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A refined way to complain

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Caption: AMA Vice President Dr Stephen Parnis (l) with Medical Board of Australia Chair Dr Joanna Flynn and Dr Susan Nuehaus at the AHPRA/MBA meeting

By AMA Vice President Dr Stephen Parnis

Last month, a working group of senior AMA members and I met with the President of the Medical Board of Australia, the CEO of AHPRA and their senior officials to continue a process begun in 2015 to improve notification processes, particularly for doctors who are the subject of a complaint.

A common problem in recent years has been that investigations have taken far too long. To better assist timely and sensible vetting of notifications and complaints, we discussed the decision matrix AHPRA has developed for use by the Health Care Complaints entities and the Medical Board. This process steers complaints and notifications to the right pathway, significantly reducing the time taken for a preliminary assessment, and reducing unnecessary angst for doctors.

It was obvious from the discussion, and from the data presented to us by AHPRA, that the benchmark times for preliminary assessment of notifications are contributing to improved performance by AHPRA, in all states except Queensland, where a new regulatory regime has been established.

With that notable exception, I expect that this is leading to a more timely and transparent process for practitioners, and it would appear to be reflected in the number of representations practitioners have been making to the AMA in recent times.

However, these benchmark timeframes are more difficult to set for formal investigations. For example, some investigations have to be put on hold until other statutory processes, such as police investigations or coronial investigations are completed. That said, the Medical Board and AHPRA, following representations from the AMA, has recognised the necessity of better communicating the process to practitioners. I expect that here, too, improvements are being felt.

Ageing cases are now automatically escalated, so that more urgent and senior people are involved. Doctors are being advised about the reasons for delay. These matters are now reviewed at specific intervals by senior staff members, and in some cases by Medical Board members at an earlier stage, to ensure that all but unavoidable delays are eliminated, and to accelerate progress if at all possible.  

Obtaining feedback from doctors about their experience is essential, and the Medical Board and AHPRA now accept that gaining a better understanding of a medical practitioner’s experience is essential to refine processes. I expect further work and progress in this area over the next year.

I and my AMA colleagues have raised serious concerns about the Medical Board’s practice of seeking out the expectations of complainants about the outcome of their complaint. We are particularly concerned that this may give rise inappropriate expectations, and deny due process.

According to the Board, understanding a notifier’s expectations assists AHPRA to determine the pathway for the compliant i.e. the local Health Complaints Commissioner, or the Medical Board/AHPRA. The practitioner will be provided with this information, but only as it relates to what the Board has decided to investigate. This will allow the practitioner to focus only on the issues under investigation when responding to the Board, and may expedite more timely resolution of a complaint. We will continue to monitor this issue closely.

We concluded our most recent meeting with an important discussion about how the experience of the scheme can better inform the profession to deal with poor performance earlier.

The Medical Board and AHPRA have established a unit to look at how MBS data can be used to identify risks sooner, such as by providing examples of specific types of practice or certain scenarios which regularly become cases of concern to the medical profession and the wider community.

Clearly, early detection and prevention would protect the public and further enhance the standing of the medical profession.

Prevention is always better than cure and, if used appropriately, could be used as an opportunity for effective education by our medical schools, the learned colleges, and the medical indemnifiers.

Our next task is to ensure that the data collected by this unit is sufficiently robust.

The Working Group will continue to work through this important process, and the AMA regularly engages with the Medical Board and AHPRA through frequent meetings of the AMA President and Vice President with the MBA President and AHPRA CEO.

I wish to thank the members of the working group for their tremendous expertise and commitment – Dr Susan Neuhaus, Dr Roderick McRae, Dr Antonio Di Dio and Dr Jonathan Burdon.

In closing, I also wish to acknowledge the positive and strong relationship between the AMA and the Medical Board of Australia and AHPRA. It fosters a robust and effective exchange, and will continue to improve the regulatory environment for medicine in Australia.