As you will be aware, the Medical Council of New Zealand (MCNZ) has
proposed changes to continuing professional development (CPD) programmes
for all New Zealand-registered doctors.
After seeking member
feedback, the College made a submission to MCNZ outlining our views on
these proposed changes. In response, and to clarify the council’s
intentions, MCNZ Chair Andrew Connolly asked for the opportunity to
address members directly. His explanation follows:
As many of you are aware the Medical Council of New Zealand (Council) has recently consulted on important changes to Recertification for Vocationally-registered doctors. This has generated much feedback and commentary. We received the RNZCGP submission which is very detailed and rightly outlines many of the concerns members of the College have expressed. Council recently met with the Board and CE of the College to discuss the Recertification consultation in detail. What has been clear from a number of submissions is that some confusion exists about Council’s intent. The meeting with the College was an opportunity to clarify these areas of concern. This article summarizes much of the discussion.
Recertification is a term used in the Health Practitioners Competence Assurance Act 2003 (the legislation that regulates doctors and other health practitioners). Essentially it is a strengthened CPD process. Council recently adopted a principles-based approach to Recertification. These principles include being profession-led and evidence-based. To be very clear: Recertification is designed to be “therapeutic” for each doctor and is NOT a diagnostic tool for the Council. The Medical Council relies on a number of processes to identify competence or conduct concerns. Recertification is not one of them. With respect to Recertification and the individual doctor, Council is only interested in the outcome – that is, the doctor has successfully completed the College CPD programme.
For most doctors, the changes we are consulting on will mean little if any difference to what each of us does now. Council sets the over-arching principles for any CPD programme and accredits the College - this includes accreditation of the CPD programme. The College sets the content of the programme, mapped broadly to the principles. The College is the “subject expert” for General Practice and therefore rightly needs to set the content of the programme. Council will challenge all Colleges to assess the “value” a particular activity accrues, but the content remains the domain of the College. Indeed, the College Board members closely involved in your existing CPD programme believe little if any change will be required. We have attached some key words such as “Professional Development Plan” to activity many peer groups already undertake. We do expect all doctors to reflect on aspects of their practice – for instance perhaps discussing your BPAC prescribing report with a peer may highlight areas where you feel some reading would be beneficial. We are likely to insist all colleges have a practice visit as an option for all Fellows – if it is compulsory or not will be up to each College Board to decide. These activities all have evidence to support their value.
Perhaps the most contentious aspect of the debate has been around older doctors. Again, to be clear, Council is not introducing examinations or mandatory processes for older doctors. Nor are we introducing mandatory retirement or mandatory places of practice to avoid isolation and so on. We are, however, looking at the issues of safe practice and aging. This is something all responsible doctors (and regulators) should be interested in. We know cognitive decline affects doctors at the same rate as it does the rest of the population, and we know retirement brings added stressors. We are suggesting that as we all get closer to retirement we plan for it. In my field of General Surgery, I need in the next few years, to consider if I should remain on the after-hours roster. There is good evidence my decision making at 2am may well be different to 2pm as I get older. This does not mean I should not be a surgeon, but it does mean my colleagues and I should think over these issues well in advance. This is perhaps even more important for those in sole or remote practices as the implications of change may be much harder to address.
I am heartened by the volume of responses Council has received on this important consultation. We will need time to consider all the feedback and to look at our next steps. I hope the information above reassures you that Council is not planning radical changes; indeed, we are mainly formalising and strengthening existing College programmes with little real change needed by each individual doctor given the strength of your existing College CPD structures. I reiterate, this process is about aiding each of us to maintain our competence. I firmly believe it is not adding significantly to my work as a busy doctor; but it is adding to the confidence the public can have of my competence.