‘Not right at all’: College outlines concerns on AHPRA bill

‘The balance isn’t right at all’.
 
That is the view of RACGP President Adjunct Professor Karen Price on legislation which is set to change the way medical professions are regulated.
 
The college has filed a submission about the proposed changes under the Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2022.
 
The bill is currently going through the Queensland legislative system as the host jurisdiction for national law.
 
According to the Australian Health Practitioner Regulation Agency (AHPRA), the amendments are designed to make safety and public confidence in the National Registration and Accreditation Scheme ‘the paramount guiding principle’.
 
However, the college has outlined several potential issues.
 
‘I am concerned about the impact upon GPs because there is a perception of unfairness and inability to speak about these things,’ Professor Price told newsGP.
 
‘Your reputation, which is in effect your living, can be unfairly challenged.’
 
One of the most contentious parts of the Bill is a proposal to allow information on complaints to be made public before investigations are complete. This is an area opposed by the college, except in circumstances essential for public safety where ‘there is a risk of imminent serious harm to a significant number of people’.
 
The changes to allow public statements about health practitioners are a particular issue for GPs as small business owners dependent on their reputation, the submission states.
 
The RACGP said it ‘understands the intent … but we remain concerned about the potential impacts for practitioners’.
 
It called for greater clarification on this amendment, as well as advocating for decisions on clinical risk to be made by ‘those with the appropriate clinical expertise and professional judgement regarding the true likelihood of serious harm’.
 
‘We note the inclusion of show cause and appeals processes and the requirement for a regulatory body to revoke a public statement,’ the submission states.
 
‘While welcome, this does not prevent unforeseen damage that could occur from a public statement issued where the practitioner is not at fault.’
 
The submission acknowledges the work of AHPRA and the National Boards to address existing issues such as ‘inadequate vetting of complaints, lack of communication and transparency, poor timeliness, and lack of recognition of the professional and personal consequences of investigations’.
 
However, it says ‘many issues remain’ and the college cannot support laws that allow more actions to be taken before all investigations and appeals processes are complete.
 
Another concern raised in the submission is an amendment that would allow disciplinary action to be taken while health practitioners are unregistered.

The college references the National Boards’ already existing powers to prosecute ‘more serious instances of practising without registration’.
 
‘Therefore, it appears these changes would only work to allow National Boards to apply conditions more quickly where issues are identified as minor and/or inadvertent,’ the college states.
 
It gives the example of where there has been an administrative error processing the registration, or where contact details have changed, causing practitioners to miss a renewal notice.
 
A proposed power to allow AHPRA and the National Boards to refer cases to health services and employers before the end of an investigation is also queried, with the college concerned it could make the complaints process lengthier and ‘more complex’.
 
Professor Price suggests the approach could ‘fragment the compliance process and spread potential issues before they have even gone to a resolution’.
 
Lack of trust in the existing system is central to the college submission and Professor Price’s concerns.
 
‘It is perceived to focus more on the prosecution of practitioners than the protection of patient safety through remediation of the issues that lead to the complaint,’ the submission reads.
 
‘Undergoing an investigation for a complaint can be an extremely stressful and time-consuming process, that can have significant reputational and professional consequences, regardless of whether the practitioner in question is at fault.’
 
Fear of vexatious complaints and prosecution can lead to a more defensive medicine being practised, the college states, with the current set-up risking misdiagnosis, as well as ‘over-treatment of benign conditions, or under-treatment of serious conditions’.
 
The role of regulatory burden in deterring would-be GPs from a career in general practice is also stressed by Professor Price, who highlights the dwindling number of medical graduates choosing general practice as a career.
 
‘We have to make sure that we are protecting the public, that’s our prime concern,’ Professor Price said.  
 
‘But we can’t protect the public if we are denuding the general practice cohort of new graduates, and if we’re turning otherwise good GPs off general practice.’

The college does, however, welcome aspects of the proposed reforms, which legislators say are designed to make public safety and public confidence in the safety of registered health practitioners and students as a ‘paramount guiding principle’.
 
The college submission acknowledges support for provisions on cultural safety, as well proposals to ensure National Boards give practitioners the opportunity to show cause after a change to proposed actions.
 
It also welcomes the proposal to allow practitioners to request the removal of information from the public register ‘where there is a risk to safety for themselves or their family’.
 
College correspondence notes the legislation recently introduced to the Queensland Parliament remained unchanged from its draft version, despite previous submissions.
 
Professor Price says she hopes the new government will be more open to change and states the college will continue advocating strongly on the matter.
 
‘We’re pushing this very hard,’ she said.
 
‘We’ve been talking about this very rigorously in terms of having an educative process, in terms of trying to get processes right, and talking about the impact on wellbeing for doctors.
 
‘[We need] to try to set up a better way of managing what needs to be done … in a way that has accountability on both sides.
 
‘We’re talking about keeping the public safe: well, doctors are the public too.’
 
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