Criterion 3.2.1 Medical staff qualifications and training
All medical staff in our health service are appropriately qualified and trained, have current Australian registration, and participate in continuing professional development.
► A. All the doctors in our health service can provide evidence of current Australian registration (document review).
► B. Our health service can demonstrate that all our doctors are recognised Fellows of the relevant medical colleges OR Where the recruitment of Fellows of the relevant medical colleges has been unsuccessful, our health service can demonstrate that doctors have the qualifications and training necessary to meet the needs of our patients (interview, document review).
► C. For each doctor in our health service, we can provide evidence of satisfactory participation in the continuing professional development program of the relevant medical college (document review).
► D. Our doctors have undertaken training in CPR in accordance with RACGP QI&CPD recommendations (document review).
► E. Our doctors can describe how to use our automated external defibrillator (interview).
The Standard guidelines for corrections in Australia41 stipulate that each prisoner is to have access to evidence based health services, provided by a registered and competent health professional, who is providing a standard of care comparable to that which they would receive in the general community.
This requirement poses special challenges for health professionals on two key fronts.
First, the closed environment of prisons means that prisoners necessarily have restricted access to the broad range of healthcare that is available in the wider community. Second, the patient population in prisons is generally characterised by complex clinical needs, making it more difficult for health professionals to achieve good health outcomes.
These factors mean it is imperative that medical staff working in prisons are appropriately qualified and experienced.
All doctors in the health service need to meet the standards of the relevant Australian specialist medical college, in terms of their vocational training and their continuing professional development.
General practice is a distinct discipline in medicine and requires specific training. Doctors providing general practice care need to be appropriately trained and qualified in the discipline of general practice, and be either vocationally recognised or have Fellowship of the Royal Australian College of General Practitioners (FRACGP). The RACGP defines a GP as a registered medical practitioner who is qualified and competent for general practice in Australia, has the skills and experience to provide patient centred, comprehensive, coordinated and continuing medical care, and who maintains professional competence for general practice through continuing professional development.42
In some areas it may be impossible to recruit vocationally recognised GPs. In such circumstances, doctors who are not recognised GPs need to be appropriately trained and qualified to meet the needs of the patient population. Doctors who have not yet met the equivalent of the RACGP Fellowship need to be assessed for entry to general practice and be supervised, mentored and supported in their education to the national standards of the RACGP. Adequate professional and personal support for doctors working in health services in prisons is critically important.
Doctors providing general practice care who are not participating in the RACGP Quality Improvement and Continuing Professional Development (QI&CPD Program triennium need to demonstrate recent and continuing participation in activities equivalent to Category 1 activities of the QI&CPD Program. The RACGP QI&CPD Program is based on adult learning principles (ie. knowledge is more likely to be gained when the adult undertaking the learning recognises a need to know, goes looking for the knowledge, and reviews what has been learnt) and requires GPs to undertake a minimum of two Category 1 activities in each triennium (eg. small group learning or clinical audits). Further information about the RACGP QI&CPD Program is available at http://qicpd.racgp.org.au.
The RACGP recognises that cardiopulmonary resuscitation (CPR) skills are used infrequently and there is evidence that these skills diminish without use. There may be additional medicolegal risk for a medical practitioner who is perceived not to have assisted a patient by providing CPR. Although Indicator D does not mandate CPR training more frequently than 3 yearly, many general practice professionals believe CPR training should be conducted on a more frequent basis, preferably annually.
The nature of incarceration means that patients have restricted ability to directly contact and use mainstream primary health and emergency services. As a consequence, health services in prisons need to have appropriate equipment for emergency care and resuscitation including an automated external defibrillator. All members of the clinical team should be trained in resuscitation techniques (CPR) and the use of the defibrillator.