Report on the 2010 review of the Medicare provider number legislation

Chapter Two - Status of the 2005 Biennial Review of the Medicare Provider Number Legislation recommendations

Page last updated: 15 November 2012

Just over half of the recommendations from the 2005 Biennial Review have been fully implemented. Four recommendations were superseded over the five years since the Review and are no longer relevant (3.1, 3.4, 11.2 and 12).

The status of the recommendations and results are shown in Table 2.1. The recommendations that were not fully implemented are listed below.

Recommendations not implemented

  • Recommendation 1: Provide one more opportunity for doctors who meet the necessary criteria to be grandfathered onto the Vocational Register.
  • Recommendation 3.3: Consider further investment to support the quality and training aspects of the RLRP, AMDS Program and other s3GA workforce programs because of their value in providing quality care to rural areas.
  • Recommendation 5.3: Specifically, implement a staged program that over time will lead to ensuring that all medical practitioners participating in the RLRP for an extended period of time (e.g. more than 12 months) receive the appropriate assessment and training to achieve Fellowship of a recognised specialist college.
  • Recommendation 6.2: The Divisions of General Practice and local MDSss are to develop closer cooperation to promote coordination between general practice and MDSs with a particular emphasis on participation of MDSs in Division Aged Care GP Panels to assist in providing after-hours services to residential aged care facilities and the possible use of MDSs in providing in-hours care to these facilities.
  • Recommendation 8: GPET, the AMC and the relevant medical colleges to review the entry criteria for the AGPT Program to enable OTDs with suitable qualifications (other than passing the Australian Medical College exam) and experience to enter the program.
  • Recommendations 10.1 and 10.2: The Australian Government to establish a review committee (membership as specified in Recommendation 10.2) who will call for and respond to submissions on the problems and possible solutions associated with applications for provider numbers and 3GA programs.

The seven recommendations not yet fully implemented address issues that are still current; these are discussed in the following chapters. In most instances there is little information to explain why the recommendations were not actioned.

Three recommendations called for interagency committees to be involved in refining guidelines or addressing issues. It appears that although two of these recommendations were actioned, the organisation responsible for managing the programs did the work and formal interagency committees were not involved.

Table 2.1 Status and results of 2005 Biennial Review Recommendations

No.RecommendationStatusResults and comments
1
Provide one more opportunity for doctors who meet the necessary criteria to be grandfathered onto the Vocational Register.Not implemented.Affected group of doctors and their patients disadvantaged financially.
2
The MTRP be directed to monitor and report regularly on the activities and progress made to ensure adequate intern and training positions are in place to meet the increasing numbers of new graduates.Implemented.MTRP Annual Reports provide data on intern placements.

Data assists industry to understand training needs and initiatives to address these. More information needed about availability of Postgraduate year (PGY)1–3 and prevocational placements.
3.1
The review concludes that there is a need to maintain the current list of s3GA training and workforce programs and sees no need for any additional programs. Superseded.List has changed to meet changes in policy, and new circumstances.

Approved placements meeting policy needs.
3.2
There should be an increasing emphasis on standardised assessments, structured education, supervision and mentorship in all the workforce programs.Implemented.National Assessment process for OTDs introduced.

Guidelines on most workforce programs strengthened. Not implemented for SAPP and Temporary Resident Other Medical Practitioner (TROMP) Program.

More support being provided but stakeholders remain concerned about quality of supervision/sufficiency of support for training.
3.3
The Australian Government should consider further investment to support the quality and training aspects of the RLRP, the AMDS program and other s3GA workforce programs because of their value in providing quality care to the rural.Not implemented.No additional investment made.

Additional investment being sought.
3.4
The Australian Government should continue to stress the need for medical boards to have a more consistent national approach to their assessment and approval processes.Superseded.A standard national assessment process was introduced in 2008 and a national registration process in 2010. Both processes used by all workforce programs.
4
DoHA to monitor the progress of Queensland Health’s review of the Queensland Country Relieving Doctors (QCRD) Program and the implementation of changes with particular attention to ensuring the guidelines provide for effective preparation, training and support and work towards achieving the same standards expected of other s3GA workforce programs.Implemented.New program guidelines require supervisors to be identified and parameters set for adequate supervision.

Compulsory induction and training courses to prepare locums developed.

Queensland Health report locums are better prepared and have better access to support and supervision.
Stakeholders remain concerned about adequacy of supervision given the inexperience of junior doctors on locums and associated risks.
5.1
DoHA to establish a formal and representative committee including non-Rural Workforce organisations (e.g. groups associated with quality and training) to review the guidelines of the RLRP.Partly Implemented.Guidelines reviewed in 2008 and 2010 by RHWA (2010 draft not approved by DoHA).

Guidelines operating effectively, being followed. No interagency committee.
5.2
The review of the RLRP should take into account the recommendations of the 2003 Review not already implemented with particular emphasis on addressing quality assurance issues around assessment, mentoring, supervision and training.Implemented.Guidelines cover quality issues for mentoring and training.

Assessment done under national assessment process, with States and jurisdictions having their own final assessment processes before recruiting.

Supervision set by registration requirements. Adequacy of supervision remains a concern because of lack of capacity in some locations.
5.3
Specifically, implement a staged program that over time will lead to ensuring that all medical practitioners participating in the RLRP for an extended period of time (e.g. more than 12 months) receive the appropriate assessment and training to achieve Fellowship of a recognised specialist college.Not fully implemented.Additional Assistance Scheme has waiting list and is underfunded; established in 2003.

GPs can access $7,000 for training through Additional Assistance Scheme

Funding for this scheme was doubled in 2010-11 to address the waiting list.
6.1
DoHA to complete and implement the revised guidelines for the AMDS program in line with the recommendations of the 2003 review.Implemented.Quality processes strengthened. New guidelines developed in 2007 and being implemented.
6.2
The Divisions of General Practice and local MDSs are to develop closer co-operation to promote coordination between general practices and MDSs with a particular emphasis on: participation of MDSs in Division Aged Care GP Panels to assist in providing after-hours services to residential aged care facilities and the possible use of MDSs in providing in-hours care to these facilities.Not fully implemented.MDSs not currently providing in-hours care to residential aged care facilities.
6.3
To streamline the administration of the program, DOHA are to extend the duration of both the Deeds for MDSs and provider numbers to doctors.Implemented.Improved administration of program for practices.
7.1
The Australian Government monitor and plan to ensure that there are adequate positions available to cover the increase in demand that will result from an increase in the number of medical graduates.Implementation in progress.Places on training programs are being expanded.

Sufficient places available on AGPT program in 2010.

RVTS had more applicants than places in 2010.

Concerns over adequacy of infrastructure and capacity to provide GP training placements.
7.2
The National Advisory Committee examine the feasibility of establishing some demonstration sites to test the feasibility of part-time placements.Implemented.More flexibility for students and practices.

Part-time placements allowed on PGPPP.
8
GPET, the AMC and the relevant medical colleges to review the entry criteria for the AGPT to enable OTDs with suitable qualifications (other than passing the AMC exam) and experience to enter the program.Not implemented.35% of current AGPT cohort are OTDs. Temporary residents are not eligible.
9
DoHA to provide an extension for medical practitioners on the Approved Placements for Sports Physicians Program until the AMC makes a decision regarding recognition of their speciality and training program.Implemented.Program extended until October 2010. Sports medicine recognised as a speciality in January 2010. Program removed from list as of 31 October 2010.
10.1
The Australian Government to establish a review committee who will call for and respond to submissions on the problems and possible solutions associated with applications for provider numbers and “Approved Placement Programs”. Not implemented.Appears no such committee was formed.

Stakeholders remain frustrated about requirements for applications for provider numbers and timeliness of processing.

DoHA reports recent administrative arrangements are reducing waiting times for exemptions and provider numbers.
10.2
The committee should comprise amongst others the Australian Medical Association (AMA), GPET, the Australian Rural and Remote Workforce Agencies Group, NAMDS, Medicare Australia and DoHA.Not implemented.Appears no such committee was formed.
11.1
The Review concludes that there is a need to maintain the role of the MTRP.Implemented.Role has been maintained since 2005.

Valued forum with recognised expertise on medical training.
11.2
The MTRP should improve the process for the more effective use of funding provider under the National ProjectsSuperseded.The MTRP no longer administers National Project funding.
12
DoHA are to consider and if necessary meet with appropriate agencies to determine the best method of collecting data on the number of resident doctors who have been granted a provider number for six months or more.Superseded.Information about primary visa applications granted medical practitioners by visa sub-class is available through the Australian Government Department of Immigration and Citizenship.
Since the 2005 Biennial Review there have been significant policy changes impacting overseas trained doctors these include changes to the operation of s19AB of the Act, the issuing of non end dated s19AB exemptions under the Act and the introduction of national medical registration and accreditation.