Approved practice setting (APS)
An employer or service may choose to meet the standards to become recognised as an approved practice setting (APS) for the purposes of employing and supervising international medical graduates. Once a service has been recognised as an APS it will not need to submit individual supervision plans to the Council for approval.
Benefits of recognition as an APS
The accreditation as an APS demonstrates that appropriate support and supervision is available and provided to IMGs. This ensures their safe integration into medical practice in New Zealand, and demonstrates there is ongoing assessment being provided. Benefits of being accredited as an APS include:
- A supervision framework can be established for services that span more than one site
- Individual supervision plans for each IMG applying for a provisional general or special purpose scope of practice do not need to be submitted
- Service or practice does not need to submit supervision reports (RP3s) to Council unless they are unsatisfactory. Supervision reports (RP3) need to be completed for each IMG and stored in the services’ portfolio for the IMG
- The APS provides a mechanism to streamline the internal processes and policies of the service or practice.
Criteria for recognition as an APS
To be recognised and accredited, an APS must provide evidence that there are systems to support:
- effective clinical management of doctors
- clinical governance; and
- regulatory assurance
Effective clinical management of doctors
There are several requirements to ensure the effective clinical management of doctors:
- An annual appraisal or assessment process for individual doctors, based on the principles of Good medical practice.
- Processes for credentialling international medical graduates on appointment (or alternative appropriate process in general practice), with annual review.
- Documented induction and orientation processes for international medical graduates. These should meet the Council’s best practice guidelines, with a formal mandatory programme that includes cultural competence, the Treaty of Waitangi, and an understanding of the New Zealand health system.
- A documented framework for the supervision of international medical graduates that meets the requirements outlined in the Council’s booklet Orientation, Induction and Supervision for International Medical Graduates. An APS requires a service to have a minimum of two doctors registered in the same vocational scope as the international medical graduate. If the service spans two or more sites, by either a network or joint service arrangement, then evidence must be provided of the extent to which the international medical graduate will work with other doctors registered in the same vocational scope, and how this will occur.
- Portfolios for each international medical graduate should include:
- a logbook of procedures performed (for procedural specialties)
- evidence of peer review activities and audit of medical practice
- documentation of training and educational activities
- supervision report
- information about complaints or incidents relevant to fitness to practise, including any concerns raised by colleagues, and
- other relevant papers or correspondence
- Relevant training or continuing professional development based on identified educational needs, so that doctors have access to and participate in activities to update the knowledge and skills relevant to their professional work.
- A learning environment for the international medical graduate must be provided – for example, access to the internet and relevant literature.
A system of clinical governance or a quality assurance system must be in place. It must include clear lines of responsibility and accountability for the overall quality of medical practice, as set out below:
- A formal structure must be in place that is supported and used for service or hospital-wide decision making on key clinical issues, including evidence of:
- an organisational structure that supports clinical governance
- meetings occurring with content on clinical matters, and
- structured and regular peer review/ case review processes that focus on learning, with evidence of attendance and submissions to review.
- There must be evidence that quality and patient safety are a priority for the service or organisation.
- Clear policies aimed at managing risks must be in place and evidenced by:
- a risk framework in the service or organisation
- a formal incident management system, using tools such as root cause analysis, and including methods of improving the processes and systems that have contributed to the incident; and
- evidence of support for staff involved in any incidents or near misses that provide a learning opportunity.
- There must be evidence of acting on and learning from complaints, including:
- a formal consumer complaints policy, and process, with evidence of feedback to staff; and
- evidence of full disclosure to patient(s) and family members as appropriate.
- Concerns about doctors’ fitness to practise must be identified and acted upon. This should include:
- procedures to support the individual to improve their performance whenever possible
- support for doctors in their duty to report any concerns about colleagues’ fitness to practice (including conduct, health, or performance); and
- clear procedures for reporting concerns so that early action can be taken to avoid harm to patients and to remedy problems.
Each APS must provide regulatory assurance that all employed or contracted doctors:
- are registered with the Medical Council of New Zealand
- hold a current practising certificate
- are working within any conditions of their practising certificate; and
- are both required and enabled to abide by Good medical practice.