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DOCTORS around Australia have stepped up to help the nation prepare for and respond to the coronavirus disease 2019 (COVID-19) pandemic. Agencies and individuals across the health sector have made significant changes to their operations, planning and policies. The whole health sector has prioritised its readiness to respond. We have seen an unwavering commitment to shared goals and new levels of collaboration and flexibility.
As regulators, the Medical Board of Australia and the Australian Health Practitioner Regulation Agency (AHPRA) must balance public safety with the need to enable doctors, health services and governments to do what is needed to respond to COVID-19.
While maintaining standards to keep the public safe, we have introduced revised policies to increase practitioner and employer flexibility and get more doctors into the health system quickly if they are needed and wish to be involved. The changes reflect our existing policy and standards framework and recognise the new environment in which doctors are now practising as a result of the COVID-19 pandemic.
None of us knows what lies ahead and we will continue to be flexible as we plan for a range of scenarios. We will keep prioritising patient safety, while supporting Australia’s readiness to respond to COVID-19.
Uncertainty takes its toll. More than ever, we encourage doctors to look after themselves and look out for each other. If you need support, we encourage you to contact your local doctors’ health service, doctors4doctors.
In early April 2020, when none of us knew how hard the pandemic would hit Australia, we helped create a surge workforce by establishing a new pandemic subregister. This fast-tracked the return to the register of experienced and qualified, recently retired doctors. Fortunately for us all, we appear to have avoided the worst possible impacts of COVID-19 and the surge workforce has for the most part not been mobilised.
The Medical Board also made a range of policy decisions and process changes that will apply during the pandemic. These aim to support doctors at the frontline to provide safe care and give the health services that engage doctors the flexibility to make this possible.
Redeployment has become a critical issue, and if the pandemic worsens, more doctors may need to work outside their usual scope. Doctors want to know what they can and can’t do, and the agencies that engage doctors want to know how they can use their people to meet emerging demands.
Good medical practice requires all doctors to know their limits and practise within them. In Australia, the Medical Board does not regulate scope of practice and does not prescribe what individual medical practitioners can and cannot do. That is a decision for each practitioner and the organisation engaging them, prioritising patient safety.
Medical practitioners with general and specialist registration are not restricted in their scope because they have specialist registration. Specialist registration confirms that a medical practitioner has additional specialist qualifications, as well as the qualifications for general registration.
Decisions about scope should be made case by case and take into account each doctor’s qualifications, training and experience, as well as the transferability of their skills to deliver safe care. Each decision needs to also consider the conditions in which the doctor will be working, including facilities and their access to supervision and training. Now more than ever, long established local processes for credentialing and defining scope of practice will be crucial.
To help individuals and health services safely navigate changes to scope of practice, we have published more information about what we expect.
Telehealth has been embraced with enthusiasm by GPs and other specialists, enabling doctors to care for patients safely and effectively while maintaining physical distancing. Safe telehealth means adhering to the same principles you would apply in a face-to-face consultation. If you think a face to face clinical consultation is necessary to assess or treat the patient and provide safe care, this judgement still applies.
We have published guidance for practitioners using telehealth in the context of the COVID-19 pandemic.
Last month, the Board confirmed it would not take action if you cannot meet the continuing professional development (CPD) registration standard when you renew your registration this year. These relaxed requirements apply to the CPD doctors would have expected to undertake in 2020, and to their declaration in the year that covers 2020 CPD. If you have general registration, this will be the declaration you make when you renew your registration in 2020. If you have specialist registration, it may be related to the declaration you make in subsequent years, about the 2020 CPD year. We are clarifying this because the CPD cycles for specialist colleges vary. We have also made requirements for interns more flexible in 2020 and changed a range of requirements for international medical graduates.
A full list of changes is accessible on our website.
If there is a complaint about you during this time, the Medical Board of Australia will take into account the circumstances in which you are working, and the demands being made of you.
As we write this, the curve in Australia has flattened and the number of new cases of COVID-19 has reduced to a trickle. But we must all be vigilant as social distancing measures are gradually relaxed. We understand that medical practice may not be back to normal for a long time and may have changed in some ways for ever. The Board is committed to continuing to be flexible and sensible about the situation in which doctors are finding themselves. We thank all doctors who are practising under much more stressful circumstances than usual. The profession is manifestly rising to this very great challenge.
Dr Anne Tonkin is Chair of the Medical Board of Australia. She has been involved in medical regulation for more than 10 years and was first appointed to the Medical Board of South Australia in 2009.
Martin Fletcher started with AHPRA in December 2009 as the inaugural CEO. He has more than 19 years’ experience in patient safety in Australia, the UK and internationally.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.