Policy and Advocacy wrap for 2024

As most of us wind down for the year, I wanted to take this opportunity to walk you through the year in MIGA’s Policy and Advocacy efforts.

National Law proposals

The year kicked off with a meeting of Health Ministers’ proposing changes to the National Law. These changes aim to be tougher on professional misconduct findings of a sexual nature and provide more protections for notifiers regarding non-disclosure agreements. Additionally, amendments will require a reinstatement order from a tribunal following a period of disqualification for practitioners, rather than applying directly to the medical board. MIGA raised concerns about procedural fairness and the scope of these reforms. We are pleased to report some small wins that soften the harsher edges of the proposals.

A quirk of the National Law meant these amendments were put to the Queensland Parliament just before the state election. The Bill lapsed when the parliament was dissolved. The Bill is likely to be reintroduced and passed in some form, and we will keep you updated on its progress in the new year.  You can find the proposed bill here.

Gillick test for mature minor consent remains in NSW 

In March, MIGA was invited to comment on proposed changes to the age of medical consent in NSW. The proposal aimed to legislate the Gillick competency test for mature minors, recognising that minors aged 16 and above have the capacity to consent to medical treatment as adults. This change would have provided better clarity for clinicians in NSW. Unfortunately, this change was abandoned. As such South Australia remains the only jurisdiction that assumes adult competency for minors aged 16 and above. Doctors in all other jurisdictions still need to assess minors to identify if they are “mature minors” and document accordingly.

Removal of Collaborative Arrangement for Midwives and Nurse Practitioners

March also saw the introduction of the Removal of Requirement for a Collaborative Arrangement Bill, passing in May. This Bill removed the need for nurse practitioners and midwives to have collaborative arrangements with medical practitioners to access certain MBS and PBS items. The amendments came into effect on 1 November, 2024. MIGA has updated its policy documents to reflect these reforms.

Scope of Practice Review in primary care

Next was the Scope of Practice Review, which examined barriers preventing primary care practitioners from working to their full scope. The final report, recently published, includes 18 recommendations across four themes: Workforce Design, Legislation and Regulation, Funding and Payment Policy, and Enablers and Other Key Considerations. MIGA welcomes the recommendations for harmonising regulations nationally and streamlining the National Registration and Accreditation Scheme.

MIGA made submissions emphasising need for robust change management support to accompany any reforms. We are encouraged to see change management feature heavily in the report, with dedicated transition funding and planning and evaluation identified as key aspects of any reform. You can find out more about the review here.

NRAS Complexity Review 

The National Regulation and Accreditation Scheme (NRAS) has been in place since 2010 to protect public health and safety by ensuring health practitioners meet expected standards. Despite many reviews, recommendations often fail to materialise. This review, led by Sue Dawson, the former NSW Health Care Complaints Commissioner, aims to address this.

Ms Dawson has conducted several face-to-face consultations, including one with MIGA, and produced a consultation paper outlining the scheme’s complexities. MIGA has called for greater transparency and efficiency in the Ahpra notification and investigation process. We advocate for more robust risk-based complaints handling, reserving Ahpra processes for matters related to professional standards and leaving other complaints to appropriate entities. You can read more about the review here.

AI in Healthcare 

The adoption of AI in health care is progressing rapidly. The Department of Industry, Science and Resources (DISR) is leading the Safe and Responsible Use of AI agenda. DISR has proposed “guardrails” for AI systems in high-risk settings, while allowing AI use in low-risk settings within existing laws. Healthcare, being generally high-risk, has specific consultations led by the TGA and DoHAC to identify appropriate guardrails.

MIGA made a submission to the DoHAC consultation as it had a specific focusing on clinical practice. One key issue is the “Human in the loop” concept, where a clinician or expert is always involved in reviewing AI output and bearing ultimate responsibility. While reasonable, there are concerns this approach could lead to complacency among developers, employers, and system administrators.

We advocate for thorough consideration of liability and shared responsibility for patient care. We do not want clinicians to be solely responsible for both patient care and AI system monitoring. AI has great potential to improve patient care and efficiency, but its adoption must be managed effectively to avoid unreasonable demands on practitioners.

For more information on DISR guardrails, click here. For the DoHAC review, click here.

It has been a busy year in the advocacy team with the topics listed above highlighting both progress and the nature of change.  We look forward to serving you in 2025 and continuing to ensure that the interests of practitioners are effectively represented.