Director’s report
The eleven years since the passage of Part VAA of the Health Insurance Act 1973 establishing Professional Services Review (PSR) have seen widespread changes in the way medicine is practiced in Australia. Over the last decade more doctors have started practicing in large, vertically integrated medical centres. This phenomenon, once confined to large cities, is now spreading into regional areas. Allied to this trend is the growing popularity of part-time medical practice; many doctors now consider their leisure and family time as important as their work. The benefits of a computerised practice have also become widely accepted. Doctors now regard an Internet connection as essential as a stethoscope. General practice seems to have embraced computers more extensively than the specialist community.
The community has also changed. The public is now better educated and informed regarding their own and their family’s health.
There is a greater community expectation of quality care when accessing health services. Consumers are less willing to accept medical advice uncritically. The increasing use of alternative medicine and other therapies has provided the community with at times a bewildering choice of health options.
The challenges for medical regulators and governments around Australia in this new environment are considerable. Professional Services Review is not immune from this change. To maintain both Parliamentary and professional support for the PSR process we are reviewing all our current processes with the aim of keeping pace with change.
In June all PSR staff attended a two-day workshop at Bowral NSW where our mission statement and key performance indicators were reviewed and rewritten. This has given us a clearer focus for the future. It has also been an excellent preparation for a review of the PSR scheme to be completed around the end of December 2005. It is my intention to bring to PSR the principle of continuous quality management to ensure we are able to keep pace with the environment in which we work.
The robustness of the PSR scheme has been tested in the Federal Court on many occasions. PSR has been found to have consistently applied the legislation with due regard to fair process and equity. The scheme depends for its success on the commitment of the members of the PSR panel. Clinicians in active practice who apply peer standards to evaluating their colleagues, give the scheme its legitimacy and its widespread support. I would like to thank all those members of the panel who have given of their time to sit on committees.
Committee members require particular skills in questioning and report writing. New panel members often feel they have learnt these skills from their practice of medicine. Experience has taught us that to achieve a robust result, members require training to acquire the necessary skills. Professional Services Review runs training workshops regularly for new and existing members. The last training workshop was held at Werribee in Victoria. PSR staff and our consultants, including two current and one retired Justices of State Courts, conducted the training. Members of the panel invariably come away with a new-found respect for their legal colleagues.
I would also like to particularly thank the 21 panel members who are appointed as Deputy Directors and as the Chairs of Committees. The Deputy Directors are senior members of their professional groups. Committee work for a Chair requires considerable dedication both in time and effort. I am very appreciative of the support the Deputy Directors have given me since my appointment on 14 February 2005.
The Professional Services Review scheme is a highly litigious area. In general, practitioners who are investigated by the scheme are well resourced and are defending their livelihood. Many practitioners take full advantage of seeking judicial relief. As at 30 June 2005 there were 27 Federal Court actions either active or pending. The challenges to the integrity of the process range from issues of procedural fairness to invoking the Constitution. I am pleased to report that to date PSR has won almost all of these actions, although some have been taken on appeal to the Full Court of the Federal Court. We have been greatly assisted in this by the exceptional service offered by our solicitors Minter Ellison and the very able counsel engaged.
The Professional Services Review Tribunal finished its role this year with its last decision. I would like to pay tribute to work done by the Tribunal and in particular to thank the Hon. Alan Neaves for his unstinting dedication as the Presiding Officer.
The Determining Authority is now the only decision-making body that determines sanctions. It is only at the Determining Authority stage where there is any direct consumer input into the PSR process. In carrying out its function the Determining Authority must decide, inter alia, on the possible impact on the community if a particular practitioner is excluded from the Medicare arrangements for a length of time. The consumer representative’s input is germane to these assessments.
In August 2004 Professional Services Review moved to its new home, in the Brindabella Business Park at the Canberra Airport. Despite some initial misgivings, staff are happy with PSR’s new home. Bright colours and light airy spaces make for a very pleasant working environment.
Dr John Holmes, PSR’s foundation director
retired in February 2005. Dr Holmes has had a long and distinguished career with public health administration spanning 18 years. Dr Holmes started PSR with a staff of three and over the last 10 years guided the organisation through many difficult times including several serious court challenges and changes of legislation. Dr Holmes’s single-minded determination to keep PSR as an independent organisation has resulted in the high esteem PSR commands within the profession. PSR’s processes are accepted as being fair and transparent to those practitioners who are investigated. Dr John Holmes can rightly claim credit for this legacy.
The year has not been without its problems. Professional Services Review depends entirely for its workload on requests from the Health Insurance Commission. In previous years this has been in the range of 40–50 requests per year. In the 2004–05 reporting period this dropped to just nine. This has caused severe dislocation within PSR, particularly as the organisation had no prior warning that this was to occur. The Health Insurance Commission changed its internal processes nationally and the process of change resulted in a significant decrease in requests for review. We have been assured that this is a temporary aberration. However, it has had a profound effect on PSR. We have had to downsize our organisation by offering voluntary redundancies to almost 30 per cent of staff. This has been a very traumatic and disruptive experience for a small organisation.
The change in the Health Insurance Commission’s procedures has resulted in much more thoroughly worked-up requests. As a result, I believe it will now be less likely for the conduct of practitioners referred to PSR to be dismissed.
Since the Medical Indemnity industry has offered insurance cover most medical practitioners who come before PSR are legally represented. Generally lawyers who work in this area have sufficient experience to give timely and helpful advice to their clients. Experienced lawyers acting for a practitioner can greatly assist the committee process and in general keep their clients from making unwise decisions. It is also noteworthy that many more practitioners are wishing to enter a negotiated agreement under section 92. I believe this is also due to their having legal advice available.
The next five years will see a widening gap in the demand for services and the supply of practitioners in Australia. With a finite Health Budget this creates an imperative for governments to require that the quality of the services it funds be of the highest order. In the past more emphasis has been placed on accounting for expenditure than on quality outcomes. We are at a crossroad in health care and decisions made now will affect the health of Australians and how it is funded for decades to come. I believe Professional Services Review has a role to play in shaping this agenda and I look forward to the year ahead.
Tony Webber
Director