Bills Digest no. 132 2009–10
Health Practitioner
Regulation (Consequential Amendments) Bill 2010
WARNING:
This Digest was prepared for debate. It reflects the legislation as
introduced and does not canvass subsequent amendments. This Digest
does not have any official legal status. Other sources should be
consulted to determine the subsequent official status of the
Bill.
CONTENTS
Passage history
Purpose
Background
Financial implications
Main provisions
Concluding comments
Contact officer & copyright details
Passage history
Health
Practitioner Regulation (Consequential Amendments) Bill
2010
Date introduced: 24
February 2010
House: House of
Representatives
Portfolio: Health and
Ageing
Commencement: Sections 1 to 3 on the day the Bill receives Royal
Assent; Schedule 1 on a day to be fixed by Proclamation.
Links: The
relevant links to the Bill, Explanatory Memorandum and second
reading speech can be accessed via BillsNet, which is at http://www.aph.gov.au/bills/.
When Bills have been passed they can be found at ComLaw, which is
at http://www.comlaw.gov.au/.
The purpose of the Health Practitioner Regulation (Consequential
Amendments) Bill is to:
- provide for consequential amendments to Commonwealth
legislation to recognise and support implementation of the National
Registration and Accreditation Scheme (NRAS) for the Health
Professions
- streamline processes involved in the recognition of doctors
under the Health Insurance Act 1973 for the purpose of
claiming Medicare.
Background
In Australia, the states and territories are empowered to
legislate to register and regulate health professionals.
Requirements and conditions of registration for all the professions
have therefore varied significantly across jurisdictions.
Variations have included:
… the form and content of registration
Acts, including, but not limited to, the categories of registration
that apply and the terminology used to describe these, the
registration application and renewal requirements and processes,
the continuing professional development and indemnity insurance
requirements, as well as differences in how complaints of
unprofessional conduct are investigated and prosecuted and the
sanctions that may be imposed. Board funding arrangements (and the
level of registration fees charged) and the statutory relationships
between boards and the responsible ministers and departments also
vary widely.[1]
Some attempts have been made in the past to simplify the
registration and regulation process. The Mutual
Recognition Act 1992 was one such cooperative attempt by
the states, territories and the federal governments. This Act
allowed individuals registered to practise an occupation in one
jurisdiction, to obtain registration to practise an equivalent
occupation in another participating jurisdiction.[2]
Despite this move, and other initiatives, for instance, the
establishment of cooperative national arrangements in some
professions, which have seen the delegation of certain registration
and accreditation functions to national bodies, increasingly there
have been calls for greater reform in this area.[3] Reasons cited in support of reform
have ranged from administrative—reduction of red tape
involved in multiple registrations would assist practitioners to
move more easily between, and work across jurisdictions—to
safety and quality considerations. The issue of safety and quality
of care has been the most fundamental motivation for change. This
is most likely because inconsistencies which can occur in
assessment, registration and renewals of licences for health
professional to practice, as well as differences in what
constitutes acceptable practice and discipline can, and have had
serious consequences for the delivery of safe and effective health
care.
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In its December 2005 report on Australia’s health
workforce, the Productivity Commission (the Commission) recommended
the establishment of a single national registration board for
health professionals, as well as a single national accreditation
board for health professional education and training. The
Commission saw this move as a means to help deal with workforce
shortages and pressures faced by the Australian health workforce.
It would increase flexibility, responsiveness, sustainability, and
mobility, and, in the process also reduce red tape.[4]
In response to the Commission’s recommendations, the
Council of Australian Governments (COAG) agreed in 2006 to
establish national schemes for registration of health professionals
and for the education and training of the health workforce.[5] In April 2007, COAG
announced that one national scheme would be established to
encompass registration and accreditation. It intended that the
scheme would commence in July 2008 and apply to nine health
professions.[6] COAG
was convinced the scheme would deliver ‘stronger safety
guarantees for the community’ as health professionals would
be registered ‘against the same, high-quality national
professional standards’.[7]
The election of a new federal government in November 2007
delayed the implementation timetable for the national scheme. In
March 2008 however, health ministers agreed that it would commence
operation in July 2010. Under the terms of an intergovernmental
agreement for this National Registration and Accreditation Scheme
for Health Professionals (NRAS) initially national boards for each
of the nine medical professions to be covered were to be
established. Each state and territory was required to pass
legislation to give effect to the national scheme and to
… use their best endeavours to repeal
their existing registration legislation which covers the health
professions that are subject to the new national scheme. This will
have the effect of abolishing the current state and territory based
registration boards for those health professions.[8]
The NRAS was to involve a Ministerial Council, an independent
Australian Health Workforce Advisory Council, a national agency
with an agency management committee, national profession-specific
boards, committees of the boards, a national office to support the
operations of the scheme, and at least one local presence in each
state and territory.[9]
National bodies set up under the scheme were to
have authority to:
- manage the development of registration, practice, competency
and accreditation standards and continuing professional development
requirements
- approve a list of accredited courses of study that meet the
qualifications required for general registration, and
- oversee the assessment of the knowledge and clinical skills of
overseas trained practitioners whose basic qualifications are not
recognised in the list of approved courses of study and determine
their suitability for registration in Australia.[10]
The Queensland Government was given responsibility for the
development of the NRAS under an applied laws model. This involved
the enactment of a finalised National Law by Queensland. Other
states and territories would become ‘participating
jurisdictions’, upon enacting their own legislation. The
legislation for the other states and territories would include
jurisdiction-specific provisions.
Queensland introduced the Health Practitioner Regulation
(Administrative Arrangements) National Law Bill 2008 (Qld) in
October 2008. The legislation, which set out the structure and
functions of the new scheme, was passed in November 2008.[11]
Following passage of this first
piece of legislation, the Australian Health Ministers’
Advisory Council set up a group to consult on the matters to be
included in consequential legislation. In June 2009, the
group advised that as a result of consultations undertaken with
stakeholders that changes would be made to the original proposals.
These were reflected in an exposure draft of the National Law which
was released for further public consultation.[12]
The Health Practitioner Regulation National Law Act
2009 (Qld) (also known as Bill B), which was introduced into
the Queensland Parliament following this consultation process,
continued administrative arrangements established under the first
stage legislation. It also dealt with more substantial elements of
the national scheme. These included registration and accreditation
arrangements, complaints, conduct, health and performance
arrangements, privacy and information sharing arrangements and
transitional arrangements.[13] The Queensland National Law legislation, received Royal
Assent on 3 November 2009.[14]
New South Wales and Victoria have since passed legislation to
adopt the National Law in their jurisdictions.[15] Bills have also been introduced
into parliaments in Tasmania, the Australian Capital Territory and
the Northern Territory.[16]
The National Law operates as a
unified set of state and territory laws and, as the Minister for
Health and Ageing pointed out in her second reading speech,
consequential amendments are required to federal legislation
‘to ensure that medical practitioners continue to retain the
same Medicare billing eligibility from July 2010’ when the
NRAS comes into effect.[17]
This Bill was referred on 25 February 2010 to the Community
Affairs Legislation Committee for inquiry and report by 9 May 2010.
The reason given for the referral was for the examination of
implications for healthcare providers, particularly the reserve
powers relating to registration requirements.[18] It is expected that submissions
or evidence will be received from:
- the Australian Medical Association (AMA)
- AMA state branches
- the peak bodies for each health discipline.
Details of the inquiry are at
http://www.aph.gov.au/Senate/committee/clac_ctte/health_practitioner_reg/index.htm
In 2008, the Australian Medical Association (AMA), the Committee
of Presidents of Medical Colleges (CPMC) and the Royal Australian
College of General Practitioners (RACGP) expressed concern that a
national registration scheme would not enhance patient safety. The
RACGP considered that such a scheme could also amount to
interference by government in the setting of professional
standards.[19] Further, that there was a danger the scheme could
result in the lowering of continuing professional development
standards ‘to allow some doctors to perform tasks beyond
their skill level if the government dictated
requirements’.[20]
The AMA and the CPMC also labelled the model developed by COAG
as ‘heavily bureaucratised and remote…too centralised
and removed from where medicine is practised’.[21] They proposed instead
a model that they claimed allowed ‘for more rapid responses
to concerns and the exchange of information at the local level to
identify local problems and avert potential
disasters’.[22]
Medical journalist Heather Ferguson noted also:
The AMA and 11 other medical colleges,
including the RACGP, were also concerned that national registration
could provide a ‘vehicle’ for other health
professionals to take on tasks traditionally performed by doctors
without consulting the medical profession. There was no requirement
for another health professional board to consult with the medical
board prior to any decision to expand their scope of practice or
qualifications, they said. ‘If the podiatry board
independently said their members could operate on ankles ... the
government could agree they have adequate training to do
that’.[23]
In March 2009, as part of the consultation processes involved in
setting up the NRAS, the Senate Community Affairs Committee
undertook an initial inquiry into scheme.[24] The Senate committee noted that a
number of changes to the original proposal had already taken place
as a result of the work carried out by the National Registration
and Accreditation Implementation Project.[25] These changes were said to have
responded to concerns, such as those raised by the medical
profession about maintaining accreditation functions that were
independent of government. Other changes to the scheme
involved establishing general and specialist registers for
professions, separate registers for nurses and midwives, imposing
requirements for continuing professional development in relation to
annual renewal of registration, and extending the scheme to three
other professions from 1 July 2012.[26]
The changes made were generally well received by stakeholders.
At the same time, some groups remained concerned that there was a
potential threat to the independence of the accreditation function
undertaken by the various professions. This was inherent in the
power to be given under the scheme to the Ministerial Council to
issue directions relating to accreditation standards. It was
thought that this power contradicted the fundamental objective of
the NRAS—to improve patient safety by ensuring health
professionals were suitably qualified.[27] Similarly, some disquiet was
expressed over aspects relating to registration, such as the use of
the title specialist. The AMA was concerned for
example, that too many people could use the term doctor and that
they could be mistakenly considered medical doctors, thereby
misleading the public.[28]
On the other hand, the Australian Osteopathic Association (AOA)
pointed out, medical practitioners, dentists and veterinarians are
allowed to call themselves doctor if they possess only a Bachelor
degree. The AOA sought the use of the title for
osteopaths, who have completed a five-year Masters
degree and are to be registered under the scheme.[29]
Discussion about accreditation and registration issues proposed
under the NRAS was essentially entwined with what one witness to
the Senate committee hearings noted was tension between public
safety and quality and workforce supply.[30] The underlying fear appeared to
be that the necessity of recruiting health professionals to work in
difficult-to-fill positions would result in the Ministerial Council
bypassing assessment procedures; and bypassing these processes had,
in a number of high profile instances, already resulted in
considerable harm to patients.
The reference to high profile instances of harm most probably
included the case of Dr Jayant Patel, who is due to face trial in
Brisbane in the first half of 2010.[31] Patel was an overseas trained doctor
who in 2003 was able to gain registration from the Queensland
Medical Board and appointment to a Queensland Health surgery post
in Bundaberg, despite a questionable medical record. Patel trained
in India and worked in the United States for more than 20 years.
However, before he sought registration in Australia he had been
found guilty of gross negligence in the early 1980s in New York,
and again in 2000 in Oregon. He has been accused of manslaughter
and causing grievous bodily harm during his time at Bundaberg, as
well as committing fraud to obtain his position with Queensland
Health.
Recent media coverage has again broached the issue of the role
of non professionals in determining standards under the NRAS. It is
likely that this issue will continue to be raised in conjunction
with any discussion of this legislation. The AMA remains convinced
that health ministers will decide training standards for the
medical profession and that ministerial deliberations will take
place behind closed doors. This will then allow politicians to put
workforce or budgetary considerations before safety or quality of
care.[32] While it
has not been clearly stated in the limited media coverage of the
issue, there appears to be the implication that the potential for
another Patel case may be a possible outcome of allowing
unqualified officials to have any role in setting standards for
health professionals.
Comment in the March edition of the Medical Journal of
Australia is also critical of the NRAS. According to former
president of the Medical Board of New South Wales, Peter Arnold,
there is a hidden agenda associated with the scheme which is about
governments combining their powers over new registration
authorities (and Medicare) ‘to exercise ham-fisted controls
over doctors’.[33] Moreover, Arnold claims, the government’s primary
goal is control of doctor numbers, education, registration,
standards and the nature and location of medical practice. This
view is most likely not shared by the majority of medical
practitioners, but it does suggest that some in the medical
profession may be concerned about the extent to which the various
pieces of legislation under the National Law will influence the
practice of medicine and other health professions. These concerns
are likely to be included in submissions to the inquiry to which
this Bill has been referred.
Since the introduction of this Bill the AMA has made little
comment, its main reaction to date has been to express its
agreement with the decision of the Medical Board of Australia to
maintain the recognition of general practitioners as specialist
medical practitioners under the NRAS.[34] As it has been a difficult road for
general practice to achieve specialist recognition under the
current registration and accreditation regime, the lobby group was
clearly keen for this not to be undermined.[35]
The AMA was less pleased that some medical practitioners who are
currently recognised as general practitioners may be discriminated
against under the NRAS. It had been suggested this may be the case
and that only Fellows of the Royal Australian College of General
Practitioners (RACGP) and some Fellows of the Australian College of
Rural and Remote Medicine (ACRRM) would be considered specialists
under the scheme. The AMA wrote to the Medical Board of Australia
arguing that limiting the title of specialist general practitioner
to those with fellowships would create two classes of general
practitioners and would mean in some cases that a highly qualified
and experienced practitioner would have the same registration
status as a doctor in training.[36] The AMA therefore welcomed the Board’s
decision to allow vocationally registered general practitioners as
well as Fellows to use the title specialist general practitioner
(item 27 of the Bill). The AMA saw the decision as
a common sense approach to the issue and one which would ensure
that thousands of highly qualified general practitioners were not
‘shunned and professionally out in the cold’.[37]
Despite opposition to the NRAS from groups such as the AMA, many
high profile health commentators have been consistently supportive
of the scheme. Professor Peter Brooks, Executive Dean of Health
Sciences at the University of Queensland, for example, has argued
that the medical profession’s criticisms of the scheme amount
to another manifestation of ‘turf wars’ and are about
maintaining the power base of the medical profession.[38] Brooks believes that
for medical practitioners, the national registration scheme will
improve the sharing of information and mobility. Professor Nick
Zwar has also been supportive of the national scheme concept. He
suggests in opposition to claims that it may produce more instances
of incompetency, it may be more likely to ensure incompetent
doctors are detected and not allowed to practice. It may indeed
prevent instances manifest in the Patel case. [39]
Other supporters of the national scheme have included some
sections of the nursing profession and the Consumers Health Forum
of Australia (CHF).[40] The CHF has been supportive of the scheme as it
believes it will help to ‘protect consumers against the tiny
proportion of health professionals who cannot be trusted’ and
that it will increase ‘workforce mobility in the current
environment of severe workforce shortages’[41] It should be noted,
however, that the Nursing Federation of Australia, while initially
supportive, has recently modified its stance. It has argued this is
because of an implied threat to nursing standards under the
scheme—a similar concern to that expressed by the medical
profession.[42]
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Key Issues
The complexity of ensuring that all health practitioners are
properly qualified and competent has been acknowledged by a number
of sources.[43] In
the case of medical practitioners, a number of articles have
suggested that this task has been made more complex as a result of
Australia’s reliance on overseas trained doctors in the past
decade or so. Instances such as the Patel case in Queensland have
highlighted the need to introduce uniform and consistent standards
across Australia to ensure that practitioners who are inadequately
qualified are not registered to practice. As one article notes, it
is possible that Patel’s ‘tainted registration
history’ was not discovered because the Queensland Medical
Board was ‘lax per se’, or because it was intentionally
less thorough because of his area of need appointment or because it
presumed Patel was competent because of his experience in the
United States.[44]
Whatever the reason for Patel’s registration, the instance
illustrates the fundamental need for a more reliable and responsive
registration process. Similarly, it justifies the objective of
creating a cooperative, national system of registration to improve
the quality of health care delivery.
From the apparent perspective of Peter Arnold and, to some
extent the AMA, better quality care will not be achieved under the
NRAS, however, because government does not think in terms of
‘standards’ of care. Rather, its bottom line is the
number of practitioners delivering care. In relation to medical
practitioners, from a government point of view according to this
line of argument, it is therefore better to have an inadequately
trained doctor in an area of need, than no doctor at all. In
Arnold’s view, the old system worked in terms of standards;
what needed fixing was the lack of coordination between
governments. In other words, what the professions did was not broke
and did not need fixing—the administration was the problem.
Under the new system, the devil is likely to be in the
administrative details also; that is, in the regulations.
It is proposed in this Bill for example, that certain classes of
medical practitioners will be specified in the regulations as being
able to practise medicine, despite their not being on the general
practice or specialist registers (item 3 and item
9). That is, if these practitioners are delivering
services in accordance with their registration ‘so as not to
disadvantage patients’.[45] Therein may be some of the detail—the
variety of interpretations of what amounts to patient
disadvantage. It follows from this perspective that the
question is: what exactly will the regulations specify as
acceptable? Similarly, if the current system has led to cases like
Patel, how will the NRAS be different, if this type of
‘loophole’ is still present? And, perhaps the most
important question, if non professionals in the form of the Health
Ministers are able to direct Medical Boards to register
practitioners who do not meet Australian standards in order to fill
area of need placements, how is the new system an improvement on
the old?
On the other hand, Anne-Louise Carlton makes the point that the
model of regulation that has applied to Australia has enshrined the
principle that practitioners are the best persons to judge what
constitutes professional and unprofessional conduct and how best to
protect the public. However, while they may be the best persons to
judge clinical and professional expertise, they
… may be ill prepared for a role that
requires an understanding of the principles of natural justice and
procedural fairness, and they may, at times, lack insight where
professional interests conflict with the broader public
interest.[46]
It may be, therefore, that the high level oversight of the NRAS
at Ministerial level will bring a more comprehensive evaluation of
what constitutes the public interest than has been the case under
the present scheme. It could be argued that an earlier suggestion
by the AMA that Ministerial determinations should be subject to a
public interest test is worthwhile in this context, and would be
worth reconsideration.[47]
Other issues which may be raised in conjunction with discussion
of this legislation may include arguments put by those professions
that will not be registered under the National law for their early
inclusion. For example, in jurisdictions such as the
United Kingdom, paramedics are registered nationally, but in
Australia there is ‘no genuine regulation of paramedic
practice’.[48] Each state and territory has legislation which governs
the delivery of ambulance services and individual services set and
monitor their own standards of practice. Paramedic is not
considered a restricted or licensed title. Until recently
paramedics were referred to simply as ambulance officers. Many
people probably still consider that these ambulance officers only
provide first aid and pain relief for patients before they are
transported to hospital emergency departments for
‘real’ treatment.
As one commentator notes, there is ‘no national regulatory
scheme for the independent accreditation of statutory and private
contract service providers. Paramedics aren’t even listed as
allied health professionals by the Commonwealth’. The same
commentator notes that other health professionals are not able to
practice without registration, yet unregistered paramedics deal
with thousands of patients annually, making life and death
decisions. This raises ‘legitimate questions regarding
transparency, public accountability and performance management,
which would appear to mandate an independent regulatory and
national registration regime’.[49]
According to the Explanatory Memorandum to this Bill, it will
have minimal financial impact on the Department of Health and
Ageing. While there may be some administrative savings in Medicare
resulting from the allocation of fewer resources to the process of
specialist recognition, these are likely to be offset
‘through improvements in information technology
systems’.[50]
The Explanatory Memorandum offers the following background
information:
COAG has allocated $19.8 million over four
years for implementation of the NRAS. It had been agreed that this
will funding will be provided in accordance with the Australian
Health Ministers’ Advisory Council cost share formula as
shown below.
| Jurisdiction |
C'wealth
|
NSW
|
Vic
|
Qld
|
WA
|
SA
|
Tas
|
ACT
|
NT
|
| Amount ($m) |
9.90
|
3.31
|
2.45
|
1.91
|
0.98
|
0.75
|
0.24
|
0.16
|
0.10
|
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As mentioned, clause 2 proposes that the
Bill’s effective provisions will commence on proclamation.
This is apparently necessary because they are dependent on
legislation to establish the national scheme being passed by all
states and territories.[51]
Schedule 1 Part 1
Schedule 1 Part 1 will amend the Crimes Act 1914 and
the Health Insurance Act 1973.
Crimes Act 1914
Item 1 will amend the definition of nurse in
the Crimes Act, removing the term ‘registered’. This is
necessary due to the insertion of a new definition in the Health
Insurance Act (item 5).
Health Insurance Act 1973
Items 2 to 10 propose to amend
subsection 3(1) of the Health Insurance Act to
ensure definitions of certain health practitioners will be
consistent with definitions under the NRAS. These amendments,
according to the Explanatory Memorandum to the Bill, will more
clearly identify the practitioners and ‘modernise’ the
definitions.[52]
A new definition of ‘consultant physician’ under
item 2 will remove the need for there to be a
determination under section 3DB or 3E that a
person is recognised under the Act as a consultant physician.
Under the proposed change a consultant physician will be a
medical practitioner in relation to a particular speciality if
certain conditions are satisfied:
- the medical practitioner is registered in the specialty under
the law of a state of territory
- the specialty is prescribed in regulations
- the medical practitioner satisfies any other requirements
prescribed by the regulations.
In addition, under this item regulations will be
also able to prescribe a class of medical practitioners as
consultant physicians if they are not on the NRAS specialist
register, but still providing specialty services for which Medicare
benefits are payable, and which are in accordance with their
registration.
Item 3 proposes to repeal the
definition of ‘general practitioner’ and substitute a
new definition. The new definition of general practitioner will
be:
- a medical practitioner who is registered under a state or
territory law in the specialty of general practice or ‘a
medical practitioner of a kind specified in the
regulations’.[53]
The latter aspect of the definition is intended to cover persons
who are not on the specialist general practice register, but who,
in keeping with the terms of their registration are providing
general practice services for which a Medicare benefit is
payable.
Item 4 will repeal the
definition of ‘medical practitioner’ and substitute a
new definition. It is proposed that a ‘medical
practitioner’ will be someone registered under a state or
territory law as a medical practitioner. According to the
Explanatory Memorandum, this revised definition is intended to
capture all person registered under the NRAS to practice medicine,
apart from students.
The Explanatory Memorandum notes that the revised
definition does not replicate paragraphs (a) and (b) of the
existing definition. These paragraphs relate to a person whose
registration as medical practitioner has been suspended, revoked or
cancelled following an inquiry into his or her conduct. Under the
NRAS, persons whose registration has been revoked or cancelled in
any jurisdiction will not be considered medical practitioners in
any jurisdiction nor under the Health Insurance Act. Persons whose
registration has been suspended will not be considered medical
practitioners during the period of suspension. The net effect is
that there is no change to the practical operation of the
legislation.
Item 8 repeals the
current definition of ‘registered nurse’ in the Health
Insurance Act. Currently, a registered nurse is person registered
under a state of territory law (except in South Australia) as a
general nurse or a person registered under South Australian law as
a nurse. Item 5 proposes to insert a new
definition of ‘nurse’. A nurse will be a person
enrolled under a state or territory law as a registered nurse
(Division1) or a person enrolled under a state or territory law as
an enrolled nurse (Division 2).[54] As a consequence of the new definition of
‘nurse’ in item 5 the term registered
will also be omitted from the definition of nursing care under
item 6.
It is proposed
in item 9 to repeal the current definition of
‘specialist’ in sub section 3(1) of
the Health Insurance Act. It is intended that this will be replaced
with:
- a medical practitioner will be a specialist in relation to a
particular specialty if he or she is registered in the specialty
under the law of a state or territory, the specialty is prescribed
in the regulations as a specialty and the practitioner satisfies
any other requirements in the regulations relating to the
specialty. The definition of specialist will also apply to a class
of specialist as prescribed in the regulations.
As will apply in the item 3
definition of general practitioner, this application of the
definition of specialist potentially includes another class of
practitioner. It is intended by the Government that this will be
able to capture those medical practitioners who may not be on the
specialist register under the NRAS, but who are nevertheless
providing services related to a specialty, in accordance with their
registration and for which Medicare benefits are payable.
The Explanatory Memorandum notes that although
the definition of specialist under the revised Act will include the
specialty of general practice, there will remain a distinction
between general practice and other specialties in the Health
Insurance Act. This will be to accommodate the differences in
Medicare items for general practitioners as opposed to other
specialties.[55]
Item 11 proposes to repeal a
number of sections in the current Health Insurance Act. These
sections apply to the current processes for recognition of
specialists and consultant physicians under the current system.
Under the NRAS, the Medical Board of Australia in conjunction with
Australian Health Practitioner Regulation Agency will maintain a
specialist register of all medical practitioners who are registered
as specialists.
Item 12 proposes to substitute a
new definition of ‘medical college’ which will be
required as it is proposed to repeal section 3D
under which medical college is currently defined. The new
definition proposes that a ‘medical college’ is:
- an organisation accredited by the Australian Medical Council as
a specialist medical college and
- specified by the Minister in writing to the Medical Training
Review Panel for that purpose.
Items 14 to 21, according to the Explanatory
Memorandum, propose to ‘modernise’ the language used in
certain subsections of section 19C and
section 19CB of the Health Insurance Act. The
intention is not to make substantive changes to the sections.
Schedule 1 Part 2
Items 26 to 29 in this Schedule deal with
transitional provisions. Item 26 will insert new
definitions. It is proposed that ‘commencement time’
will mean the time the Schedule commences. ‘New law will mean
the Health Insurance Act 1973 as in force after the
commencement time, and ‘old law’ will mean the
Health Insurance Act 1973 which was in force immediately
before commencement time.
Item 27 will provide that the Governor General
may make regulations to ensure that persons who, before the
commencement time of the Schedule to this Bill, were vocationally
registered general practitioners under section 3F,
will continue to be considered as ‘general
practitioners’ for a ‘period specified in the
regulations’. It is proposed this will be the case even if
those practitioners do not meet the new definition of general
practitioner to be inserted under item 3. The
Explanatory Memorandum notes that this transitional provision is
intended ‘to offer flexibility to deal with people who may be
affected by the introduction of the NRAS and the amendments made to
[the Health Insurance Act]’.[56] The provision will also cover
practitioners who have outstanding applications or appeals before
the General Practice Recognition Eligibility Committee or the
General Practice Recognition Appeal Committee.
Items 28 and 29 will provide that directions
made by the Minister relating to payment of Medicare benefits prior
to the commencement of the Schedule to this Bill continue to be in
force after the amendments to those subsections come into
force.
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Concluding comments
This Bill will make a number of changes to federal legislation,
most specifically, to the Health Insurance Act, to accommodate the
introduction of the NRAS. The proposed changes appear generally to
be uncontentious. Issues associated with the National Law
overall may be more likely to elicit comment, however. In
particular, health profession stakeholders, particularly the
medical and nursing professions may use discussion surrounding this
Bill to iterate concerns about government oversight of
accreditation standards. There could be some lobbying by
professions which will not be registered under the National Law
also for inclusion under the NRAS.
Further, the medical profession may question an apparent
‘loophole’ which is likely to give the government the
ability to allow classes of medical practitioners, who may not be
qualified to Australian standards, to practise as general
practitioners or other medical specialists. The issues will be
whether the aims of the NRAS will indeed be undermined by this
situation, and whether the potential for another Patel case
remains. On the other hand, it is difficult to see what alternative
the government has to allowing the flexibility to register non
Australian trained medical practitioners to work in areas of need,
given that reliance on overseas trained doctors will continue in
rural and remote Australia for some years to come.
Members, Senators and Parliamentary staff can obtain further
information from the Parliamentary Library on (02) 6277 2429.
Dr Rhonda Jolly
11 March 2010
Bills Digest Service
Parliamentary Library
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