RACGP calls for regulation overhaul amid growing complexity

The RACGP has put forward a long list of recommendations it says are urgently needed to overhaul and improve the current complexities of Australia’s healthcare regulation system.
 
In a new submission, the RACGP has addressed several areas of concern impacting GPs, including evidence and issues, governance and stewardship, accreditation functions, and complaints handling.
 
Its advocacy comes in response to an independent complexity review within the National Registration and Accreditation Scheme (NRAS), which has been tasked with creating a more streamlined and harmonised system.
 
The Complexity Review arose in the wake of concerns around Australia’s healthcare watchdogs, whether they are still fit for purpose, and how efficient the current complaints management and disciplinary processes are.
 
Its first consultation paper was released last month and included actions to strengthen the National Scheme to ensure it is ‘in line with public expectations’.
 
In her letter to the review, RACGP President Dr Nicole Higgins said one of the prevailing themes that emerged in member feedback was the lack of trust between the Australian Health Practitioner Regulation Agency (AHPRA) and GPs.
 
‘This is a significant issue when expecting GPs to accept regulatory decisions and policy changes,’ she said.
 
‘Our members are particularly keen to see improvements made to complaints processes given the mental health impacts of vexatious complaints and delays in investigating/managing complaints.’
 
In its submission, the RACGP highlights the need for effective management of complaints to healthcare regulators, and how analysis of these requires a particular skill set, consistent application of methodology, and industry knowledge.
 
When asked if it supports a ‘single front door for lodging complaints within state and territory health complaints entities’, the RACGP said it supports measures to simplify or streamline complaints handling in principle.
 
However, it says it requires more information regarding the costs and benefits of a single front door process.
 
‘The triage and management of complaints should be sophisticated enough to afford timely review and outcomes,’ it said.
 
‘However, even more important than timeliness is that all parties to the complaint have confidence that the process observes the traditional principles of natural justice, objectivity, consistency and confidentiality.
 
‘Initial assessments of notifications to AHPRA could be made more efficient by determining whether a practitioner has already been deemed to pose a threat to patient safety.’
 
The submission laid bare the current ‘insufficient processes to separate frivolous or trivial complaints’ and a perceived ‘lack of concern’ for practitioner wellbeing.
 
RACGP Vice President Associate Professor Michael Clements told newsGP this was an issue which is ‘particularly close to the heart of GPs’.
 
‘We all have either ourselves had complaints raised against us, or we work with people that have,’ he said.
 
‘It’s a terribly stressful period of time when we know complaints are made, but don’t yield any further action, and we get appropriately frustrated by the delays in the process.
 
‘Whatever framework they go down for notifications, and whether that’s a national-based as opposed to a state-based framework or not, doesn’t matter as much as it does the process.’
 
The RACGP also called out the challenges associated with attracting and retaining GPs, and the need to strike the right balance between ‘protecting public safety and ensuring regulations and red tape do not impede workforce growth’.
 
The college’s submission states that it does not support expanding the powers of the Ministerial Council due to the risk of fragmentation between states and territories.
 
It also raised significant concerns about the Medical Board’s expedited pathway for overseas-trained medical specialists, which began for GPs on 21 October.
 
When asked if there is a need for the National Scheme to work more closely with other regulators and agencies, the RACGP cautioned against enhanced regulation through the NRAS regarding GP training.
 
Associate Professor Clements said he is ‘very cautious and nervous about the efforts to bring other professionals into the medical space where we don’t know more details’.
 
‘If we try and say that workforce need overrides regulation and safety, then we’re going in the direction of the UK model with unregulated practitioners pretending to provide medical services,’ he said.
 
‘This this is an environment where the health ministers are starting to intervene in regulation to achieve a political game in terms of workforce.
 
‘We saw that with the health ministers wanting to fast-track registration or reducing safety for the benefit of extra bums on seats.’
 
The RACGP’s submission also highlights the difference between individual practitioner accreditation and system accreditation, as well as the interrelation of the NRAS and the National General Practice Accreditation (NGPA) Scheme.
 
‘Touchpoints between the NRAS and NGPA Scheme are part of a changing regulatory landscape where there is growing recognition of the need for better alignment and collaboration between different regulatory and accreditation bodies,’ it said.
 
‘As the health workforce continues to face pressures, eg workplace shortages, alignment between the schemes would support a unified, high-quality health service environment.’
 
The second consultation paper is due for release in January next year, with further consultation to occur from January to March 2025.
 
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AHPRA Australian Health Practitioner Regulation Agency complexity review