Dr Peter Arnold: Can a "one size fits all" approach work for national registration?

ONCE upon a time, in a place long past, the colonial government of New South Wales needed to know which medical practitioners were qualified to give evidence at inquests. Thus, in 1838, the world’s first medical boards were created, in NSW and in Tasmania, which had split off from the original colony.

This month, after 182 years of successful self-regulation, these boards, and those in the other states and territories of Australia, have been replaced by a single national board.

Originally, medical boards were concerned with registration; then with action against rogues. More recently their role was extended to helping doctors with problems (mental and physical) to be well enough to attend to patients. Lastly, boards became involved with the quality of our practice, investigating alleged low standards and applying educational remedies.

As of 1 July, 2010, these functions become the responsibility of the National Medical Board, part of a new Australian Health Practitioner Regulation Agency. How might this new board handle these responsibilities?

1. Registration

This should be simple. The Australian Medical Council already maintains a database of practitioners in all states and territories. Ironing out duplications is straightforward, following the Mutual Recognition agreement between the jurisdictions many years ago.

2. Discipline

In a country the size of Australia, this could be awkward. The gathering of complainants, witnesses (of fact and expert) and of respondents, together with legal representatives, must surely be decentralised. Facilities and standards necessarily vary between cities, towns and countryside.

Fairness would demand that local circumstances be taken into account. Compliance with conditions on a doctor’s registration can only be checked locally – again a problem for a national body. This is already difficult for city-based boards in their own jurisdictions, especially regarding rural and remote areas.

3. Impairment

As with discipline, compliance with any conditions with respect to fitness to practice would need to be checked, again entailing local delegation.

4. Performance

Whereas the monitoring of conditions relating to impairment would be a periodic assessment by a specified treating doctor (usually a psychiatrist), monitoring of conditions relating to standards needs more consistency, if not, at times, a colleague looking over the doctor’s shoulder.

With the new Board starting its journey on 1 July, I cannot help but wonder how it is going to overcome these problems.

Posted: 5 July, 2010

Dr Peter Arnold is the former Deputy President, NSW Medical Board and Former Chairman of the AMA Federal Council and a non executive director with the Doctors’ Health Fund.