Re-entering practice

A GP re-entering practice in Australia must adhere to the Board’s ‘Recency of practice’, ‘Continuing professional development’ (CPD) and ‘Professional indemnity insurance’ standards.

To meet the ‘Recency of practice’ standard, a GP must practise within their scope of practice for a minimum total of:

• four weeks full-time equivalent (152 hours) in one registration period; or
• 12 weeks full-time equivalent (456 hours) over three consecutive registration periods.

‘Full-time equivalent’ equates to 38 hours per week and is the maximum number of hours that may be counted in a week.

A GP who has been practising in a jurisdiction outside Australia will meet the ‘Recency of practice’ standard provided they:

• have not been absent from practice for a year or more
• are not intending to change their scope of practice.

With respect to the CPD standard, a GP with specialist registration must meet the RACGP’s CPD requirements.

In addition, the GP must be able to demonstrate that they are a ‘fit person for practice’; that is, that they do not have an impairment, a criminal history or a professional disciplinary history that may impact upon their practice or has relevance to their ability to practise. The GP must also have the necessary professional indemnity insurance in place for when they commence practice.

When a GP has been absent from practice and not registered, or registered as non-practising, for more than one year and is applying for registration, the Board will consider:

• registration and practice history
• when the practitioner last practised and the period of absence
• the number of years of experience prior to leaving practice
• activities related to the practice of medicine undertaken since they last practised (this includes CPD, education or professional contact)
• intended scope of practice, including the proposed role and position.

For a GP with two or more years of clinical experience and now returning to practice, the Board has additional requirements based on whether they have practised or not during the period of absence:

• If they have not practised for up to and including 12 months
  • no additional requirements before re-entering.
• If they have not practised for between 12 months and up to and including 36 months
  • at a minimum, the equivalent of one year’s CPD activities relevant to the GP’s intended scope of practice, before re-entering practice. These activities must have been with respect to maintaining and updating knowledge and clinical skills.
• If they have not practised for more than 36 months
  • a plan for professional development and re-entry to practice must be provided to the Board for consideration and approval. The GP will have to work under supervision for a designated period of time (as determined by the Board). Consequently, a supervisor (who has agreed to undertake the supervisory and support role and report to the Board) must be nominated.

A GP with less than two years of clinical experience now returning to practice is required to work under supervision in a training position approved by the Board.

If a practitioner is changing their field or scope of practice, they may be required to undergo additional training to ensure they are competent in the new field or scope of practice. The Board’s requirements differ depending on the type of change.

If the change is:

• to a subset of the GP’s current practice (ie narrowing the scope of practice), there are no additional requirements
• an extension to the GP’s practice that might reasonably be expected for a practitioner in that field, the GP is required to undertake any training that would be expected by their peers in that field, before taking up the new area of practice
• to a different field of practice, the GP is required to consult with the relevant specialist college and develop a professional development plan for entering the new field of practice for the consideration and approval by the Board.

The Board may sometimes require the practitioner to undergo a performance assessment before re-entering practice. This will generally occur when the practitioner has previously been investigated with respect to their professional practice and/or there is concern for patient safety. Unsatisfactory performance is defined in part 1, section 5 of the Health Practitioner Regulation National Law Act 2009 as follows:

'Unsatisfactory professional performance, of a registered health practitioner, means the knowledge, skill or judgment possessed, or care exercised by, the practitioner in the practice of the health profession in which the practitioner is registered is below the standard reasonably expected of a health practitioner of an equivalent level of training or experience.'

The aim of a performance assessment is to identify any deficits in a practitioner’s performance, so that a plan can be developed to ensure that the practitioner meets the expected standards, as well as to protect the public. It is usually conducted by one or more GPs who are not Board members, and who have the necessary expertise to assess.

As a result of a performance assessment, the Board may decide to:

• take no further action
• investigate the practitioner further
• refer the matter to a performance and professional standards panel
• impose conditions on/accept an undertaking from the practitioner
• require the practitioner to undergo a health assessment
• caution the practitioner
• refer the matter to a tribunal
• refer the matter to another entity (such as a health complaints entity).

The RACGP considers that the onus for determining the clinical competency of GPs re-entering clinical practice after an extended period of leave lies with the GP, their employer and the Board.

The RACGP may provide the following assistance to a GP who is planning to take leave of absence from practice or to re-enter practice:

• Guidance on the process to follow when contemplating a planned absence and re-entry.
• Advice with respect to CPD requirements at the time of re-entry.
• Assistance in the development of a learning plan for re-entry.
• Advice with respect to suitable educational activities.
• Assistance with finding a suitable mentor and/or supervisor.
• Support for the nominated mentor and/or supervisor.

The RACGP also recommends the following, based on the period of absence:

• Absence of less than 12 months
  • While there are no specific Board requirements, a mentor would be of support to any GP who is apprehensive or has any concerns about how they will cope.
• Absence of between 12 and 36 months
  • In addition to the Board requirement that a minimum of 12 months’ equivalent of CPD must have been completed prior to re-entry, it would be helpful for the GP to engage a mentor (who could be a colleague within or outside of the practice) to provide ongoing support and to assist with the formulation of a learning plan (for the CPD that has to be completed prior to re-entry and going forward after that), and/or a supervisor (within the practice) to provide day-to-day support and assistance with any concerns, teaching, and formative assessment of clinical skills by direct observation.
• Absence of more than 36 months
  • The GP must meet the Board’s specific requirements, including the preparation of a professional development or learning plan and working under supervision. Whether a mentor will be helpful, in addition to a supervisor, will depend on the re-entering GP’s needs and the terms of engagement with the supervisor. For example, the supervisor may not be involved in the formulation of a learning plan and a mentor may assist instead. A mentor may also be able to provide ongoing support. While the supervisor will have certain reporting responsibilities to the Board, they are also ideally placed to provide in-practice support.
  • The following initiatives would be useful as part of the re-entry plan
    • Regular teaching time
    • Formative assessment of clinical skills by direct observation
    • Prescribing and medical records review.

Figure 1

Requirements and recommendations for re-entry to practice

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GPs are encouraged to commence planning as early as possible, ideally from the moment when a leave of absence from practice is being planned, but certainly when there is serious intent to re-enter. They should become familiar with the Board’s regulations and how these regulations apply to their context because some processes can take time, particularly when the absence has been for more than 36 months.

It is each individual GP’s responsibility to ensure their safety to practise as well as their personal wellbeing. A well-considered plan for re-entry will be guided by these two principles and will ensure a smoother transition into practice.

Chronic illness and disability is not a contraindication to clinical practice. Once again, patient safety is paramount. Allowances and adjustments can be made in the workplace so that the GP may function to the best of their ability, and advice and/or assistance in achieving this may be sought from:

• the GP’s treating doctor(s)
• a rehabilitation physician
• an occupational physician
• an allied health professional, such as an occupational therapist or physiotherapist, who has knowledge of the GP’s health issues and is in a position to advise.

While there is significant overlap between the roles of the rehabilitation physician and the occupational physician, the occupational physician is possibly better positioned to provide independent advice and support to not only the GP re-entering the workforce but also to the practice.

The practice that the GP is proposing to work in, may itself need an action plan. Apart from supporting the GP’s re-entry, the practice should have considerations for the functioning of the organisation and of those who will be working closely with the re-entering GP.

The following four elements should be considered as part of the practice’s re-entry plan:

• Preparatory work before the GP commences
  • informing those in the practice of the GP’s intention to re-enter practice and any accommodations that will have to be made to facilitate that re-entry
  • identifying support mechanisms, including the need for mediation should relationships become strained
  • working hours and rosters
  • with respect to a disability, making any necessary adjustments or modifications to the workplace.
• Formal induction and orientation to the practice
  • identifying how re-engagement with clinical activities will be managed (perhaps gradually phasing in to the clinical role)
  • explaining organisational structures and processes (including billing)
  • providing orientation to the medical software.
• Clear communication to reduce misunderstandings and to manage expectations within the practice, including
  • briefing the supervisor and other parties that are directly involved in the GP’s re-entry program (information to those not directly involved should be on a ‘need to know’ basis)
  • communicating with patients where necessary
  • preparing for possible media inquiries or interested patient groups.
• Responding to the needs of individuals within the practice. Some individuals may feel uncomfortable or have reservations about the particular GP who will be working alongside them. Any issues should be discussed, preferably on a one-to-one basis, and the issues resolved (as far as possible) before the GP commences work.