern year

• Before 1 July 2010 (18 Oct 2010 for WA): – each S & T Board determined requirements for general

registration – Intern accreditation activities undertaken by PMCs/CETIs who

reported to their S & T Board – Funding of accrediting bodies – mix of Board and health dept – High level of consistency of requirements and standards across

jurisdiction – High level of disparity in relation to amount of funding from the

Boards

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The intern year

• Post 1 July 2011 (and 18 Oct 2011 for WA): – MBA is responsibility for granting general registration under the

National Law

– Continuing to adopt previous requirements until the registration standard for the intern year is finalised

– Board is continuing to fund PMCs/CETIs at the same level as pre 1 July 2010 with a 3% increase this year 18

Work on the intern year

• The accreditation body for medicine is the Australian Medical Council (AMC)

• The AMC has been asked to provide advice on: – Standards for intern training – What should be expected of interns at the completion of the

period to enable the MBA to grant general registration – How the AMC might apply a national framework for intern

training accreditation to the current state-based accreditation processes to ensure that appropriate and consistent standards are in place in all jurisdictions

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Draft registration standard

• Board/AMC working party formed (incl CPMC representative and junior doctor)

• Developed a draft standard for granting general registration following internship

• In consultation phase – feedback from CETI please

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Key features on draft registration standard

• Retain minimum service – 47 weeks

• Retain rotations (medicine/surgery/emergency)

• Aimed for flexibility - address workforce needs and enable training for increased numbers of medical graduates while ensuring the intern year meets educational needs of interns

• Freeing up of rotations with focus on experience – General medicine Medicine – General surgery Surgery – Emergency medicine Emergency medical care

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Rotation in “Emergency Medical Care”

• Board is interested in hearing feedback on this

• Insufficient number of rotations in emergency departments

• Exposure to emergency medicine is important. Junior doctors are very keen to continue to receive this experience

• Can experience be obtained outside of metro emergency departments eg rural general practice with hospital duties

• Guidelines to be developed

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Key features of draft registration standard

• Retain accreditation of rotations – Details to be determined

• Provide for part-time internships

• Provide for overseas rotations

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National framework for intern training

• Further work to be undertaken by the AMC for the Board

• Challenge is to develop a national framework for intern training accreditation that: – Is consistent across jurisdictions – Is responsive – Is flexible – Is equitably funded – Allows for innovation

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Intern in difficulty

• No change in the approach to managing the intern in difficulty

• Local management, supports etc

• Involve AHPRA/MBA if: – Required to do so by the National Law – Not responding to local measures

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Performance assessments

• No changes in the process for performance assessments in NSW

• Nationally, performance assessments are a feature of the National Law

• Prior to 1 July 2010, some states used performance assessments

• National Board work plan includes promotion of performance assessments in all jurisdictions – working group to develop assessment tools, assessors etc

• Not an appropriate tool for intern level

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Mandatory notifications – registered practitioners

• Practitioners and employers must report a registrant who they believe has engaged in notifiable conduct

• Belief formed through the practice of the profession

What is notifiable conduct?

• The practitioner has: – Practised the profession whilst intoxicated by alcohol or drugs,

or – Engaged in sexual misconduct in connection with the practice

of the profession, or – Placed the public at risk of substantial harm in the practice of

the profession because the practitioner has an impairment, or – Placed the public at risk of harm because the practitioner has

practised in a way that constitutes a significant departure from accepted professional standards

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Mandatory reporting

• Threshold for reporting is high – • For example, impairment is only notifiable if it is placing the

public at substantial risk of harm

• Notifiers are protected under the National Law – if notifications made in good faith (civil, criminal or under an administrative process)

• No significant increase in number of notifications to AHPRA or to doctors health services (though incr in the number of inquiries about mandatory reporting obligations)

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QUESTIONS?

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