Fitness to Practise Dr Alison Reid Medical Director March 2004

Legislation … to protect the health and safety of the public by providing mechanisms designed to ensure that medical practitioners are fit to practise medicine

Professional Regulation Historically, medical boards; recognised basic qualifications required payment of an annual fee responded to complaints

Professional Regulation Medical registration must be an up to date indication of a doctor’s fitness to practise, and not just an statement that they once achieved a basic qualification and have subsequently paid an annual registration fee.

Fitness to Practise Qualifications and experience Health Professionalism –Professional expertise –Professional conduct

Fitness to Practise Qualifications and experience

Medical practitioners must possess accepted qualifications and experience commensurate with the nature of their work.

Fitness to Practise Qualifications and experience Health

Medical practitioners’ personal health may impact on their capacity to practise medicine safely and effectively.

Health A person is considered to be impaired if they suffer from any physical or mental condition which detrimentally affects or is likely to detrimentally affect the their capacity to practice medicine.

Impaired? It’s all about insight and the person’s capacity to cope with their illness and practise within their safety zone.

Framework for managing impairment Protecting the public Maintaining the registrant in employment / training, if safe Encouraging personal responsibility Requiring, but not directing treatment Long-term follow–up and review

Fitness to Practise Qualifications and experience Health Professionalism –Professional expertise

Professional Expertise (competence) In order to practise effectively, medical practitioners must possess a large body of up-to-date knowledge...

Professional Expertise (performance) …and be able to apply it

Miller’s framework Competence Performance

Competence v Performance Experience System factors Detractors moneyillnesspersonality familyisolationstress alcohollitigationcognition addictionworkloaddisability

Competence v Performance It is likely that an incompetent doctor will perform poorly. However, a competent doctor cannot be guaranteed to perform well.

Professional Expertise Monitored through; participation in CPD Patient complaints and other notifications

Performance Spectrum A graduated series of responses. Educative / cautionary written comments Educative / cautionary interview Full performance assessment

NSW Performance Assessment Program Features performance focus peer assessment and standard educative / remedial & protective strong legislative support –compulsory participation / binding outcomes systems awareness

Fitness to Practise Qualifications and experience Health Professionalism –Professional expertise –Professional conduct

Professional Conduct Medical practitioners must exhibit behaviours and attitudes that reflect the expectations of those with whom they interact and the society in which they work.

Professional Conduct Monitored through; practitioners’ declaration of any criminal charges / convictions Patient and other complaints

Professional Conduct Disciplinary action only when a doctor’s conduct has been; reckless unethical wilful criminal ‘The RUWC test’

Professional Regulation In all other situations, regulation should focus on maintenance of standards through; early intervention and resolution remediation

Fitness to Practise...can never be guaranteed. Boards will always rely on notifications of impairment, poor performance and aberrant behaviour.