Roles and responsibilities

It is the individual GP’s responsibility to ensure their safety to practise. The onus is therefore on the GP to:

• continually reflect on their practice and maintain the required level of knowledge and clinical skills appropriate to that practice (prevention)
• demonstrate that any identified performance concerns are addressed and resolved.

Assessors and investigators:

• investigate performance concerns
• assess the clinical skills of the GP and identify deficiencies
• make a determination as to the GP’s safety to practise
• make recommendations addressing performance issues
• evaluate the outcomes of the Remediation Plan
• ensure they (ie the assessors/investigators) have adequate training and support (including appropriate indemnity) to undertake their role
• ensure they are clear about their decision making and any recommendations they make regarding a Remediation Plan.

Medical educators:

• assist in investigating and assessing performance concerns
• deliver and monitor Remediation Plans
• assist in evaluating the outcomes of Remediation Plans
• ensure they have adequate training and support (including appropriate indemnity) to undertake their role and be aware of the scope of their decision making.

AHPRA has requirements with regards to educators delivering interventions to GPs who have to comply with conditions imposed by the Medical Board. The requirements are that the educator must:

• be approved by the Medical Board
• be a registered medical practitioner holding unrestricted registration
• be senior to the GP in question by either years of experience or position, or with additional training, experience and/or qualifications to deliver the education
• not be in a close collegiate, social or financial relationship with the GP in question
• agree to
  • deliver the required intervention (education, audit of medical records, mentoring or supervision)
  • provide a plan for the proposed intervention
  • provide a report to the Medical Board at the completion of the intervention
  • report immediately to AHPRA any unsafe practice or inappropriate conduct of the GP in question.

A colleague in the practice may be asked to supervise a GP about whom there are performance concerns. Supervision may be formal or informal and will depend on the context (eg formal supervision is more likely to be required following an extended period of absence from practice or when significant performance issues have been identified).

Mentoring is a developmental process whereby a more experienced GP (‘mentor’) helps a less experienced GP (‘mentee’) in their personal and professional development.

Mentors:

• provide personal support
• challenge thinking and promote the development of reflective skills.

Employers/practices:

• have a duty of care to the public (patient safety) as well as the GPs in their employ (GP safety)
• develop and maintain policies and procedures that identify and address performance concerns as early as possible (prevention)
• ensure that performance management is done, as much as is possible, with the cooperation of the GP about whom a concern exists
• provide a supportive environment that allows remediation to take place without putting patients or the GP at risk.

Employers and practices may not have the requisite resources and skills to appropriately investigate and manage performance concerns. In that event, advice and/or assistance should be sought from an expert in the field of performance management or the RACGP.

The RACGP:

• sets standards for general practice
• provides suitable educational resources
• advises and supports the GP, practice, investigator, assessor, educator, mentor and/or supervisor
• provides suitable professional development programs for investigators, assessors, educators, mentors and supervisors.

Additionally, there is scope for the RACGP to:

• work closer with AHPRA to facilitate the investigation processes
• advocate for the GP under investigation.

AHPRA manages investigations into the professional conduct and performance of medical practitioners, on behalf of the Medical Board (except in New South Wales and Queensland).

The Medical Board:

• sets and maintains standards of medical practice against which a doctor’s professional conduct can be evaluated
• makes decisions and imposes conditions on the doctor under investigation.

The tribunal has the power to de-register a doctor.

The Health Care Complaints Commission:

• can investigate and prosecute complaints about the conduct of medical professionals and unregistered health practitioners
• can also investigate health service providers.

The Medical Council of New South Wales:

• works in collaboration with the Health Care Complaints Commission to receive and manage complaints about registered doctors and registered medical students in New South Wales
• can place conditions on a doctor’s registrations and/or use urgent action powers to suspend a doctor’s registration as an interim measure to protect the health or safety of the public while proceedings by the Health Care Complaints Commission or the courts are underway
• does not have the legal power to cancel the registration of a New South Wales medical practitioner. This can only be ordered by the NSW Civil and Administrative Tribunal following successful prosecution conducted by the New South Wales Health Care Complaints Commission.

MDOs:

• assist GPs and practices with risk identification
• provide medico-legal advice and support to GPs and practices
• make available a variety of medico-legal educational resources.