Medical Council News - March 2020

Important message from the Ministry of Health

Kia ora koutou

The Ministry of Health is seeking expressions of interest from doctors who have let their registration or practising certificate lapse and would like to return to work for a limited amount of time as part of the national strategic approach to managing COVID-19. We are seeking interest from doctors who ceased practice in the last three years.  

In the first instance, we are seeking doctors who can immediately join the Healthline and contact tracing initiatives.  This work will include:

  • providing initial and on-going advice to members of the public
  • undertaking tracing of people who have been in close contact with a person with COVID-19.

The Ministry will continue to liaise with the Medical Council, as our understanding of New Zealand’s pandemic workforce needs develops.  It is likely that we will be seeking doctors to work in more clinically-focussed roles as we scale up the workforce as part of response to COVID-19.

Key points to note:

  • This is a paid role and you will be working for the organisation providing the health service
  • As part of your expression of interest, please provide the following information:
    • Name
    • Date of Birth
    • Physical address
    • E-mail address
    • Whether you are currently registered
    • When you last held a practising certificate
    • What scope of practice you held
    • Your registration number
  • Please also tell us whether you would like a non-contact or contact role (or both) and whether you wish to be considered for future roles as they become available

To register your interest, please go to the following link:

https://tinyurl.com/covid19nz

If you require a practising certificate, the usual requirements will apply. The Medical Council will ensure the process is as efficient as possible, with skills matched appropriately, and public protection the key priority.

Thank you for your on-going support as we continue to take steps to manage the strategic response to COVID-19. If you have any questions please get in touch using the details above.

Anna Clark
Deputy Director General Health Workforce
Ministry of Health


Medical Council guidance for doctors working with (potential) COVID-19 patients

This is a particularly challenging time for the profession. A global pandemic presents new and complex issues for all doctors but particularly for those doctors who are working directly with patients who may have COVID-19. In this issue we are focusing on COVID-19, our response, and providing guidance to the medical profession.

We have updated the advice which was emailed to all practising doctors on 11 February 2020. Since then, the COVID-19 pandemic has continued to spread around New Zealand and the world, with over 180,000 confirmed cases globally, and 11 confirmed cases in New Zealand. The expectation is that more will soon be diagnosed, despite best efforts. Planning and action is occurring at all levels of Government in response to the economic challenges to the country and to prepare for the health impacts in communities and at practice and hospital doorsteps.

We have had an increasing number of enquiries from doctors who are seeking guidance relating to their professional responsibilities and obligations.  There are two aspects to this. Firstly, when the patient poses a risk to the doctor. Secondly, when the doctor poses a risk to the patient.

Council’s statement Good Medical Practice provides Council’s guidance on the ethical and clinical conduct expected of doctors. It is important to emphasise that this is guidance and that as such it will not necessarily provide specific answers to the many different circumstances that might apply in any given situation. As with most of medical practice, doctors need to exercise judgement but with reference to guidance.

The first points made in Good Medical Practice are ‘make the care of patients your first concern’ and ‘protect and promote the health of patients and the public’. These points apply regardless of which way around the risk is being posed.

Good Medical Practice also states ‘If a patient poses as risk to your own health and safety or that of other patients or staff, you should take all reasonable steps to minimise the risk before providing treatment or making suitable arrangements for treatment.’ And also ‘In an emergency, offer to help, taking account of your own safety, your competence, and the availability of other options for care.’

The key phrase in this guidance is that ‘you should take all reasonable steps’. The nature of these steps will depend upon the specific situation but guidance on how to minimise risk in a pandemic situation is available from many sources but I would particularly point to that available from the Ministry of Health, which is regularly updated, and is an important and consistent single information resource and can be found here .

Experience demonstrates that health care workers can safely provide care to patients with COVID-19, and have an important role in limiting the spread of the infection by adhering to strict infection control protocols.

Council does not expect any doctor to deliberately put themselves in danger to treat a patient in a pandemic or emergency. You should not risk exposure to COVID-19 when examining or treating patients if appropriate personal protection equipment is not available. It is also important that you make yourself aware of any relevant protocols in effect at your place of work, in addition to those notified by the Ministry of Health.

Council also has expectations when a doctor poses a risk to their patients. These expectations arise from the consideration of whether a doctor has the ability to perform the required functions of a doctor as required under the Health Practitioners Competence Assurance Act 2003. Under this consideration Council includes that a doctor must not risk infecting patients.

Below are links to relevant Council statements, which I encourage you to read.  This includes guidelines issued by Council, in conjunction with other health practitioner regulators in New Zealand (the HRANZ joint guidelines).

Council will continue to provide support and leadership to the medical profession, so that the profession can continue to serve the public in these most challenging of national and global circumstances. I am confident Council has the resources, people, and processes to provide “business as usual” in an environment that is anything but usual.

As always, we welcome your feedback and suggestions, and I thank you on behalf of the public for your dedication and commitment.

Noho ora mai e te whānau whānui,

Curtis Walker
Chair
Medical Council of New Zealand


Message from the Chief Executive

We have been considering a number of issues related to COVID-19 from the perspective of supporting the Ministry of Health and the profession in protecting the public, supporting our staff and ensuring business continuity. We have taken a number of steps including, but not limited to:

  1. Implementing Council’s COVID-19 pandemic scope of practice. This allows doctors who have ceased practice within the last three years to be registered and be issued a practising certificate.
  2. Activating our business continuity plan and being fully prepared to run the necessary business of the Medical Council with staff working from home.
  3. Holding all Council and Council Committee meetings via videoconference only, and ceasing international travel, and all non-urgent domestic travel.
  4. Considering the implications that COVID-19 may have on interns and their training and education in their PGY1 and 2 years, as well as on all doctors and their ability to complete continuing professional development and recertification requirements.
  5. Working with District Health Boards and vocational training providers (colleges) to reschedule accreditation visits and extend accreditation periods where necessary.
  6. Working with other local and international medical regulatory bodies and the Government, through the Ministry of Health on coordinated national and international response.

We appreciate the excellent work the profession is doing to protect the public during this challenging time. We also acknowledge those doctors who may have recently retired who have expressed a strong desire to help.

Ngā mihi

Joan Simeon
Chief Executive
Medical Council of New Zealand

 

Intern training requirements during COVID-19 pandemic

We are aware of concerns of PGY1s and PGY2s in meeting the time requirements for the prevocational training programme if/when they are required to self-isolate during the COVID-19 pandemic.

A further question has also been raised around whether interns can be requested to take up other roles outside of their accredited clinical attachments in order to support pandemic service delivery – e.g. in mobile, community-based clinical teams. We will consider this after receiving further advice.

We will be liaising with prevocational educational supervisors to ensure interns are not disadvantaged because of issues arising from COVID19.

 

Recertification (including CPD) requirements

We will be liaising with medical colleges about taking a flexible approach to recertification (including CPD) requirements during the COVID-19 pandemic. It is sensible to ensure doctors can focus on helping with the most urgent needs facing our communities at such a difficult time. We will be encouraging colleges to ensure doctors are not disadvantaged throughout the course of the pandemic.


Concerns raised to us about conduct and competence issues

Every year, the Medical Council (Council) receives around 200 notifications about a doctor’s conduct or competence. Notifications come from a range of sources – including the Accident Compensation Corporation, the Health and Disability Commissioner (HDC), District Health Boards, the Police, colleagues, employers and other health practitioners.

We also receive notifications from the public, however, when a notification relates to health and disability services provided to a health consumer, we are required by law to refer the notification directly to the HDC.

Conduct concerns

Conduct concerns are treated differently from competence. Conduct concerns relate to the appropriateness of a doctor’s behaviour or actions, or an alleged breach of professional or ethical standards required of doctors.  Conduct concerns can be referred by us to a Professional Conduct Committee (PCC) for a full investigation. As a result, the PCC may recommend to us that it review a doctor’s fitness to practice and/or health, and/or adopt an educational approach. For more serious breaches, the PCC can determine to lay a disciplinary charge in the Health Practitioners Disciplinary Tribunal (HPDT). The Tribunal may order various penalties including cancelling or suspending the doctor’s registration, imposing a fine of up to $30,000, or imposing conditions on the doctor’s practise.

Competence concerns

Competence issues relate to whether a doctor is able to safely practise medicine to a satisfactory standard. Competence concerns may result in a referral by us to a Performance Assessment Committee (PAC), which undertakes a broad-based performance assessment, including a comprehensive practice visit. If the PAC considers the doctor is not practising at the standard of competence required for a doctor at that level and in that scope, then generally a rehabilitative and educative approach is taken to bring them up to the required standard of competence.

Public safety

Our primary focus is on public health and safety, through ensuring doctors are fit to practice. We take all notifications about doctors’ conduct and competence very seriously. We also recognise that it is a very stressful time for doctors being subject to these notifications. To protect the public and to ensure doctors receive a fair process, we have a set of transparent procedures in place that adhere to the principles of natural justice, when dealing with notifications about doctors. These procedures are based on the Health Practitioners Competence Assurance Act 2003.

Occasionally, we are notified of particularly serious concerns that pose a possibility of serious harm to the public. When this occurs, and depending on the situation and the severity of the risk, we have the option to impose conditions on a doctor’s practise or suspend a doctor’s practising certificate. Fortunately, these situations are rare, but when they do occur, there are strict legislative requirements we must follow.

Trends in PCC investigations

Although the total number of notifications to us has remained relatively constant over recent years, there has been a significant increase in the number of referrals of conduct concerns to PCCs for further investigation. Some key trends have also arisen in recent years.

In 2016, approximately 18% of all referrals to a PCC were for alleged breaches of sexual boundaries, in 2019, it was approximately 30%. A possible explanation for this is shift in cultural and societal norms towards sexual misconduct and harassment – a flow-on effect from the global #metoo movement. The public are more empowered to identify inappropriate professional behaviour, encouraged to speak out, and consequently have an increased willingness to make notifications, including for historic offending. We have a zero tolerance position on breaches of sexual boundaries, and PCCs that find evidence of a breach of sexual boundaries will invariably refer the matter on to the HPDT.

Trends in PAC assessments

The number of PAC assessments ordered by us has remained relatively constant in recent years. There are fewer referrals to PACs than to PCCs each year, with PAC referrals resulting from approximately 11% of all notifications to us in the past two years.

Unlike PCC investigations, which relate to a particular concern, PAC assessments are broad and encompass the doctor’s entire practice. As such, trends in the concerns referred are not easily identifiable. Approximately 29% of PAC assessments between 2015 and 2019 have resulted in doctors being directed to take part in education programmes to improve aspects of their performance.  These education programmes tend to address multiple areas of concern as identified in the PAC assessment.  About 20% of doctors who undergo educative programmes to remedy competence concerns are later the subject of further notifications.

A safe profession for New Zealand

New Zealanders rightly have a high degree of trust and confidence in the medical profession. Of the approximately 17,000 doctors with current practising certificates in New Zealand, only a very small proportion come to our attention for concerns about their conduct or competence.  When notifications are received, we have rigorous and transparent procedures in place to assure public safety.  Our procedures are designed to be safe, accessible, fair and proportionate, and transparent. Assuring public safety, through safe medical practice, maintains confidence in the profession and supports high quality healthcare for all.


Statement of providing care to yourself and those close to you

Council is concerned at the high number of notifications involving doctors treating or prescribing themselves or those close to them (typically family members). Such a practice is a risk to the doctor and the person receiving treatment.

Council released the most recent version of its Statement on providing care to yourself and those close to you in November 2016. This statement is clear that doctors should not provide treatment to themselves, or anyone close to them except in ‘exceptional circumstances’ (as defined). Council strengthened this statement to make it clear that in the vast majority of clinical situations, Council expects you will NOT provide care or prescribe to yourself or those close to you.

The rationale behind this is to ensure continuity of care and clinical objectivity is maintained. Regrettably, over three years on since the 2016 statement was released, the number of referrals to PCC alleging doctors’ self-prescribing and prescribing to those close to them, have increased.  It is unclear why, given that Council’s expectations in this area have evolved over the past 15 years, many of the allegations referred to PCCs have involved doctors prescribing drugs of potential abuse on repeated occasions to friends and family, or to themselves. 

If in doubt, don't do it. If still in doubt, contact the Council for advice.

 


'Publication orders'

A recent change to the Health Practitioners Competence Assurance Act 2003 sets a new requirement on all health profession regulators, including the Medical Council.  We are now required to publish a policy setting out on when we might make public in some way, information about an order or direction made by us about a doctor.

Following consultation in 2019, with a wide range of stakeholders, including all registered doctors, we finalised the policy late last year and it is published on our website. It will come into effect on 1 April 2020. Click on the link below for more information or to view the policy.

Council's publication orders (Naming policy) - April 2020