Feedback on the second draft of the RACGP Standards for general practices (5th edition)

Feedback from medical indemnity insurers

Contents:

• Avant - p. 2 • MDA National Insurance - p. 6 • MIGA – p. 19

30 September 2016

Dr Zena Burgess

CEO

RACGP

100 Wellington Parade,

East Melbourne

Victoria 3002

By email: julie.khoury@racgp.org.au

Dear Dr Burgess

Developing the next edition of the RACGP Standards for general practices

Avant welcomes the opportunity to provide input into the development of the next

edition of the Standards for general practices (the Standards).

Our submissions on the second draft of the Standards are attached.

Please contact me on the details below if you require any further information or

clarification of the matters raised in this letter.

Yours sincerely

Dr Walid Jammal

Senior Medical Advisor-Advocacy

Direct: (02) 81999556 Email: drwalid.jammal@avant.org.au

About Avant

Avant Mutual Group Limited (“Avant”) is Australia’s largest medical defence organisation, and offers a range of insurance products and expert legal advice and assistance to over 64,000 medical and allied health practitioners and students in Australia. Our insurance products include medical indemnity insurance for individuals and practices, as well as private health insurance, which is offered through our subsidiary The Doctors’ Health Fund Pty Limited.

Our members have access to medico-legal assistance via our Medico Legal Advisory Service. We have offices throughout Australia, and provide extensive risk advisory and education services to our members with the aim of reducing medico-legal risk.

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01

Avant submissions on the second draft of the 5th edition RACGP Standards for General Practice

Avant supports the overall intent of the Standards in providing a framework for good

practice and a template for quality care and risk management in Australia. We refer

you to our first submissions dated 4 April 2016, and commend the RACGP on the

changes made to date and on the consultation process.

Avant’s comments to the second draft are contained in the attached table.

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Avant’s Comments on the Standards

Proposed RACGP Standard/Criteria

Number/page number

RACGP standards and explanatory notes state

Avant Submission

Page 27 Cost of care- Stakeholder question about the explanatory notes explaining cost of care

Yes – they are clear

Page 32 Explanatory note giving an example of an ethical dilemma as “decision to provide treatment against the patient’s wishes”

Treating a patient against their wishes is unlawful and raises a number of ethical and legal issues. As recommended in our previous submission, this example should be removed. A more useful example may be one where there is conflict between the doctor’s views and the patient/family’s views as to what is appropriate treatment.

Page 38; criterion 2.2 The explanatory notes say: “When a patient is accompanied to the practice by a third person (such as a family member or carer), the patient’s consent to the presence of that person in the consultation is implied. However, it is good practice to record their presence and the name of the third party in the consultation notes.”

We would add a sentence to indicate that the appropriateness of the continued presence of the third party should be assessed by the GP.

Page 55 In providing examples on how to deal with violent patients, the explanatory notes state: “a zero tolerance policy towards violence displaying signs that indicate the zero tolerance policy detailed steps to take when dealing with

We would suggest adding contacting the police when necessary

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violence”

Page 93 Explanatory notes on email and social media states that “ patients must be informed of your policy” Similarly, the word

“must” is used in the context of other policies.

There is no regulatory requirement that mandates practices proactively inform patients of this policy or other practice policies. We recommend removing the word “must”. We suggest wording which states that policies “should be made available” to patients.

Page 98 Criterion C8.1 The explanatory notes state: “Practices need to have an effective system to store patient’s health information in a dedicated patient health record. In addition to containing clinical information, the patient health record may also contain other relevant information, such as details of personal injury insurance claims, and legal reports”

There may be “legal reports” which may not be appropriate to keep in the patient’s records, such as legal advice sought from their MDO on issues relating to patients, or other material subject to legal professional privilege. We suggest removal reference to the legal report.

Page 153 Criterion GP 1.3C

Examples on meeting this criteria includes: “Ensure diagnostic services have contact details of the practitioner who ordered the investigation.”

Whilst we think this suggestion is good practice, we suggest not making this a mandatory requirement, as it effectively mandates the 24 hour availability of all doctors. This is an unreasonable expectation.

Page 163 Explanatory notes state that practices should keep copies of important (non routine) referral letters

Our view is that a copy of all referrals should be kept

Page 95 C7.4E Under “Maintaining a privacy policy” it is suggested that practices keep a record of the patient’s informed consent.

It is not clear what is meant by informed consent in this context, and to what informed consent applies. . We suggest removing this wording.

Email: drawalid.jammal@avant.org.au

29 September 2016

RACGP Standards Unit By Email: standards@racgp.org.au

Dear Sir/ Madam MDA National Submission – RACGP 5th Edition Standards submission Thank you for the opportunity to provide a submission in relation to the draft 5th Edition Standards. Established in 1925, MDA National is one of Australia’s leading providers of medical defence and medico-legal advocacy services. With over 45,000 Members and insureds, it works in close partnership with the medical profession on a wide range of issues which impact on medical practice. In addition to its advocacy and advisory services, MDA National’s insurance subsidiary (MDA National Insurance) offers insurance policies to MDA National’s Members which provide cover for the cost of investigations of professional misconduct and for claims for compensation by third parties. The MDA National Insurance Policy provides medical practitioners with $20 million of civil liability cover as well as a range of other professional risk covers. MDA National provides the following comments in response to the RACGP 5th Edition Standards submission. Module1: Core module Standard 1: Communication with patients Page 8 Amend typographical error, to read as follows: In order to use the Standards, accrediting bodies are required to demonstrate the following to the RACGP: ….

Page 15 Effective communication with patients is essential to ensure informed consent. It is well established that can reduce the incidence of adverse events, better ensure compliance and enable more effective continuity of care. We suggest the wording be revised as follows: “Communication must be patient-centered, which means that employees must always consider and respond to patient’s values, needs and preferences, needs and preferences, and give the patient time to provide input and participate actively in decisions regarding their healthcare. Patients must be provided with the appropriate information they need to manage their decisions’. Standard 2: Rights and responsibilities of patients Criterion2.1- Respectful and culturally appropriate care Page 31

Consequences of disrespectful care MDA submits that this paragraph should be deleted. The paragraph is convoluted and does not add to the purpose of Criterion C2.1 which is to facilitate the provision of respectful and culturally appropriate care. MDA submits that the paragraph below be substituted: “Practice staff must observe and recognise their responsibilities under Commonwealth anti-discrimination legislation when dealing with patients. The states and territories have similar legislative protections which will be relevant to the jurisdiction in which the Practice operates.” Page 32 Ethical dilemmas We submit that the following be deleted: “decision to provide treatment against a patient’s wishes”, this is potentially criminal conduct and leaves the medical practitioners and staff members criminally liable and possibly subject to adverse findings by AHPRA and their respective Complaints Commission. It is our experience that more common ethical dilemmas concern provision of sickness certificates, treating a family member, reporting a patient to a law enforcement body or licencing authority and suggest that these common examples be stated. Page 35 C2.1 A We submit that the recommendation to “Have separate entry and waiting rooms for men and women, if culturally appropriate” be deleted. This is likely to contravene the Sex Discrimination Act 1984 (Cth). Further, it impractical and costly for practices to implement. Delete the following multiple duplicate entries in C2.1 A

- Discuss cultural safety in recruitment interviews - Provide cultural safety training for practice staff and keep records of the training in the

practice staff training register. Standard 3: Practice governance and management Page 45 Planning, setting and evaluating goals We submit that the word “you” be added to the second paragraph that reads: “If you have a smaller practice (e.g. with fewer than 10 practice staff), you may wish to consider having an action plan instead of a strategy that sets out the goals and progress.” We submit that consideration be given to adding a description of what information should be contained in an ‘action plan’ ,and in what way an action plan differs from a strategic plan. For consistency, consider replacing the phrase “strategy or goals” to “strategic plan” in the paragraph that reads:

“When it comes to evaluating the practice’s progress against its strategic plan, this can be achieved in a number of ways including…” Page 46 Business risk management We submit that a comma be added in the first sentence and replace the phrase “you have managed risks” with “the practice manages business risks”. To reflect that the risk involves the whole business and not just the individual practitioner. We submit the sentence should read as follows: “You could develop a risk management strategy that identifies analyses, evaluates and explains how the practice manages business risks”. Under the paragraph that identifies practice risks, consider including a 6th bullet point:

• Poor system for updating patient contact details and following up test results

The failure of a practice to keep patient contact details updated and comply with its own procedure for contacting patients following receipt of abnormal (HIV) test results was discussed in CS V Biedrzycka [2011] NSWSC 1213). We submit in the last paragraph under the sub-heading “Business risk management” consider replacing the word “on” with “for”, so that the paragraph reads: “You could schedule regular risk management meetings and/or include risk management as a standing agenda item for team meetings so identified risks are reviewed, updated and minimised.” Induction program We submit replacing the word “process” with “processes” in the 1st bullet point, so that it reads:

• an overview of the practice’s systems and processes

Page 47 Demonstrating how you meet this Criterion Criterion C3.1A We submit that the 3rd and 4th points should be combined into one point (given that action plans are intended to apply to smaller practices, with strategic plans applying to larger practices), so that it reads: “Maintain a business strategic/action plan” Criterion C3.1 B We submit that the first point should have consistent terminology, so that it reads: “Maintain progress reports against the strategic/action plan”

Page 48 Demonstrating how you meet this Criterion Criterion C3.1 F We submit that the 4th point should be amended so that it reads: “During recruitment interviews and employee inductions inform both prospective and current practice staff that they are encouraged to be involved in practice operations by providing input and feedback on improving business operations.” Accountability and responsibility Criterion C3.2 Page 49 Meeting this Criterion Roles and responsibilities We submit that the first two sentences are inconsistent; the mandatory requirement that one member of the team is responsible for both risk management and complaints resolution is inconsistent with the next sentence that provides that the same person need not be responsible for both areas. We submit that the sentences be amended so that they read: “Your practice must appoint at least one team member with responsibility for leading risk management and co-ordinating the resolution of complaints. The roles need not be done by the same person. “ Page 50 Roles and responsibilities We submit that the second paragraph on this page should be amended by replacing the word “could” with “should”, so that it reads: “Each employee should sign and date their position description to indicate that they understand their roles and responsibilities. Position descriptions should be reviewed regularly …”. We submit that this enables the staff and their employers to have a clear idea of their roles and responsibilities in the event of a performance issue or adverse outcome. Performance monitoring We submit that the recommended requirement of regular performance meetings be changed from “weekly” to perhaps “monthly”, as weekly meetings may be too onerous for busy practices. We submit that the 5th paragraph be amended so that it reads:

“Some practitioners are contracted to practices. In order to facilitate adherence to this Criterion, the practice should state in the contract for services that the practitioner must comply with the practice’s policies and procedures.” We submit that the reference to the Standards (RACGP Standards) in the 5th paragraph be deleted. The practice policies and procedures should already incorporate the requirements set out in the Standards, therefore making it unnecessary and superfluous to specifically refer to this document in the contract for services between practice and practitioner. Page 51 Managing complaints We submit that the 5th paragraph be amended by replacing the word “mediation” with “conciliation”. We submit that the Health Care Complaints Commissions, Health Services Commissioner and the Office of the Health Ombudsman offer conciliation, not mediation, of complaints. We agree that the practice has an obligation to inform patient or others that they can complain to a Complaints entity if they have an issue with the service that has been provided. We submit that the sentence reads: “If the matter cannot be resolved, the patient can contact their state’s Health Complaints Commission for advice and possible conciliation”. We submit that the 6th paragraph, final sentence:

- be rephrased so that it doesn’t suggest that the practice has an obligation to advise the patient to seek legal advice.

- the need for an interpreter should be considered at the time when the complaint is made, not only when it is incapable of being resolved at the local level. Suggest changing the final sentence so that it reads:

“Consider the cultural and/or language needs of the patient during the complaint process and, where necessary, engage the services of an interpreter to assist the patient when managing the complaint at the local level.” Page 52 Criterion C3.2 A Demonstrating how you meet this Criterion

We submit that the 4th point should be amended by replacing the word “Show” with “Maintain”, so that it reads: “Maintain records of contracts or letters of agreement with external providers.” Page 55 Dealing with violence We submit that the 1st paragraph should be amended by replacing the word “could” with “should”, so that it reads: “Because patient aggression and patient-initiated violence in healthcare settings continues to be an issue, your practice should development a risk management strategy…” We submit that employers have an obligation to ensure a safe workplace and therefore it is essential that a strategy or policy is in place. We submit that the two bullet points in the 2nd paragraph headed; You could take the following specific actions, should be amended to ensure consistency, as follows: 1st bullet point, third sentence- The Practice is to keep a record of the process… 2nd bullet point- Set up a duress alarm system that practice staff can use if a patient is threatening or violent. Practices should have a response plan if the alarm is triggered. We submit that the practice should ensure that staff are trained in relation to the ‘response plan’. Standard 4: Health promotion and preventive activities Criterion C4.1- Health promotion and preventative care Page 62 Providing a systematic approach to preventive care We submit that the 4th bullet point: establishing a recall and reminder system be amended. We submit deleting the word “recall” when recommending the establishment of a reminder system. Recall systems are typically used to follow-up patients when test results become available. Standard 5: Clinical management of health issues Our practice provides care that is relevant to the patient and consistent with best available evidence. We submit that the sentences below be amended as noted in bold and the words: also and practitioners be added. Contemporary practice is based on the best available evidence for Australia’s current primary healthcare systems. This recognises that in the absence of properly conducted clinical trials or other evidence of equal or greater reliability, peer group consensus is an accepted level of evidence and may be the best available evidence at the time.

It is important that practitioners can exercise clinical autonomy in decisions that affect clinical care. It is also important that practices provide practitioners access to up to date clinical information and have appropriate support processes in place.

Criterion C5.1 – Diagnosis and management of health issues

Page 67

Meeting this Criterion We submit that the words should ensure be added. To read as follows: Practices should ensure that clinical practice guidelines are current, best evidence and accessible, whether online or paper-based. When clinical teams discuss clinical care, they must always compare their discussions with the best available evidence, to ensure their clinical care aligns with best practice.

Demonstrating how you meet this Criterion C5.1 A Facilitate access to clinical guidelines

We submit that ‘commence’ be deleted and the criterion read as follows:

“Have regular clinical team meetings or regular group emails documenting the topics of discussion,

and the decisions made.”

Criterion C5.2 – Clinical autonomy for practitioners

Page 69

Indicator A. Our clinical team can exercise autonomy in decisions that affect clinical care. All members of the clinical team must within the boundaries of their knowledge, skills and competence, …”. We submit that the bracket ) at end of competence be removed. Standard 6: Continuity of Care Preface to draft of Standard 6: Continuity of care Page 70 We submit that 6.3-Transfer of care and the therapeutic relationship be amended as follows; “Our practice team transfers care to another practitioner (in our practice or in another practice) when a patient requests a transfer.”

Criterion C6.1 – Requesting a preferred practitioner

Meeting this Criterion

Page 72 Courtesy notifications We submit that the paragraph be amended as follows: “When a practitioner leaves a practice, if agreed with the practice beforehand it may be appropriate to notify the practitioner’s regular patients and, if appropriate, inform them about how they can access their health information if required. Practitioners should ensure that any notification complies with privacy legislation.” We submit that it is essential to have agreement from the departing practitioner and the employer before regular patients are notified to ensure the patient’s privacy is not breached. Criterion C6.2 – Clinical handover

Page 73 Why this is important We submit that issues relating to transfer of care can not only result in legal action but also patient complaints. Suggest that the sentence be amended to read: “ It can also result in legal action and complaints.”

Page 73 Meeting this Criterion We submit that the first sentence be amended as follows and ‘must ’ be inserted as it is imperative that there is legal and medico legal obligation to ensure a clinical handover. We submit the sentence should read: “Clinical handover must occur whenever there is a crossover of care by different providers” Page 74 We submit that the first sentence should be amended to emphasise that he price should have a written policy to ensure standard processes are followed during a handover. The sentence should read as follows: “ The practice should consider having a written policy to ensure standard processes are followed during a handover’.

Criterion C6.3 – Transfer of care and the practitioner-patient relationship

Indicators Page 75

A. First sentence we submit should be amended and ‘team ‘ be deleted.

Why this is important We submit that the 2nd sentence be amended as follows: “Whether the patient chooses to see another practitioner at your practice or another practice, the practice needs to have a system that ensures that the patient receives continuous and coordinated primary care.” Page 75 Meeting this Criterion Patient requests for transfer of care We submit the first bullet point be amended as follows:

• “ a copy of the patient’s health information should be transferred to the other practice in a timely manner following receipt of a signed patient authority.

A signed authority is essential to ensure that the patient’s privacy is not breached.

• “your practice must comply with all legal requirements governing the transfer of patient health information.”

Practitioner requests for transfer of care We submit should be amended as follows: “Practitioners have the right to discontinue treatment of a patient, especially when the practitioner considers they can no longer give the patient optimal care, or when the practitioner considers it is no longer appropriate to treat the patient, (e.g. when a patient has behaved in a threatening or violent manner, or where there has been a significant breakdown in the practitioner-patient relationship). The practice should have a documented process for managing the process of discontinuing a patient’s care. This could include the process if the patient makes subsequent contact with the practice. The process could highlight the need for the practice to consult with their medical defence organisation, where necessary. “ Criterion C6.4- Contingency Plan Page 77 Indicator We submit should be amended as follows: “Our practice has a contingency plan for unexpected events, such as natural disasters, pandemic diseases, and an unplanned absence of clinical staff or medical emergencies at or in the near vicinity of the practice .” It is well established that health care professionals have a legal duty to attend a medical emergency. We submit that the following sentence be added:

“An unscheduled emergency for a patient attending the practice or a person who is not a patient but presents with a life threatening emergency requires a planned response so that the emergency can be managed and your practice can continue to provide services to regular patients at this time.” Meeting this Criterion We submit that under the heading ‘Patients’ a 3rd bullet point be added:

• Unscheduled emergency presentation. Supplies and services We submit that the first paragraph be amended and the following bullet point be added:

• Maintaining a roster for emergency responses

Demonstrating how you meed this Criterion Page 78 We submit that C6.4 A- regarding Contingency plan be amended and the following be added:

• Regular updates of contact details This will ensure that contact with staff can be readily facilitated and the plan can be implemented. Standard 7: Information management Page 83 Definition of ‘Information management’ refers only to electronic records, not paper, which are still in use by some practices. We submit that the definition be amended to include ‘paper records’. Criterion C7.3- Confidentiality and privacy of health information Page 88 Throughout Criterion C7.3 should consistently use one term instead of the following terms used variably:

- Personal health information - Health information - Patient health information

Page 89 Under “A privacy policy” we submit the following points be added, which were highlighted by an OAIC review of a random audit of GP privacy policies:

- Reference to the APPs - The kinds of personal information collected and held

- Obtaining informed patient consent when collecting or transferring health information - Contact information for patients to request access or correction, or to make a complaint - Reference to collection, use or disclosure through My Health Record system

Page 91 Criterion C7.4 Information security Meeting this Criterion We submit that under “– 3rd bullet point, add the word ‘manual’ after the word ‘procedures’: templates you can use to create a policies and procedures manual relating to information security and the use of computers Page 93 Transfer of health information We submit change ‘insurer’ to ‘medical defence organisation’ . Email and social media policy We submit add the following 2 bullet points:

• Defining what type of information can be sent by email to or from the practice

• Whether emails are encrypted

Also consider referring to RACGP’s Using email in general practice –guiding principles and

AHPRA’s Social media policy.

Standard 8: Patient health records

Criterion C8.1-Patient health records

Page 98

Why this is important

We submit that the following: ‘‘Consultation notes and patient health records are a way of

managing risks”, be changed to:

‘Consultation notes and patient health records are essential to continuity of care, and are also a

way of managing risks.’

Page 98

Patient identification

We submit that pursuant to Australian Privacy Principle 2 patients must be given the option of not identifying themselves, or of using a pseudonym.

Page 99

Content of the patient health record

We submit that in the consultation notes ‘old medications should be routinely deleted from the current medications list, and the Health Summary should be kept up to date.’ Page 100 Consultation notes must contain the following information: We submit that ‘diagnosis’ and ‘any referrals to other healthcare providers or health services’ be moved from the optional to the must contain list. Pages 101-102

Demonstrating how you meet this criterion

‘Maintain a privacy policy’ is listed as the only mandatory item for each sub-criterion, but these

relate to things that would not usually be included in a privacy policy, e.g. demonstration of follow

up in health records.

Standard 9: Education and training of practice staff

Page 106

Indicators

We submit that the following bullet point be added:

• have appropriate professional indemnity insurance that is adequate for the practitioner’s

scope of practice

Why this is important

We submit that: “Ensuring that all healthcare practitioners are suitably qualified reduces the risk of

medical errors and ensures that your practice provides patients with safe, high quality care” be

changed to:

“Ensuring that all healthcare practitioners are suitably qualified reduces the risk of medical errors

and assists your practice to provide patients with safe, high quality care.”

We submit that unsafe practices can still occur even with qualified doctors and nurses.

Page 107

Criterion C9.1 A- Demonstrating how you meet this Criterion

We submit that the 1st point should be amended to read:

“Keep current practitioner registration and professional indemnity insurance records.”

MDA National welcomes the opportunity to provide further feedback in relation to the 5th Edition Standards. Yours sincerely Deborah Jackson Claims and Advisory Counsel MDA National Insurance Pty Ltd Phone: 1800 011 255 Direct: (02) 9023 3390 Email: djackson@mdanational.com.au

29 September 2016 Dr Michael Civil Chair RACGP Expert Committee – Standards for General Practices RACGP College House 100 Wellington Parade EAST MELBOURNE VIC 3002 Via email: standards@racgp.org.au and post Dear Dr Civil MIGA feedback on second draft of RACGP standards for general practices, 5th edition As a medical defence organisation and medical indemnity insurer for many general practitioners through Australia, MIGA welcomes the opportunity to provide feedback on the RACGP’s second draft of its latest standards for general practices. MIGA’s feedback is based on our experience of advising and assisting both our members and policy holders in civil claims, disciplinary and regulatory matters, and in other medico-legal issues, and in educating the profession about a wide range of medico-legal and risk management issues. Module 1 – Core Module Standard 1

C1.2, Communicating by telephone, p18, para 1 – clarify that the results of investigations which are adverse or unexpected should not be provided by an employee over telephone, but rather an appointment be scheduled with a medical practitioner or other appropriate health professional to discuss the results, their implications and provide any necessary counselling

C1.2, Communicating by electronic means, p19, 3rd bullet point – sensitive or unexpected information which could cause distress to a patient, such as a new positive HIV result, should not be communicated by telephone, but rather in consultation with a medical practitioner or other appropriate health professional

C1.2A, Communicating by electronic means, p20 – for mandatory item ‘On each patient’s health record, record entries of when clinical staff have contacted the patient’, add at end ‘and both the detail of the contact’

C1.2, Resources, Telephone and electronic communications (p8, resources guide) – add the AHPRA Guidelines for Advertising Regulated Health Services – this document makes useful

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comment on using electronic communication for health promotion and prevention, and the guidelines deal with issues of misleading and deceptive advertising, testimonials, unreasonable expectation of beneficial treatment and encouraging indiscriminate or unnecessary use of health services

C1.5, Costs for care outside our practice, p27 – paragraph beginning “It is not necessary for you…” – reword final sentence to read “This means explaining that a service may either be covered by Medicare or that the patient might expect to pay a gap payment/private fee”

Standard 2

C2.1, Refusal of treatment and second opinions, p32, first paragraph – reword to read “Patients with decision-making capacity have the right to refuse a recommended treatment…”

C2.1, Resources, Respectful and culturally appropriate care, (p10, resources guide) – add the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia, given it deals with some of the matters canvassed in the criterion, including ethical dilemmas

Standard 4

C4.1, Providing a systemic approach to preventative care, p62 – recommend deleting the paragraph relating to ceasing use of a reminder system as it appears to contemplate a practice not having such a system generally for patients – not having any system for follow-up in appropriate circumstances would increase the risk of a general practitioner missing an opportunity to follow-up a patient, and the law on follow-up of patients does not contemplate general practitioners passing this responsibility to patients and / or others, such as hospitals. In addition, the existing advice may be inconsistent with the requirements outlined on pp156-7, Recalling patients

Standard 6

C6.3, Practitioner requests transfer of care, p75:

o reword paragraph beginning “Practitioners have the right to…” to “Other than in an emergency situation, practitioners have the right to…”

o paragraph beginning “However, there is still…” – reword end of paragraph to read “and in

rural and remote areas, careful consideration needs to be given to the patient’s ability to access alternative care”

Standard 7

C7.3, Confidentiality and privacy of health information, p87, Criterion E – reword to not require ‘informed patient consent’ for transfer of health information to a third party, but rather only patient consent, as there is no legal requirement for such consent to be ‘informed’

C7.3, Resources, Confidentiality and privacy of health information (p20, resources guide) – although yet to be finalised, it may be helpful to refer to the Office of the Australian Information Commissioner’s draft health privacy resources, which should hopefully be

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finalised later this year or early next year – they are available at https://www.oaic.gov.au/engage-with-us/consultations/health-privacy-guidance/consultation-information-health-privacy-guidance

C7.4, Information Security

o p90, Criterion H – policy on the use of email and social media – although the College has helpfully provided a social media policy template, it has not done so for the use of email – we recommend a template policy be developed as part of the College’s existing guidance on the use of email if the criterion is to be made mandatory

o p92 – Destroying information – given the:

differing state and territory requirements relating to the retention of health records

increased ability to store information electronically

benefits of keeping records as long as possible where there is a potential risk of litigation or other complaint

inherent uncertainty in, and scope for disagreement over, what are ‘out-dated’ test

results and their ‘clinical relevance’

and where the existing advice in this section could be seen as inconsistent with advice on p99 relating to retention of health records in relation to Standard 8, we recommend the first three paragraphs under the hearing “Destroying information” be removed and replaced with the following sentence:

“If you are considering destroying clinical records for patients who are no longer patients of the practice, have not been seen for many years or who have outdated results in their records, consult with your medical defence organisation to understand particular state and territory legal requirements, or other risk management considerations”

o Resources for social media (p21, resources guide) – although some of the following

material is referred to in the College’s guide for the use of social media in practice, it would be preferable to mention the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia, and both the AHPRA social media policy and guidelines for advertising regulating health services in the resources

Standard 8

C8.1, p99, ‘Additional optional information that can be included in consultation notes’ – each of any diagnosis made, referrals to other health care professionals or health services and emails sent to and by the patient should be included in information which must be contained in consultation notes

Module 3: General practice module

GP1.4A, Continuity of care within general practice, p154 – recommend that the following optional items be made mandatory:

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o document management plans in patient health records, especially for those with

complex or chronic health problems o demonstrate evidence of a recall and reminder system, where applicable o demonstrate evidence of a clinical handover system for when clinicians are away or on

leave Glossary

P199, Definition – ‘Clinical Significance’ – it appears this term has been defined by reference to civil liability legislation in various states. This may have unintended consequences. Ultimately, ‘clinical significance’ is a medical term, and should be defined by reference to medical, not legal, criteria. In addition, the term has a broader meaning and implication that mere probability or likely seriousness of an apparent ‘harm’

P201, Definition – ‘Duty of care’ – the description of the duty is incorrect, and should be expressed as “the legal obligation to exercise reasonable care and skill in the provision of health care”, consistent with Rogers v Whitaker (1992) 175 CLR 479

P204, Definition – ‘Informed consent’ – the definition conflates the concepts of ‘consent’ and ‘informed consent’, which are distinct concepts – ‘consent’ is the agreement to health care in broad terms, and ‘informed consent’ is the provision of necessary and appropriate information to a patient to allow them to make an informed decision about their health care

P204, Definition – ‘Informed refusal’ – this is not a recognised concept in Australian health care law - a patient with decision-making capacity can refuse treatment, even if it is an irrational choice

P208, Definition – ‘Schedule 8’ – given the particular legal requirements for Schedule 8 medications, it would be preferable to mention that practitioners should consult their state or territory health department to understand particular requirements which must be followed prior to prescribing Schedule 8 medications – these are mentioned on p26 of the thematic resource guide, to which could be added relevant website links in addition to telephone numbers

We trust these comments are of assistance. If you have any questions, please contact Timothy Bowen, Senior Solicitor – Advocacy, Claims & Education, email: timothy.bowen@miga.com.au or tel: 1800 839 280. Yours sincerely

Cheryl McDonald Timothy Bowen National Manager – Claims & Legal Services Senior Solicitor – Advocacy, Claims & Education