Toward revalidation in Australia Dr Joanna Flynn AM Chair, Medical Board of Australia CLEAR Congress 2017 Context Medical Board of Australia established in 2010 in national multi-profession scheme under National Law Regulates in partnership with AHPRA Primary role is patient safety, also to facilitate access to health services and workforce development Regulatory model is title protection - not scope of practice National standards for CPD, Recency of Practice Annual declaration with renewal of registration A snapshot of medical regulation in Australia 111,166 registered medical practitioners 391,253 registered nurses and midwives 678,938 registered health practitioners *as at 30 June 2017 1
Our journey towards...? Revalidation? Recertification? Renewal of licence? Maintenance of Professional Standards? A new name with or without acronym A systematic approach to ensuring continued competence throughout the working life of a doctor 1. The evidence for the validity of revalidation 2. Identify best practice 3. Propose potential models for the Australian context 2
Proposed models were difficult to apply in the unique Australian environment Independent of the Board Wide range of expertise Tasked with developing one or more models for revalidation in Australia and provide advice on how to pilot the models 1000 members of the public 3000 medical practitioners Stratified sample of age, location, gender, specialty To explore understanding and expectations re how doctors maintain competence 3
Community feedback 90% of the public trusts doctors 80% of the public knows nothing or very little about how doctors are reviewed 86% think doctors should regularly review the way they practise and 72% think doctors should be reviewed at least every 5 years (39% doctors agree) Practitioner feedback Most doctors are doing CPD traditional vs outcomes focused 95% confident they are maintaining their competence 95% know what they need to do and 91% know how much 92% agree that professional development activities help to keep my medical knowledge and skills up to date EAG Interim report Strengthen CPD to improve and enhance practice of all - Greater focus on activities shown to improve performance reflection on own practice and outcomes data, feedback Addressing risk - early identification, screening and remediation of practitioners at higher risk of poor performance 4
EAG Interim report Consultation Meetings with professional stakeholders Stakeholder forums held in each capital city More than 1000 individual doctors had their say using the Board s online discussion forum and by completing the online survey 116 written submissions received Consultative Committee 2017 EAG Interim report Consultation EAG Final report The Board has received the EAG s final report The report will be published with the Board s proposed course of action at the end of November. Underlying principles of proposed approach Smarter not harder Integrated avoid duplication Relevant, practical and proportionate 5
Dual aims of revalidation Risk based regulation? 6
Known risk factors Risk increases with age from 35 upward Male Number of prior complaints Isolation Volume both very high and very low Changes in scope of practice Some known supports High quality CPD Group/team practice Clinical governance structures Volume Early peer intervention 7
Notification rate by profession Medical Practitioner Dental Practitioner Chiropractor Pharmacist Psychologist ATSIHP Podiatrist Optometrist Chinese Medicine Practitioner Osteopath Nurse or Midwife Physiotherapist Occupational Therapist Medical Radiation Practitioner *2010-11 /16 0 10 20 30 40 50 60 Chance of receiving a notification in 2013/14 100% 80% 60% 40% 20% 0% 0 1 2 3 4 5+ Number of notifications the practitioner received in /13 Registered medical practitioners (by age) as at 30 June 2017 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 - U 25 25 29 30 34 35 39 40 44 45 49 50 54 55 59 60 64 65 69 70 74 75 79 80+ Age of practitioner 8
Notification rate for medical practitioners by age and gender 120 Notifications per year per thousandmedical practitioners 100 80 60 40 20 0 Under 25 25-34 35-44 45-54 55-64 65+ Age of practitioner *2010-16 Notification rate for registered medical practitioners 120 Notification rate notifications per year per thousand registered practitioners) 100 80 60 40 20 0 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Age of practitioner Grey lines indicate the estimate plus and minus one standard deviation, which also corresponds to 68% confidence levels. Data is 2013-16 Notification rate for registered medical practitioners full-time equivalent employed 120 FTE adjusted notification rate notifications per year per 1000 fulltime-equivalent practitioners 100 80 60 40 20 0 25-34 35-44 45-54 55-64 65-74 75+ Age of practitioner Grey lines indicate the estimate plus and minus one standard deviation, which also corresponds to 68% confidence levels. Data is 2013-16 9
Foundations for any system of revalidation Focus on patient safety Encourage self-reflective practice to maintain and improve performance of everyone over time Ensure minimum standards are met by all Recognise diversity of practice settings and scope Aim to enhance rather than undermine professionalism Our strategy for the journey Expected resistance ++ Introduced the idea and then proceeded slowly and with incremental steps Focused on the Australian context Used evidence to build the case for change and the direction Lots of consultation 10
What s next? Response to EAG report and proposed directions to be released on 28 November General agreement about the value of strengthening CPD mechanisms can be found to achieve this Identifying at risk groups and screening much more contentious Partnerships critical clarity re roles and responsibilities The future No hidden or guilty knowledge Data on actual performance readily available to practitioners and teams Individual practitioners reflective, self-aware, curious, open to feedback Culture of respect, mutual support, mutual responsibility Renewed focus on patient safety 11