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Standards for health services in Australian prisons

Criterion 1.4.2 Clinical autonomy for medical and other clinical staff

Our health service ensures that all medical and other clinical staff in our service can exercise autonomy in decisions that affect clinical care.


Indicators

A. Our medical and other clinical staff are free to determine (interview):

  • investigations relevant to diagnosing a patient’s health status
  • how and when to schedule follow up appointments with individual patients.

B. Our medical and other clinical staff are consulted about:

  • the scheduling of appointments
  • the equipment and supplies that our health service uses (interview).

C. Our health service has a written policy that confirms our medical and other clinical staff can exercise autonomy in decisions that affect clinical care, within the parameters of evidence based medicine (document review).

D. Our medical and other clinical staff can describe the notification process to be used if they believe a third party is restricting their ability to provide or coordinate safe, high quality healthcare (interview).

E. Our health service has a documented protocol for the notification of concerns regarding the provision of safe, high quality healthcare (document review).


Explanation

The intent of this criterion is that medical and other clinical staff are free – within the parameters of evidence based care – to make decisions that affect the clinical care they provide, rather than having these decisions imposed upon them. The Australian Medical Association (AMA) Code of Ethics (revised in 2006),29 which has been endorsed by the RACGP, argues that in order to provide high quality healthcare, clinical independence and professional integrity must be safeguarded from increased demands from society, third parties, individual patients and governments30 (www.ama.com.au).

Clinical staff need to be free to care for their patients without obligations or pressures placed on them by a third party, which may challenge the independence of their professional judgment. There are international guidelines for health professional practice in such circumstances.31

This criterion also means that the health service needs to discuss with medical and other clinical staff their individual preferences for the systems the health service uses to provide clinical care (including investigation options, appointment scheduling, patient load, equipment, length of counselling sessions) rather than requiring staff to use systems that may affect their ability to provide care with clinical autonomy.

This criterion is not intended to conflict with Criterion 1.4.1: Evidence based practice, and does not preclude adherence to valid guidelines for the clinical care of an individual patient based on best available evidence.

Some organisations have developed codes of practice so that health service systems do not restrict the ability of medical and other clinical staff to exercise autonomous judgment in providing clinical care. For example, there is a code of conduct for corporations who provide management and administrative services in medical facilities in Australia32 that emphasises the importance of doctors having professional independence and outlines processes for complaints about such matters.

Some health services in prisons may not have free choice in the engagement of ancillary services. For example, there may be existing corporate level agreements about the provision of services such as pathology. Where this is the case, medical and other clinical staff need to have clear avenues to raise any concerns about the quality of such services and their desire to use alternatives (see Criterion 3.1.2: Clinical risk management system).

Health services in prisons need to have clear protocol for the formal notification of any concerns about impediments to clinical autonomy or the quality of ancillary services. Such notification would be made to the relevant service provider, the relevant government department and if needed, the Australian Human Rights Commission or Commonwealth Ombudsman. The process of notification and escalation of concerns needs to be understood by all staff in the health service. In the event that a notification occurs, this needs to be documented in the relevant patient health records.

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