Doctor standards well maintained

Is it realistic to expect every single doctor is up to the job? The Dunedin-based chairman of the Medical Council, Dr John Adams, does not think so.

''Is every doctor in New Zealand competent? Well, no, and how could we expect that with 12,500 doctors on the register?''''Do we do all that we can to deal with the issues of competence when they arise and come to our attention? Yes,'' Dr Adams said.

Prompted by medical scandals, from last month doctors in the United Kingdom face a stringent new regime requiring them to demonstrate they are fit to practise.

Responsible officers would recommend every five years whether the doctor should be recertified. Doctors must maintain a portfolio of evidence supporting their credentials, including patient feedback, and have an annual assessment. The chief executive of the UK's General Medical Council, Niall Dickson, described it as the biggest change in British medical regulation for more than 150 years.

Dr Adams said for the foreseeable future ''continuing professional development'' (CPD) programmes will remain at the core of New Zealand's doctor recertification programme''.

The regulatory authority urged the sector to act promptly and notify it about problem doctors, he said. The UK's new regime looked potentially cumbersome, resource-intensive and bureaucratic, but he would monitor its progress.

New Zealand doctors were not lightly regulated, he argued, saying the various CPD programmes were rigorous. Many professional colleges stipulated higher CPD requirements for their members than the council required. Since last year, in a big step, general registrants have been subject to tougher requirements, including three-yearly practice visits.

However, the new system was not about weeding out incompetent doctors.

''This process is not about finding the doctors who are not performing.''

It was about helping doctors and giving feedback, from which competency matters might arise.

The change was not greeted with ''universal delight'' by general registrants, who are not vocationally registered. While at times it was necessary to ''drag [the profession] kicking and screaming'', good medical regulation relied on working with the profession. Otherwise, if doctors relied on an outside entity telling them what to do, they would take less responsibility.

''We have to engage the profession.''

Former health and disability commissioner Prof Ron Paterson's book, The Good Doctor, released last year, criticised New Zealand's medical regulations as too light-handed and lacking transparency. While much of the book was ''terrific'', Dr Adams did not agree with all of Prof Paterson's prescriptions.

When contacted, Prof Paterson said Dr Adams' acknowledgement not all doctors were competent was ''refreshingly honest''.

However, that state of affairs should not be accepted; the public did not want to take ''pot luck''. He believed Britain's new system was not overly bureaucratic, but had the rigour the New Zealand public tended to falsely believe applied here.

He favours a tougher recertification programme with practice reviews, annual assessments, and more stringent CPD programmes. CPD programmes tended to measure activity, rather than competence, and should be tightened up. He was pleased with the move to tighten regulations for general registrants, a group that attracted many complaints during his time as health and disability commissioner. This had not been easy for the council, which had demonstrated it saw its role as a regulator, not a professional body, which was encouraging.

''The council's in a difficult position. Council's got this role of protecting the public, but they also need to sell it to the profession. I can understand it being presented as quality assurance and improvement.''

Decent recertification programmes identified the ''bad apples'' and improved quality, not one or the other.

Even though Britain's regime was sparked in part by the murderous Dr Harold Shipman, the new system would probably not weed out another ''pathological killer''. However, it would be sufficient to prevent other scandals that had caused community outrage. It would put the UK ahead of most of the world, including New Zealand.

New Zealand had a culture of ''exporting'' doctors around the health system, which had to stop.

eileen.goodwin@odt.co.nz