24 March 2017
Is the AHPRA complaints mechanism broken?
It appears there is room to improve the complaints mechanism administered under the Health Practitioner Regulation National Law.
A recent senate submission by the Royal Australian College of General Practitioners reflected the feedback received via a member-wide consultation.
The feedback indicated a perceived lack of balance in the system whereby GPs were subject to highly stressful investigations that seemingly assumed guilt.
AHPRA’s most recent annual report notes that of the 2718 matters involving medical practitioners closed that year, 71.2% resulted in no further regulatory action.
But regardless of whether a doctor is at fault or not, the AHPRA complaints process can be stressful and onerous for doctors. It involves a large time commitment from time-poor medical professionals, can have significant reputational and professional consequences, and the stress experienced by doctors resulting from a lengthy investigative process has the potential to negatively influence patient care.
For that reason, it is important to ensure the complaints mechanism is balanced: ensuring patient safety while making sure that the process is fair and supportive of medical practitioners.
It seems that the current process is often more concerned with the prosecution of doctors than protecting patient safety. Remediation of the underlying issues that lead to the complaint does not appear to be a priority within the current system.
The RACGP submission raised concerns relating to the lack of support for doctors under the complaints mechanism. Support mechanisms are especially important for rural and remote doctors, as well as international medical graduates, who are often relatively more isolated and may have a smaller support network to call on.
Following feedback from members, the RACGP also raised concerns that AHPRA investigators and Medical Board members do not always have sufficient experience or knowledge of general practice to understand the nature or significance of a complaint.
In order for doctors to receive a fair investigation, all cases should be assessed by a medical practitioner with in-depth knowledge and relevant experience in the specialty concerned. The RACGP recommended that a wider pool of medical practitioners be sourced to ensure that cases are reviewed by doctors with an appropriate level of understanding of the relevant specialty.
Another key concern raised by RACGP members was that vexatious complaints were currently not filtered out, and the RACGP therefore recommended that a process be put in place to deter and penalise submission of vexatious complaints.
Vexatious complaints are often submitted by colleagues, rather than by patients. The submitting of complaints by colleagues was the focus of a 2016 senate inquiry into the medical complaints process in Australia. The final report from the previous inquiry is what prompted the current senate inquiry.
Communication and transparency were also identified as issues in the current system. The RACGP was informed of multiple scenarios where doctors involved in the complaints process did not receive information outlining the process or when to expect further communication. This uncertainty caused significant distress.
The RACGP recommended that a clearly defined process regarding the complaints mechanism should be developed and circulated to doctors after they received notification of a complaint, so they were aware of what to expect and when to expect communication.
The RACGP also reported that doctors were often contacted about the case by several AHPRA representatives. This was unsettling for the doctors involved, as there was a perceived lack of continuity of knowledge of the doctor’s circumstances. It would be beneficial for the complaints mechanism to strengthen the continuity of those contacting and managing each complaint.
Privacy issues were also raised. Specifically, members highlighted circumstances where details of a complaint, including findings of the investigation, were published online prior to completion of an appeals process.
Medical practices may be significantly affected by conditions that are published online and available for patients to access if it is done so prematurely. If the appeals process concludes that the practitioner is not at fault, the published conditions could have already jeopardised the reputation of the practice.
Another concern regarded the lack of security, with RACGP members noting that they have been asked to supply information via email. Members are concerned that they may be vulnerable to further prosecution for sharing patient information via an unsecure network.
The RACGP has made recommendations to the Senate committee on how to better manage sensitive information. Furthermore, a lack of promised timeliness of investigations came in for criticism. AHPRA states they aim to complete investigations within six months.
However, RACGP members reported instances where investigations had spanned several years. Timeliness is important for both for the safety of patients and the wellbeing of doctors who have been falsely accused, and their families.
The RACGP highlighted the necessity for the complaints mechanism to recognise that where practitioner wellbeing is affected, patient safety is at risk. In order to put patient safety first, a fair and supportive complaints mechanism is essential.
The RACGP offers a GP Support Program, a free service for members to access professional advice to help cope with life stressors.
Dr Edwin Kruys is a GP and Vice President of the RACGP. Susan Wall is a Policy and Project Coordinator in the PPI, Advocacy & Funding Unit at the RACGP.