Push to overhaul AHPRA notifications process

It was just last month that newsGP reported on GP Dr Raed Masoud’s two-year ordeal waiting for AHPRA to resolve a complaint filed against him, an experience that affected his physical and emotional health.
 
Unfortunately, Dr Masoud’s experience is not unique.
 
At a 8 July Senate Inquiry into the Administration of registration and notifications by the Australian Health Practitioner Regulation Agency and related entities under the Health Practitioner Regulation National Law, Chair of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), Dr Michael Wright, highlighted the fact medical practitioners are ‘overrepresented’ in the AHPRA notification process.
 
‘This is particularly concerning for GPs, who make up the largest proportion of registered medical specialists, nearly 40%,’ Dr Wright said.

During a previous Senate Inquiry in 2017, the RACGP identified a series of issues around insufficient vetting of vexatious complaints, leading the Senate Committee to recommend AHPRA develop a new framework, which was recently published.
 
While the action has been welcomed by the RACGP, Dr Wright noted during the latest inquiry that several process issues remain.
 
‘RACGP members continue to report issues around inadequate communication of the processes, lack of transparency of notification processes, lack of timeliness of decisions and – I think importantly – an inadequate recognition of the impacts that the AHPRA processes have on a practitioner’s mental health,’ he said.
 
‘We know that the overwhelming majority of complaints received by AHPRA are processed and assessed as not for further action. However, lengthy investing processes persist, and regardless of the eventual outcome, the processes can cause reputational damage and undue stress on the practitioner.’
 
While AHPRA estimates that vexatious complaints account for less than 1% of notifications received, more than 70% are deemed to not require any further action.
 
The Senate Committee noted that a high number of notifications are against overseas-trained doctors and questioned how they might be better supported through the process.
 
Dr Wright said doctors trained overseas may not always be familiar with the specifics of the Australian healthcare system. He said this can be further exacerbated by the fact many work in rural and remote areas of workforce need, and have less supports in place as a result.
 
‘So when they do get complaints, they’re often unsure what to do with them – or even less sure than what locally trained doctors are,’ he said.
 
‘And our experience is that those doctors often keep those notifications to themselves because they’re embarrassed about them.
 
‘They’re not sure if they’ll have to leave the country. And so, by the time they do start dealing with them, the process has escalated where perhaps if they were given some more support, perhaps from AHPRA or the PSR [Professional Services Review], or education earlier on, they might be able to deal with the complaints more efficiently.’
 
Dr Wright was not alone in his observations about the effects of AHPRA’s systems. Representatives from the Australian Medical Association, Royal Australasian College of Surgeons, and Royal Australian and New Zealand College of Psychiatrists also raised similar concerns.
 
In a submission, the RACGP recommends an overhaul of AHPRA’s notifications process that ensures complaints are dealt with in a timelier manner.  
 
‘We’ve suggested a better triage system is needed to identify complaints, which could be identified as systems level, rather than practitioner level, early; or identify notifications, which do not require full assessment, early,’ Dr Wright said.
 
He argued having better triage systems in place would allow AHPRA to dedicate its resources to better support notifiers and practitioners through the process more clearly, and to take appropriate regulatory action when required.
 
‘The profession often feels undervalued and even scapegoated by the approach taken by regulatory bodies such as AHPRA,’ Dr Wright said.
 
‘A recent example is that the COAG Health Council’s policy directive to ensure – and the term used was “effective deterrence” – is favoured over consideration of the potential impact of regulatory action on the practitioners’ wellbeing, and this policy of effective deterrence was included in proposed amendments to the regulatory principles for the national scheme.
 
‘The response from our GP members is overwhelmingly against this proposed change, with many viewing the change as a mechanism for AHPRA to make an example of one practitioner, rather than following the principles of natural justice.
 
‘The RACGP would strongly resist that.’
 
Mandatory reporting was also raised by the Senate Committee during the inquiry, with all representatives agreeing the current model could be improved by adopting the one followed in WA.
 
Dr Wright said GPs are currently under ‘a lot of pressure’ and do not feel that they can openly discuss their mental health issues with their own GP for fear of mandatory reporting.
 
‘Removing that barrier is potentially the greatest barrier we’ve got to all doctors, GPs and other medical specialists, being open about the mental health issues,’ he said.
 
Speaking to newsGP following the inquiry, Dr Wright said the fact there was general agreement from all representatives reinforces that ‘we’ve all recognised the problems with the current system’.
 
‘[The WA model] strikes the balance of allowing doctors to more freely declare their health conditions to their treating GP without impacting on their career, while also maintaining the capacity to keep the public safe,’ he said.
 
Dr Wright is confident in the RACGP’s contribution and is looking forward to seeing whether the college’s suggestions are taken on board.
 
‘It’s really important that the college contributes to this Inquiry and feeds back about the real-life problems GPs have, both with dealing with personal AHPRA notifications, but also in the issues of mandatory reporting,’ he said.
 
‘The senators were well informed and very approachable, and hopefully we can continue to strike a healthy balance between protecting the public, as well as protecting GPs who look after them.’
 
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AHPRA complaint investigation mandatory reporting mental health Senate Inquiry