Health Professions Council operations, services and the registration of doctors

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Health

17 August 2010
Chairperson: Mr B Goqwana(ANC)
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Meeting Summary

The Health Professions Council of South Africa briefed the Committee on its services, operations, registrations of practitioners and service delivery initiatives to the public. The implementation of the ORACLE system last year had greatly assisted the Council to support its current operational needs and projected future growth. There were however, a few teething problems with the new system but an electronic mail and short message service campaign was launched to inform practitioners of the delay. The Council emphasized the importance of registration by practitioners and that certain criteria had to be met before registering. A flowchart of the registration process was explained as well as a flowchart on the non-compliance of practitioners. Foreign qualified practitioners also needed to be registered and had to undergo a 12-month probationary period. The legal process was also explained by means of a flowchart and statistics on the number of cases finalized and outstanding was also shown. The role of Professional Boards was also of importance. Proactive initiatives by the Council were implemented to offer the best service to the practitioners.

Members raised questions on, amongst other issues, the qualification criteria for foreign doctors; the relationship between the Council and the Nursing Council; the issue of Continuous Development Points; the learning platforms and the fact that some student doctors were left unsupervised at institutions; the legal complaints that take place; the fact that some doctors were leaving South Africa to practice overseas; and the issue of the language barrier faced by foreign doctors.

Meeting report

The Chairperson commented that currently there were not enough health professionals to handle the health issues that arose in society and that it was going to be a great challenge to resolve the health issues that would arise in the future.

Health Professions Council of South Africa (HPCSA) briefing
Ms Marella O’ Reilly, Acting Registrar and Chief Executive Officer, HPCSA, gave the entire presentation. She started by giving some facts about the HPCSA. The HPCSA was a statutory body established in terms of the Health Professions Act 1974 (Act No. 56 of 1974). It was founded for the protection and guidance of patients and healthcare practitioners. The HPCSA was committed to promoting the health of South Africa’s population; determining the standards of professional education and training; and setting and maintaining fair standards of professional practice. Firstly, in terms of the HPCSA’s mandate, HPCSA regulated the health professions in aspects pertaining to registration; education and training; professional conduct and ethical behaviour; ensuring continuing professional development; and fostering compliance with healthcare standards. Secondly, registration with HPCSA was a pre-requisite for professional practice. Thirdly practitioners were legally required to keep all personal details up to date. Fourthly, an annual fee was payable – failure to pay this fee could result in erasure from the Register. And fifthly, the HPCSA was an entirely autonomous organization that received no grants or subsidies from the Government or any other source and was funded by healthcare professionals. With regard to corporate governance, it was evident in its principles and values; it served as an everyday guide in all levels of the organization; and, as a new requirement for the King III Report, it had made great strides in the following areas, namely: a) internal and external audit requirements were met and exceeded; b) environmental footprint – moving from a paper-based to an electronic system; c)social responsibility – actively involved in local communities; d) transparency in financial dealings with clear policies and procedures governing all financial transactions; and e) information technology (IT)’s strategic role had also been highlighted with the implementation of the new ORACLE system so that records and data were securely and effectively controlled  and managed, departments were not operating in silos, and that operational efficiency and business continuity was ensured.

The rationale for introducing ORACLE in November 2009 was explained: a) the ageing information system could no longer support the operational needs; b) various systems were investigated to support current needs and projected future growth; c) this required an integrated system which could host the interaction of the HPCSA and its external stakeholders namely: the Department of Health (DOH), the Board of Health Funders (BHF) and the South African Qualifications Authority (SAQA). The old system ran concurrently with ORACLE for four months to ensure the validation of data and efficiencies in implementation. However, some initial teething problems with the new system were experienced which resulted in the annual fee reminders and practicing card being sent late to practitioners. To address this problem a short message service (sms) and electronic mail (email) campaign was launched to inform practitioners of this delay. As to the reasons for registering with the HPCSA: a) registration of healthcare practitioners with the HPCSA was a pre-requisite for professional practice; b) a legal requirement to keep personal details current (failure to comply could lead to erasure in terms of the Act); c) practicing without current registration constituted a criminal offence (Section 39 of the Health Professions Act 1974); d) registration was dependent on compliance with all criteria (including validation of qualification): in certain professions it included a board examination; e) conferral of professional status to the practitioner, inclusive of the right to practice the profession that he / she was qualified for; f) the assurance that no unqualified person might practice these professions ; and g) credibility as a competent practitioner who might command a reward for his / her services. Ms O’ Reilly then discussed the various categories of registration, the workflow of registrations and the workflow of non-compliance as shown in the accompanying document.

The criteria for foreign qualified practitioners were as follows: a) new applicants who were not South Africans needed a Letter of Endorsement by the Department of Health (DOH) before applying to the HPCSA; b) the DOH did not encourage recruitment of citizens from developing nations; c) to register in the public service one must comply with the minimum requirements; d) only on the successful completion of the registered intern training programme (new applicants) would one be registered; internship in South Africa was dependent on employment as an intern by the DOH; and e) if, therefore one had not completed an accredited intern training programme, one would not qualify for registration with the HPCSA unless one applied for internship allocation and secured a written job offer to that effect from the DOH. It was important to note, however, that in special circumstances, based solely on the discretion of the Board, applicants with identified qualifications, which were assessed by the Board, might be exempted from the Examination of the Board. The criteria for independent practice for foreign qualified practitioners could be seen on the flowchart in the accompanying document. There was a growth of registers on some Boards by 50% over the last five years – emergency care rose from 30 087 in 2005 to 54 054 in 2010. There was an increase in legal complaints from 2310 in 2008/9 to 2703 in 2009/10. 491 of these were referred to the Office of the Ombudsman. The statistics on the matters finalized by the Committees of Preliminary Inquiry, matters finalized at the formal hearing stage and the legal processes flowchart could also be seen in the accompanying document.

Ms O’ Reilly then explained the HPCSA’s Professional Boards. The HPCSA currently had 12 Professional Boards operating under its auspices. These Boards controlled the professions within their ambit under the overarching co-ordination and guidance of the HPCSA. They operated as a Standards Generating Body (SGB), developing education and training outcomes, developing a professional practice framework, developing a national strategy and action plans on training, supervision and career path development (including internship). The Boards also evaluated registration applications, exercise education, training and quality assurance functions on behalf of the HPCSA as well as evaluating education and training courses and academic facilities. The Boards also recognized courses for registration and additional qualifications purposes, developing policy documents to guide professions, conduct preliminary and professional conduct inquiries, formulate regulations and rules of conduct and professional practice and assessed non-compliant applications for registration, including foreign application. The diagrams on how these Professional Boards were set up and the HPCSA structure at a political level could be seen in the accompanying document. In terms of service delivery the public and the healthcare practitioners were the clients of the HPCSA. After a high-level investigation was conducted there was a successful implementation of service delivery initiatives. There were various contact points with its practitioners namely: a) email, where the ratio was 1 agent: 11 250 practitioners; b) a call centre, where the ratio was 1 agent: 11 250 practitioners; and c) the client walk-in centre, where there was a ratio of 1 agent: 22 500 practitioners in the finance section and 1 agent: 5 000 practitioners in the registrations section. Certain pro-active initiatives were implemented for example, a) a Customer Service Officer for critical complaints management; b) a defined escalation process with a 24-hour turn-around time; c) an intensive complaints procedure for service delivery; d) Subscription to Hellopeter.com for escalative complaints resolution; e) initiatives to encourage electronic communication with the practitioners by way of websites, email, newsletters and special information campaigns , for example, annual fees; and f) streamlining processes and procedures, making the experience simpler and efficient.

Discussion
The Chairperson thanked Ms O’ Reilly for her presentation and asked the Members whether they had any questions.

Ms A Luthuli (ANC) asked: 1) How long would Ms O’ Reilly be acting in her position; 2) What was the relationship between the HPCSA and the Professional Boards? Maybe give additional power; 3) Foreigners working in South Africa could not speak the local languages and this would pose a serious communication problem with the public. What was the HPCSA doing about this? 4) What were the main underlying causes of the escalation of the legal complaints? Was it true that certain student doctors are not being supervised at the learning hospitals?

Ms T Kenye (ANC) wanted to know firstly, what the relationship with the Nursing Council was; secondly, in what way the HPCSA was involved with the local communities, and thirdly, whether the HPCSA was working together with the Nursing Council. There were a lot of gray areas.

Ms L Makhubele-Mashele (ANC) wanted to know what types of activities were given to the local communities.

Ms E More (DA) wanted to know firstly, how the staff shortages of practitioners impacted on the HPCSA; secondly, whether there were measures in place to fast-track the card delivery to practitioners; thirdly, which countries did South Africa recruit from; fourthly, what the link was between the hospital complaints and the HPCSA; fifthly, was all well in terms of the professional bodies; and lastly, what social responsible activities the HPCSA was involved with.

Mr M Waters (DA) wanted to know firstly, whether the foreign doctors from Cuba and Tunisia met the minimum requirements; secondly, how many applications the HPCSA received from practitioners to work overseas; thirdly, there was talk of stopping short courses for the Emergency Medical Services (EMS). What was happening with that? Fourthly, there was a huge backlog of complaints.  He asked what was being done about that. Lastly, he asked if the HPCSA communicated with the private sector in terms of practitioners.

Mr D Kganare (COPE) asked what steps were being taken to ensure that doctors were working in conducive conditions and how the poorer individuals could have greater access to the practitioners.

Mr E Sulliman (ANC) wanted to know what the HPCSA’s projected budget was.

Ms M Dube (ANC) wanted to know firstly, how many doctors had been struck off the roll due to malpractice; secondly, what HPCSA did in our communities; thirdly, how HPCSA viewed the patient: doctor ratio; and lastly how the HPCSA ensured that doctors who had been struck off the roll due to malpractice did not practice again.
 
The Chairperson commented that there was a distinction between malpractices, as opposed to criminal charges, for example, murder.

Ms O’ Reilly replied to the questions in no particular order. She said that she had been acting in the position since 01 February 2010. For foreign doctors, a letter of good standing was required as an indication of compliance. Also, the competency of the practitioner would be checked. There was also agreement between governments, for example, between South Africa and Cuba. 12-month probation was compulsory to establish the practitioner’s competency.

Ms O’ Reilly responded on the question of language that the HPCSA had embarked on an extensive radio campaign where the head of legal services would be addressing certain issues that were of a concern to the public in the rural areas.

Ms O’ Reilly responded that the increase of legal complaints could be explained by an apparent decline in the ethical values of some practitioners. Ethics could be taught and once this was done the ethics of the practitioners would improve markedly. Also, as a result of more people being reached the complaints had increased. A lot more could be done in terms of outreach to the communities and in the long-run the number of legal cases would decrease.

Ms O’ Reilly responded that the Nursing Council regulated the nurses. However, certain functions overlapped. The HPCSA and the Nursing Council regularly had meetings to discuss the overlapping of their functions.

Ms O’ Reilly replied regarding Continuous Professional Development (CPD) that the practitioner’s skills needed to continuously be updated so that they could offer the best service to the community. Random audits took place and the HPCSA did not find many practitioners who were non-compliant over a two-year period. It was not difficult for a practitioner to increase his / her CPD points. One way of getting a few points would be to log onto the internet and answer a few simple questions. The HPCSA continuously looked at international best practice. To comply was not that difficult.

Ms O’ Reilly responded on training platforms that learning or training platforms must be accredited and each student needed to be supervised properly. Engagement with the private sector did take place with some universities. The learners must be guided by competent professionals. The DOH had the right to strip the accreditation of institutions that did not comply.
 
Ms O’ Reilly responded on the question of the doctors leaving South Africa. It was difficult to give an indication of this. Some doctors went overseas to practice but were still registered in South Africa. They continued to pay their fees even though they were practicing overseas. The form had to be revised with possibly the insertion of a certificate of service section. This was currently in the pipeline and just a proposal at the moment.

Ms O’ Reilly replied that the question of the EMS had been was posted to the Minister of Health already and a response was still awaited.

The Chairperson asked if this question could be postponed for the time being.  

Ms O’ Reilly responded on the delay in issuing the cards. The HPCSA was pro-active in engaging with the institutions and would acknowledge the receipt even though the cards were not issued timeously. The new ORACLE system would improve the turn-around time to issue cards. The HPCSA was confident that it was in a position to service practitioners.

Ms O’ Reilly replied that the role of community representatives started at the various Boards. The representatives came to the Board to engage with the issues at the table. They know what was taking place and were tasked to add value and report back. The nine community representatives were appointed by the DOH and participated at council level from various provinces.

Ms O’ Reilly replied that the backlog of cases extended as far back as 1998. Some cases were still at the High Court. The HPCSA would work with the judicial system and the National Prosecuting Authority (NPA) to alleviate the backlog of cases.

The Chairperson thanked the HPCSA and the Members for their input.

The meeting was adjourned.



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