AMA NSW AND ASMOF NSW Submission on Health Practitioners Regulation National Law

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1 AMA NSW AND ASMOF NSW Submission on Health Practitioners Regulation National Law This submission is filed jointly on behalf of AMA NSW and ASMOF NSW. We note the submission of the Australian Medical Association et al. AMA NSW and ASMOF NSW endorse the AMA et al submission. This submission intends to address or highlight the particular concerns associated with registration in NSW. Australian Medical Association (NSW) Limited (AMA NSW) and Australian Salary Medical Officers Federation (NSW) (ASMOF NSW) are the most significant organisations representing the industrial relations and medico-political interests of doctors in NSW. AMA NSW is a medico-political organisation that represents over eight thousand doctors in training, career medical officers, staff specialists, visiting medical officers and specialists and general practitioners in private practice. ASMOF NSW represents medical practitioners employed in the New South Wales public sector. ASMOF NSW is registered under both NSW and Commonwealth laws. It is affiliated with the NSW Labor Council and the Australian Council of Trade Unions. AMA NSW and ASMOF NSW support the concept of a national register of medical practitioners. However, we have maintained considerable concerns regarding the implications of the proposed National Scheme on doctors and patients in NSW. As the largest state of registrants, NSW has highly evolved programs and processes to deal with the registration and management of issues regarding doctors. While these processes are not always without error, they are internationally well regarded. We therefore note with approval that the NSW Government has reserved the right to maintain the existing complaints, performance and impairment processes. We also note with approval that NSW will retain the Health Care Complaints Commission (HCCC) and appropriate levels of government funding to support the ongoing operation of the HCCC. With regard to the Health Practitioners Regulation National Law, we note the following specific concerns: While NSW doctors will not be subject to the operation of the public interest assessor, we note the concerns expressed by Federal AMA and associated bodies and support those concerns. The public interest assessor as currently drafted appears to have been poorly defined and to have the potential to create uncertainty for registrants and the public. We note the guiding principles of the scheme at Section 4(2) regarding reasonable fees. AMA NSW and ASMOF NSW remain concerned by the potential costs impositions for registrants. We are concerned by the additional and unwarranted level of bureaucracy, AMA NSW AND ASMOF NSW Submission Page 1

2 particularly associated with the National Agency. We note that while some registrants will experience savings associated with not being required to register in more than one jurisdiction, these registrants will be in the minority. Part 1, Preliminary Clause 6, Definitions - reportable conduct. We remain concerned that the definition places undue emphasis on the harm rather than the state of mind associated with the harm. We note and support the submissions of the MIIAA in this regard. We also support broader exemptions to the requirements, based on the fact that the legislation as framed establishes a higher reporting obligation on practitioners than the current NSW Act and again support the MIIAA submissions. Part 1, Preliminary Clause 6, Definitions - unprofessional conduct (e) We believe the provision regarding influencing or attempting to influence the conduct of another health practitioner in a way that may compromise patient care is excessively broad. Our members would suggest that that the daily discussions regarding discharging patients to free up beds in public hospitals may be viewed to contravene this provision. We seek the removal of this provision. Part 4, Australian Health Practitioner Regulation Agency, Division 1, Clause 23, Functions of National Agency AMA (NSW) remains concerned by the potential for resources to be inappropriately allocated by the National Agency. This will be particularly pronounced if NSW retains our current impairment, performance and conduct programs. These programs require considerable resources to operate appropriately and NSW doctors and patients will potentially suffer if the State Board is not entitled to control or have a significant say in the funding to be allocated from registrants. As such, clause 23 should be amended to provide stronger authority for state boards in the allocation of resources. We also remain concerned that the National Agency will have the scope to influence the policy decisions of the National Board. This would not be appropriate and should not occur. Part 7, Registration of health practitioners, Division 5 - Non-Practicing Registration AMA NSW and ASMOF NSW oppose the prohibition on practice for retired doctors. In NSW, doctors who have retired from practice may, under extremely limited and defined circumstances, write repeat prescriptions and issue referrals. The patient must have been recently reviewed by a fully registered general practitioner and the retired doctor must maintain appropriate continuing medical education. For medical practitioners, the decision to retire from practice can be difficult. The NSW Act allows retired doctors to maintain a connection with their profession and a sense of belonging while safeguarding the interests of the public. AMA NSW AND ASMOF NSW Submission Page 2

3 To the extent that there is evidence of inappropriate practice in older or elderly doctors, this evidence is restricted to doctors who remain in active practice. Denying retired doctors limited rights may potentially result in a minority of doctors continuing to practice with full registration beyond the point that it is safe and appropriate to do so. As such, we seek for Part 7, Division 5 to be amended to reflect provisions currently in operation in NSW. Part 7, Division 6 Application for Registration, Clause 101 Conditions of Registration We note that the requirement to undertake continuing professional development and hold indemnity insurance has been drafted as a condition of practice. This shows a lack of understanding of the purpose and intent of conditions of practice. Conditions of practice are intended to arise from a decision of an appropriate committee or tribunal and should reflect a deficiency in the registrant s practice or behaviour, not a standard obligation. Under Clause 101, all registrants in all professions will be required to indicate that they hold conditional registration. This will cause considerable confusion to the public and appears an unintended error. If it is intended to mandate the obligation to hold professional indemnity insurance and undertake CPD, this obligation should be referred to in terms of the annual renewal or as a direct requirement, see the Medical Practice Act NSW 1996 which contains similar provisions and obligations. Part 7, Division 8, Endorsement of Registration, Subdivision 1, Clause 110 (1) Endorsement for scheduled medicines AMA NSW and ASMOF NSW hold considerable concerns regarding the endorsement provisions at Division 8, Subdivision 1, Clause 110. Under this provision, a medical practitioner would be required to seek endorsement on an annual basis to continue to administer, obtain, possess, prescribe, sell, supply or use a scheduled medicine or class of scheduled medicines. It is clearly intended that the existing state legislation with regard to prescribing and medication will continue to apply. As such, the provisions requiring the endorsement of medical practitioners will operate in competition with existing state provisions and are an unnecessary administrative burden. They may also potentially cause harm to patients by adding delay and confusion in the administration of existing state programs to review and manage prescribing rights for medical practitioners. We therefore seek to amend clause 110(1) to state: 110(1) A registered health practitioner may administer, obtain, possess, prescribe, sell, supply or use a scheduled medicine or class of scheduled medicine if he or she is: (a) A medical practitioner; or (b) In any other case, endorsed by a National Board and whose name is entered into a Register kept by the Board as being a person who is qualified to administer, obtain, possess, prescribe, sell, supply or use a scheduled medicine or class of scheduled medicines. AMA NSW AND ASMOF NSW Submission Page 3

4 Part 7, Division 9, Renewal of registration or endorsement, Clause 124 (d), Annual statement We are concerned by the obligation stipulated at (d) to disclose if billing privileges were withdrawn or restricted. While in extreme circumstances, inappropriate billing can be in indicator of generally inappropriate practice, this clause is excessively broad and could result in the inappropriate reporting a wide range of conduct, including arguably confusion over appropriate item numbers. We are particularly concerned by the reference to private health insurers. Private Health insurers can exercise considerable commercial control over health practitioners and this clause may allow them to inappropriately deal with registrants on billing disputes. Private Health Funds, like all organisations, retain the right to submit complaints about a practitioner and this should be managed through appropriate processes, not stipulated on the annual return. This concern also relates to Clause 142(3) which further endorses the concerns by appearing to suggest that a private health insurer or Medicare Australia may have role in making determinations regarding a practitioners conduct, performance or health. The existing detailed processes associated with Professional Services Review and Medicare audit should provide an appropriate safeguard to the public. Under the PSR program, where the conduct of a practitioner is such as to potentially impact on appropriate practice, the relevant board is notified on order of the PSR. To the extent that other health professions do not currently have access to such programs as the PSR or similar, it should be a matter for the Board to determine policy to manage these issues, not the legislation. As such, Clause 143(c) should be deleted or limited to refer only to decisions of appropriately constituted review bodies such as the Professional Services Review (PSR) Committee. Part 7, Division 9, Renewal of registration or endorsement, Clause 125 (3) Decision about renewal We again note reference to continuing professional development and indemnity insurance as a condition of practice. As noted above, this is unnecessary and will cause considerable confusion to the public. These obligations can be listed as a requirement for annual renewal but most not be stipulated as a condition of practice. Part 7, Division 11, Clause 129, Restrictions on use of titles We are concerned that the protections will not be sufficient to protect the public from other practitioners holding themselves out to have qualifications which they do not possess. This concern arises under current state legislation and should be strengthened AMA NSW AND ASMOF NSW Submission Page 4

5 and reinforced under the proposed national system. For instance, in NSW, podiatrists who undertake certain procedures refer to themselves as podiatric surgeons. This causes confusion for patients and referring general practitioners. The titles of surgeon and physician, both of which imply medical qualifications, should be limited to only be used by medical practitioners. We also support the submission from the Australian College of Medical Acupuncture for the inclusion of the protected title of Medical Acupuncturist in the listing of titles allocated to medical practitioners. Part 7, Subdivision 6, General, Clause 148, Directing or inciting unprofessional conduct or professional misconduct There should be no exemption to the charge of directing or inciting a registered health practitioner. Health practitioners in public and private facilities can be extremely vulnerable to direct or indirect pressure on their practice and they must maintain rights to refuse such pressure. Part 8, Complaints, performance, health and conduct, Division 1, Clause 154 (2) We support the ability for the National Agency or complaints body, howsoever described, to assist with the documentation and preparation of complaints, however, we oppose the suggestion that verbal complaints may be acted upon. The process of managing complaints is a serious matter for both the patient and the registrant. It is therefore critical that the patient s concerns regarding the complaint are clearly established before the registrant is required to respond to the complaint. On this basis, complaints should be required to be in writing. This will result in the more expeditious management of complaints, without placing the patient at a disadvantage. Part 10, Information and privacy, Division 3, Registers in relation to registered health practitioner, Clause 272 We seek a direct prohibition on the publication by the National Board of conditions relating to impairment. While we note the public interest test and accept that it is appropriate for a practitioner with health conditions to have their register noted as conditional, there should be no discretion for the publication or disclosure of the nature of the health condition. AMA NSW AND ASMOF NSW Submission Page 5

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