National Registration and the Intern Year
Associate Professor Peter Procopis
Member of the Medical Board of Australia 12 August 2011
Chair, NSW Board of the Medical Board of Australia
1

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
2

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
3

Before July ’10… Since July ’10…
• Eight States and Territories • One national scheme
• 10 health profession boards
• >85 health profession boards
• Nationally consistent
• 66 Acts of Parliament legislation (largely)
4

Health Professions in the Scheme
July 2010 July 2012
1. chiropractors 1. Aboriginal and Torres
2. dental care (including dentists, Strait Islander health
dental hygienists, dental practitioners
prosthetists & dental 2. Chinese medicine
therapists), practitioners
3. medical practitioners 3. medical radiation
4. nurses and midwives practitioners
5. optometrists 4. occupational therapists
6. osteopaths
7. pharmacists
8. physiotherapists
9. podiatrists
10.psychologists 5

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)
6

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
Ministerial Council
National Agency
Advisory Council
Health Workforce Boards Management Committee
Advisory Council
Advice
Accreditation National
Authorities National
Committees National Office
Accreditation Authorities
Committees
Contract
State/Territory/Regional
State and Territory
Boards Support
Offices
8

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
9

New South Wales structure
10

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
11

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

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
13

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)
14

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
16

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
17

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
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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
20

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
21

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
22

Key features of draft registration
standard
• Retain accreditation of rotations
– Details to be determined
• Provide for part-time internships
• Provide for overseas rotations
23

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
24

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
25

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
27

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
28

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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