Philip PigouChief Executive Officer

Medical Council of New Zealand

9:50 - 10:10 Medical Registration Issues

Regulation and registration of doctors in New Zealand

GPCMERotorua

Philip Pigou

Chief Executive

June 2016

The Lancet view 1897

New Zealand described as …

“… a happy home for every kind of unfeathered quack.”

Lancet 1897 (1): 490

Protecting the public – purpose and vision

Statutory purpose

‘… to protect the health and safety of the public by ensuring that doctors are competent and fit to practise’

And our vision is

‘Provide leadership to the medical profession and enhance public trust by promoting excellence and openness in medical practice’

Challenge for medical regulation

Regulation has limits – regulators are not and cannot be at every doctor/patient interaction (the point of risk)

Create a system that is focused on patient and public safety, that hears their voices and speaks for them; where the quality of doctors is assured and the quality of doctors is continually improved; and where networks and relationships are established that reduce risk to patients.

… and enhances the working and professional environment for doctors

Our principles of regulation

• We make decisions as an independent regulator, free of influence from external bodies

• We operate as a right touch regulator, ensuring the most effective, efficient, consistent and proportionate regulation

• We work collaboratively with stakeholders

• We work to improve cultural competence with the aim of improving health equity

Core Functions of Council

• Scopes of practice, qualifications, registration and accreditation

• Ensuring the ongoing competence of doctors

• Set standards of clinical competence, cultural competence and ethical conduct

• Manage individual cases of health, competence and conduct

Changes in Health

• Health changes are rapid – ‘knowledge doubles every 80 days’

• The public want excellence in their healthcare

• Our knowledge of health is increasing

• Telemedicine is taking off

• Population and workforce are aging

• Mistakes do occur which drives the quality agenda

And we see economists and governments reviewing where funding goes

Change is coming

Prevocational changes

• Changes implemented November 2014

– NZCF

– ePort

– Assessments

– Accreditation

• Community Based Attachments – now to 2020

Registration of IMGs

• 1200 IMGs registered every year (140 in GP)

• NZREX graduate doctors are interns at the level of a PGY1

• Orientation and supervision – quality assurance tools

– Primary supervisor in vocational scope onsite

– Additional supervisor where only one vocationally registered primary supervisor is available onsite

– Supervision reports required every three months

Approved Practice Settings

An alternative to individual supervision plans

• accreditation as an APS demonstrates that appropriate support and supervision is available and provided to IMGs

• an APS must provide evidence that there are systems to support:

– effective clinical management of doctors

– clinical governance; and

– regulatory assurance

Cultural competence

‘Discourses referencing the culture and behaviour of Māori (and Pasifika) were identified. Aspects of Māori culture—or what is understood to be characteristic of Māori patients—such as shyness, passivity, a fatalistic attitude, large and uncontrollable families and impulsive and deviant behaviours around health were all drawn on as potential causes of health inequities.’

Rowan Manhire-Heath

Master of Public Health

University of Otago

Recertification

Council’s focus:

• A collegial approach to identifying learning needs

• Evidence based learning

• An emphasis on standards and the Code of Consumers Rights

• Cultural competence

Practising Certificate is not a tax receipt, it is the visible display of competence

Ongoing challenges

Multitude of challenges we face as a regulator

• Both quality improvement – moving the bell curve to the right …

• and continually improving our quality assurance.

• Identifying and managing risk factors – who are we concerned about; and why?

• Engagement with key stakeholders – what is their role in regulation?

The Regulators

Medical Council of New Zealand

Health and Disability Commissioner

Health Practitioners Disciplinary Tribunal

Accident Compensation Corporation