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The next Healthcare Professionals Crossing Borders conference will take place in Dublin on Monday, 4 February 2019. As the local hosts, the Pharmaceutical Society of Ireland (PSI), the pharmacy regulator, and Ireland’s Health and Social Care Professionals Council (CORU), look forward with the HPCB to welcoming regulatory colleagues from across Europe, and to engaging on topics of mutual interest in the historic surrounds of Dublin Castle in the centre of Ireland’s capital city.

The conference programme with the theme – mobile professionals, safe patients – aims to capture and provide opportunity

to discuss topics of value and concern to those in health and social care regulation at a critical time in the European context. With the remaining uncertainties of Brexit and European Parliament and Commission elections upcoming, it is important that key issues associated with health and social care mobility, as facilitated by the professional qualifications framework, are kept on the European agenda to assure and work for the safety of patients.

We at CORU and the PSI, hope that other regulators will also find the conference topics as timely and useful as we expect them to be, and that the conference location

HPCB conference – mobile professionals, safe patients – we welcome you!

Ginny Hanrahan, CORU and Niall Byrne, PSI

Welcome to the 43rd edition of the Healthcare Professionals Crossing Borders (HPCB) Update. In this edition we are pleased to launch registration for the forthcoming HPCB conference which takes place on Monday 4 February 2019. The conference will be held at Dublin Castle and will be co-hosted by the Pharmaceutical Society of Ireland (PSI) and the Health and Social Care Professionals Council (CORU). More information on the conference can be found in our main article below. This edition also looks at the European Commission’s implementation of the cross-border healthcare Directive (2011/24/EU), Brexit, and we hear from the UK Nursing and Midwifery Council (NMC) on regulating nursing associates, and its second year of revalidation.

CONTENTSHPCB conference 1 Conference Registration LIVE 2

EU INSTITUTIONAL DEVELOPMENTSCross-border healthcare Directive 3 • Application of patient’s rights • Enhancing information provisions • Member state data • EU Auditors to examine cross-border healthcare Brexit update 4 Proportionality test Directive 4 RPQ Directive infringements 4 SEPEN – call for experts 4#Declaration4PatientSafety 5New Director General DG SANTE 5

EUROPEAN PARLIAMENT QUESTIONS Working time Directive in Austria 6Extension of the EPC 6RPQ infringement proceedings 6Application of RPQ Directive 6Proportionality test 7Impact of Brexit on healthcare in Ireland 7Annex V rehabilitation 7

EUROPEAN NETWORKS UPDATEENMCA Paris meeting 8 CPME statement on Turkey 8

DEVELOPMENTS IN EUROPEAN REGULATION NMC regulating nursing associates 9 NMC publishes revalidation findings 10UK Emerging concerns protocol 10GMC EEA insights paper 11

AROUND THE GLOBE Right touch regulation spreads across the globe 12IAMRA’s 13th conference, Dubai 12Nursing Now! update 13AHPRA Collaboration Centre for health workforce 13Vexing not vexatious 13Doctor burnout 14Upcoming events 14Newsletters and updates 14

Autumn edition I Issue 43

Crossing Borders Update

For further information please contact: Olivia Guthrie, HPCB, 350 Euston Road, London NW1 3JN Tel: +44 020 7189 5162 Email: hpcb@gmc-uk.orgContinued on next page >

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will provide a pertinent viewpoint from which we consider and discuss cross border health, social care and eHealth. While considering trends and expectations in the mobility of professionals, the discussion will remain on patient and public safety, as innovations occurring in working environments potentially change the delivery of care to patients.

As in previous years, the 2019 HPCB conference is an opportunity for attendees to engage with national and

European counterparts in the regulatory sector, and government representatives from across Europe. We are grateful for the support of Ireland’s Department of Health and sincerely hope that the Minister for Health will be in a position to join us for the opening of the conference.

We look forward to the HPCB conference returning to Dublin after many years, and to extending our warm welcome (céad míle fáilte, in Irish) to all attendees in February!

Register now! Registration for the mobile professionals, safe patients HPCB conference is now open! To view the draft programme and to find out how to secure your place, please follow this link. The conference is being held at the iconic Dublin Castle on Monday, 4 February 2019, and is a rare opportunity for European healthcare professional regulators, professional bodies and national government representatives to engage and discuss key issues facing health and social care mobility across Europe.

Due to limited numbers, priority registration will be allocated on a first in first served basis to healthcare competent authorities and regulators across Europe. For more information please see our website at www.HPCB.eu or for further enquiries please contact HPCB@gmc-uk.org.

HPCB conference Dublin Castle Monday, 4 February 2019

Niall Byrne Registrar and CEO, PSI

Ginny Hanrahan CEO/Registrar, CORU

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The European Commission has published an implementation report on the cross-border healthcare Directive which was adopted in 2011. The report Commission report on the operation of Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare states that since the adoption of the Directive, no further European court rulings have been needed to ensure cross-border rights. The report also shows that patients are increasingly aware of their rights under the Directive however, patient mobility within the EU remains relatively low.

At the same time, the European Parliament’s Internal Market and Consumer Protection (IMCO) Committee is also considering an own initiative report on the implementation of the Directive. A draft opinion from the last IMCO meeting from MEP Maria Grapini can be found here. A Eurobarometer survey has shown that less than 10% of Europeans felt well-informed about their rights in cross-border healthcare, with only one European in 10 aware of the national contact points. The report is due to be adopted in plenary in February 2019. For further information on the IMCO Committee discussion please follow this link.

Report on the application of patients’ rights in cross-border healthcare

The European Commission has published its final study on Enhancing information provision to patients. The study has found that patients in Europe are still generally unaware of their rights and the possibility to access health services in other EU member states, as well as of the existence of national contact points (NCPs) to help them exercise their rights under the cross-border healthcare Directive.

The aim of the study was to identify how to improve the current level of information on cross-border healthcare available to patients. The study found that although the information available to patients on NCP websites was vast and adequate, the websites themselves need improvements especially sections on patients’ rights (for incoming patients), quality and safety standards (for incoming patients) and reimbursement of cross-border healthcare costs (for outgoing patients).

The study has also resulted in the development of a practice-orientated toolbox and training materials to help the NCPs improve the quality of information for patients, as well as a set of guiding principles and indicators for establishing an NCP service that is more uniform, patient-centred and aligned with European legal requirements.

Study on cross-border healthcare: enhancing information provision to patients

The European Commission has published a report based on 2016 patient data from the Directive 2011/24/EU on patients’ rights in cross-border healthcare. The report, entitled Member state data on cross-border patient healthcare following Directive 2011/24/EU, was conducted in order to assess the impact of the Directive.

A questionnaire was sent to all member states in 2015, 2016 and 2017 to collect information on patient mobility from the preceding year. The report provides an overview of the data on patient mobility in 2016, collected from July to November 2017. The questionnaire was completed by all thirty countries contacted (all 28 EU countries plus Norway and Iceland).

It should be noted, however, that several member states had difficulties in reporting all the requested data. Accordingly, the baseline numbers referred in different sections vary, and percentages should be interpreted with caution.

Member state data on cross-border patient healthcare

https://www.eca.europa.eu/en/Pages/ecadefault.aspx is conducting an audit of cross-border healthcare arrangements in the EU. The auditors will examine the European Commission’s monitoring and support for putting EU legislation on cross-border healthcare access into effect, the results achieved to date for patients, and the effectiveness of the EU funding framework and of the actions funded. The audit will also cover the eHealth sector, where information technology is used to improve healthcare delivery and the health of citizens.

The audit will include visits to Denmark, Sweden, the Netherlands, Italy and Lithuania. The report is expected to be published in the first half of 2019.

EU Auditors to examine cross-border healthcare

EU institutions: Cross-border healthcare, Brexit, proportionality Directive, RPQ infringements.

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Brexit negotiations have continued over the summer with the aim of finalising the Withdrawal Agreement at the European Council meeting on 18-19 October. If signed, the Agreement would pave the way for an 18 month transition period from 30 March 2019. Over the summer, the UK Government published a white paper setting out its negotiating position for the future relationship between the UK and EU.

In terms of the recognition of professional qualifications, the paper stated that the UK will seek “a system for the mutual recognition of professional qualifications, enabling professionals to provide services across the UK and EU”. The proposed system would:

Be broad in scope, covering the same range of professions as the mutual recognition of qualifications Directive

Include those operating either on a permanent or temporary basis across borders

Be predictable and proportionate, enabling professionals to demonstrate that they meet the necessary requirements, or to undertake legitimate compensatory measures where there is a significant difference between qualifications or training, in a timely way

Provide transparency, with cooperation between regulators to facilitate the exchange of information about breaches of professional standards, and to review changes to professional qualifications over time.

Work is also underway in both the UK and Brussels to determine the recognition regime should the Withdrawal Agreement not be signed and a so-called ‘hard Brexit’ take place in March 2019.

Brexit Update

Formal adoption of the proportionality test DirectiveIn June 2018, the EU formally adopted the Directive on a proportionality test for new regulation of professions. The Directive creates a legal framework for conducting proportionality assessments before introducing new, or modifying existing, legislative, regulatory or administrative provisions restricting access to or pursuit of regulated professions. The Directive must be implemented into national law by summer 2020.

The European Commission has sent out the first infringement notices for failure to comply with the revised Directive on the recognition of professional qualifications which was implemented in January 2016.

It has sent letters of formal notice to 27 member states (all members except Lithuania) regarding the conformity of their national legislation and practice with the EU rules.

EC officials have stated that they are now working on a second batch of potential infringements for more substantive provisions, in particular with regards to health professions. This will likely be published in the late autumn.

EC issues infringement proceedings against 27 member states This is a reminder that the call for experts to join the

Support for the health workforce planning and forecasting expert network (SEPEN) is open and you can register your interest here!

Following an update from the Health Workforce Planning and Forecasting Expert Network on the three-year joint tender in our last HPCB edition, you can find the consent/registration form here and SEPEN will add your information to the expert database. A privacy statement on the use of your personal data for the purposes of the joint tender is also available.

All information and contact details for SEPEN can be found on their website.

SEPEN network, call to join!

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Healthcare professionals stand together to foster patient safety On 17 September 2018, Health First Europe celebrated International Patient Safety Day by launching the campaign #Declaration4PatientSaftey. The campaign run jointly with European Specialist Nurses Organisations (ESNO), Council of Occupational Therapists for European Countries (COTEC) and European Federation of Public Service Employees (EUROFEDOP) calls on Ministers of Health from across Europe to agree a high level of understanding on patient safety standards to streamline national policies.

The campaign refers to the latest data released by OECD which shows that around 15 per cent of hospital expenditure in European countries is due to preventable harms e.g. patients being infected while in hospitals.

It also notes that no country can afford unsafe healthcare and quality of care will always rely on the critical role of health workforce. It calls on Ministers to discuss common health challenges and joint workforce planning at the European Health Forum in Gastein, Austria from 3-5 October 2018.

The full press release can be found here https://healthfirsteurope.eu/news/healthcare-professionals-stand-together-to-foster-patient-safety/.

European Commission appoints new Directorate-General to its health and food safety department

The European Commission has announced that as of 1 October 2018 Ms Anne Bucher, the current chair of the Commission’s Regulatory Scrutiny Board, will take up position as the new Director General of the Commission’s Directorate-General for Health and Food Safety (DG SANTE).

Ms Bucher, a French national, has been working for the European Commission for 35 years. Throughout her career, she has focused on a variety of policy areas – economy and finance, development and social policy, taxation and information society. She has held management functions for most of her career and has been a senior manager in the Commission’s Directorates-General for Economic Affairs and for Communications Networks, Content and Technology respectively since 2008. In March 2016, Ms Bucher became the Chair of the Commission’s Regulatory Scrutiny Board (RSB), providing independent advice to the College of

Commissioners. Amongst other issues, the RSB has contributed to the delivery of over 50 legislative proposals for the sectoral programmes under the new long-term budget of the EU for 2021-2027.

For more information please see the EC’s press release here.

Ms Anne Bucher, new Director General for Health and Food Safety (DG SANTE)

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European Parliament questions

Implementation of European working time Directive in Austria Monika Vana MEP has questioned the EC on the recent introduction of a 12-hour day in Austria which she described as an attack on workers’ rights. In response the EC stated that it had not been informed of Austria’s intention to introduce a wider transposition of the opt-out provision of Directive 2003/88/EC and that it is currently assessing its compliance with EC law.

The full response can be found here.

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Extension of European professional card to other professions Antonio López-Istúriz White MEP has questioned the EC over its plans to extend the scope of the European professional card to other professions, in particular to engineers. In response, the EC stated that it had suggested including engineers in the first group of professions to be covered by the EPC but at the time member states could not agree to this. The Commission is open to receiving expressions of interest by the relevant stakeholders and will explore with member states whether and to which professions the EPC could be extended. To date there are no specific timelines for such an extension.

The full response can be found here.

2.

RPQ Directive infringement proceedingsAnnie Schreijer-Pierik MEP has asked the EC for further information on how it plans to monitor the implementation of the revised RPQ Directive, in particular the implementation of the European alert mechanism for medical practitioners. The Commission has responded by confirming that it has finalised the check of completeness of implementation of Directive 2013/55/EU, as all member states have now notified full transposition. It is currently analysing the national measures transposing the Directive to check the correctness of implementation. As regards the alert mechanism, the Commission is continuously monitoring the functioning of the system.

The full response can be found here.

3.

Application of Directive 2013/55/EU on health professionsSophie Montel MEP has queried the application of the RPQ Directive on health professions and claimed that a number of countries have refused to transpose its provisions into national law. She stated that in France, transposition allows any healthcare professional from an EU member state to practise a profession in the healthcare sector provided that access to the profession is not regulated. In response, the EC has confirmed that the Directive does apply to the health professions including Article 4f on partial access.

The full response can be found here.

4.

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European Parliament questions

Proportionality test before adopting a new regulation on professionsDimitrios Papadimoulis MEP has questioned the EC on the newly adopted proportionality test Directive which, he states, will complicate the regulation process by creating excessive bureaucratic load, as well as potential legal impediments when adopting new regulation at national level. He has particular concerns about the impact on health professions whose regulation should be left exclusively to member states, based on each country’s needs. He asked the EC what measures it is willing to take to ensure that public health and health professions are protected.

In response, the EC stated that the Directive confirms member states’ margin of discretion on whether and how to regulate professions and what level of protection they would want to afford in relation to the public interest objectives that regulation seeks to protect. The Directive contains specific references to health professions and their regulation which confirm beyond any doubt that member states may seek the attainment of a high level of public health and patient safety protection through their regulation.

The full response can be found here.

5.

Impact of Brexit on healthcare in IrelandMartina Anderson MEP has questioned the EC on the impact of Brexit on cross-border mobility of patients and healthcare professionals, particularly in relation to accessibility of health services in border regions and the recognition of professional qualifications.

In response, the EC stated that cross border collaboration in healthcare as well as access to specialised health services does not depend on the continued application of EU law. Persons and medical professionals will continue to be able to move freely between Northern Ireland and Ireland to access health services or their workplaces thanks to the Common Travel Area arrangements between Ireland and the UK. It further stated that once the UK withdraws from the EU, the RPQ Directive will no longer apply to and in Northern Ireland.

The full response can be found here.

6.

Physical and Rehabilitation Medicine in Annex VCostas Mavrides MEP has questioned the EC on the inclusion of the title of physiotherapy rather than the correct title of physical and rehabilitation medicine in Annex V of the recognition of professional qualifications Directive. He argues that this causes confusion between medical specialists which benefit from automatic recognition and physiotherapists who do not benefit from automatic recognition. In response, the EC stated that the use of term ‘physiotherapist’ does not refer to physiotherapists but instead refers to a medical specialisation falling under the automatic recognition regime, otherwise known as physical and rehabilitation medicine.

The full response can be found here.

7.

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Networks update

European medical regulators meet in ParisThe latest meeting of the European Network of Medical Competent Authorities (ENMCA) took place on 22 June in Paris. The meeting was hosted by the French Medical Council regulators from 18 member states met to discuss a range of issues including the recognition of third country qualifications, the use of fraudulent documents by professionals, and the impact of Brexit.

Bernard Zaglymayer from DG GROW in the European Commission attended and spoke about the recent EC analysis of the alert mechanism and European professional card. The next ENMCA meeting will take place on 26 November 2018 and will be hosted by the Austrian Medical Chamber in Vienna.

For more information about the network or the upcoming meeting please contact contact@enmca.eu.

European doctors request end of campaign physicians in Turkey

The standing Committee of European Doctors (CPME) released a press release in August calling on the Turkish Government to immediately withdraw its decision to dismiss leaders of the Turkish Medical Association (TMA) from public service and to reinstate them.

The call follows the removal of TMA Secretary General Dr Bülent Nazim Yilmaz from his duty as a public servant and the termination of family medicine contracts of TMA Council members. “We join the World Medical Association (WMA) in calling on the Turkish authorities to immediately end this state campaign against the leading members of the TMA. Together with the WMA, the CPME supports the Turkish colleagues in their public statement issued earlier this year declaring that war is a public health problem”, said Dr Jacques de Haller, CPME President. “This statement is perfectly in line with WMA and CPME policies, as is TMA’s record of upholding human rights and denouncing unnecessary violence”, he continued.

The full press release can be found here.

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Developments in EU regulation

Nursing and Midwifery Council becomes the regulator of nursing associates in England

Jakob Stenkvist, NMC

In July 2018 the UK Parliament passed legislation making the Nursing and Midwifery Council (NMC) the regulator of the new nursing associate profession in England. The first nursing associates will join the NMC’s register from January 2019.

The nursing associate role is a new health and care role designed to bridge the gap between unregulated health care assistants and registered nurses. It is a stand-alone role in its own right and is not a nurse, but will provide a route to progression to graduate level nursing with additional training. Nursing associates will be trained to work with people of all ages and in a variety of settings. It is intended that the role will enable registered nurses to focus on more complex clinical duties.

Nursing associates will be regulated in England only, as governments in Northern Ireland, Scotland and Wales have decided not to introduce or regulate nursing associates at this time.

The NMC consulted on its proposed approach to the regulation of nursing associates between April and July

2018. This included on the standards of proficiency, which sets out the skills, and knowledge all nursing associates must have to join the NMC’s register. The NMC also proposed that its Code, with a new introduction, will apply to nursing associates as well as to nurses and midwives.

The NMC’s standards and approach to regulating nursing associates was approved by its Council in September 2018. The NMC published the finalised standards on 10 October 2018. The new nursing associate part of the register will open to new entrants in early 2019.

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In March 2018, the General Pharmaceutical Council (GPhC) commenced the roll out of revalidation for pharmacy professionals in Great Britain. This is a momentous change for the sector and, as such, has been developed in full collaboration with pharmacy professionals, professional organisations, charities and patients over a number of years. It has been met with strong support throughout.

Revalidation models are currently used by other health professions throughout the UK including doctors, nurses and midwives. However, pharmacy professions are distinct from other professions, and from each other, so the proposed framework for pharmacy professionals is similar in name, but fundamentally different in design, to other models so that it works well for pharmacy.

There are a range of benefits in asking professionals to revalidate. Indeed it is one of the ways that the GPhC can provide assurance to the public that their trust in pharmacy professionals is well placed. Revalidation builds upon what pharmacy professionals do – as part of their

work and development – to make sure they remain fit to practise through using, maintaining and developing their professional knowledge, attitudes and behaviours. We know that health and social care has changed considerably to meet the changing needs of the population, and it will continue to do so. Revalidation will help both professionals and the regulator to adapt to these changes. To find out more about revalidation visit the GPhC website or watch this short video about revalidation’.

Pharmacists start revalidation Nursing and Midwifery Council publish findings from second year of revalidation of nurses and midwives in the UK Jakob Stenkvist, NMC

Latest figures from the Nursing and Midwifery Council’s (NMC) findings from its second year revalidation report show that 204,218 nurses and midwives revalidated in the past year, with 406,917 revalidating since the process began in 2016. This means that two thirds of the UK’s nurses and midwives have now revalidated with the NMC and by 2019 we expect 690,000 nurses and midwives to have gone through the process.

The NMC introduced revalidation in April 2016 with the ambition to improve public protection by making sure that nurses and midwives demonstrate their continued ability to practise safely and effectively throughout their career. As a part of the process nurses and midwives will have to demonstrate how they meet the NMC’s requirements, which include minimum practice hours, continuing professional development, and reflective discussion, reflective written accounts relating to their practice.

As a part of measuring the impact of revalidation the NMC publishes annual data and evaluation reports on its progress. Findings from the two first years of revalidation show that revalidation is encouraging nurses and midwives to analyse the care they give by reflecting on their practice and seeking feedback from colleagues, patients and service users. Reflective practice in particular is viewed as a likely driving force behind changing attitudes and behaviours among nurses and midwives.

Additionally, the reports found that many of those who have been through revalidation feel positive towards the process. There is also evidence of a growing understanding of the Code and continued positive attitudes towards its role in nurses and midwives practice. Many of those who have revalidated agree that the Code is improving the quality of their practice and is central to the care they provide.

New agreement on emerging concerns protocol

Eight UK health and social care regulators and other bodies have signed a new agreement to help them share concerns with each other more effectively. The ‘Emerging Concerns Protocol’ seeks to provide a clearly defined mechanism for the regulators to share information and intelligence that may indicate risks to users of services, their carers, families or professionals.

The protocol formalises and strengthens existing arrangements for sharing emerging concerns between

regulators. The protocol covers England only, and regulators with responsibility for regulating across the UK or Great Britain will continue to work collaboratively with the relevant national organisations in the home countries.

The signatories currently include the Care Quality Commission, General Pharmaceutical Council, Nursing and Midwifery Council and the General Medical Council. The General Dental Council is supporting the protocol and will look to become signatories.

*Summary of year 2 revalidation data – April 2017 to March 2018

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EEA qualified doctors working in the UK

The UK General Medical Council (GMC) has published an updated report on EEA qualified doctors working in the UK. It is an update to two previous papers on the same topic, and summarises the latest data on doctors who gained their primary medical qualification (PMQ) in the European Economic Area (EEA) and who have a licence to practise medicine in the UK.

The report gives updated data on the location, area of practice, and years of experience of EEA graduate doctors, and highlights sections of the profession that have more EEA qualified doctors. It also presents data on the profile of EEA graduates in each country of the UK, and looks at how many EEA graduates are joining and leaving UK medical practice.

9% of all licensed doctors in 2018 were EEA graduates. The number of licensed EEA graduates has remained fairly constant over the last three years.

Figure 1: The number of licensed and registered EEA graduates on

the UK medical register as at June 30 each year

For the first time, 2018 saw the number of graduates from Central

Europe, Eastern Europe and Baltic countries exceed those from

North-western Europe. But, as in 2017, over half of all EEAs graduated

from just four countries: Ireland, Greece, Italy and Germany.

The data also shows that 14% of the specialist register were EEA

graduates with certain specialties such as ophthalmology (24%) and

surgery (18%) being more reliant on this group.

When the four countries of the UK were compared, Northern Ireland had

the largest percentage of its workforce holding an EEA PMQ, with 71% of

those graduating in the Republic of Ireland.

Figure 2: Number of licensed doctors from each EEA country by register type in 2018

Rank PMQ PMQ Country

Licensed Doctors

GP (only)

Specialist (only)

GP and specialist

Neither and not in training

Neither and in training

1

2

3

4

5

6

7

8

9

10

Ireland

Greece

Romania

Italy

Germany

Poland

Spain

Czech

Republic

Hungary

Bulgaria

3,210

2,444

2,178

2,162

2,028

1,776

1,244

1,170

1,062

738

747

46

226

105

547

215

301

195

64

51

1,442

1,560

752

1,416

1,049

749

680

342

626

346

16

2

10

13

28

21

30

4

14

4

605

546

971

505

320

451

206

396

276

300

400

290

219

123

84

340

27

233

82

37

Register type

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Around the globe

Global: Right touch regulation spreads across the globe

The UK Professional Standards Authority (PSA) has released a paper Right-touch regulation in practice showcasing the experiences of regulators from five countries in applying right-tough regulation. Contributors to the report included the Australian Health Practitioner Regulation Agency, College of Registered Nurses of British Columbia, College of Veterinarians of Ontario, General Pharmaceutical Council (UK), Occupational Therapy Board of New Zealand, CORU Ireland, and the Royal College of Dental Surgeons of Ontario.

All contributors share their experiences of using right-touch regulation to inform their thinking, policies and practice. The contributions set out the interesting and varied ways in which different regulators in different sectors and in different countries have applied right-touch regulation to their particular problems and challenges.

A common theme in the papers is that right-touch regulation is an adaptable approach, flexible enough to be useful in different regulatory regimes, and clear enough to provide a consistent framework for problem-solving.

IAMRA’s 13th International Conference on Medical Regulation

On 6 – 9 October 2018, the International Association of Medical Regulatory Authorities (IAMRA) held its biennial conference and member’s general assembly (MGA) in Dubai, United Arab Emirates. The conference, in conjunction with it’s sister conference (Dubai Health Regulation conference), brought together over 1000 participants from across the globe.

The theme of this year’s conference was ‘Empowering regulation with innovation and evidence’ and was hosted by the Dubai Health Authority in tandem with their annual Dubai Health Regulation Conference.

A wide array of plenary and workshop sessions covered topics as diverse as: transformational disruption of health and medical regulations; the late career physician: possibilities, perils and the role of regulatory authorities; and doctors, patients, sex and chaperones: rethinking medical regulation.

The full conference programme and related materials are available on the conference website: http://iamra2018.com

At the Association’s MGA, IAMRA adopted the following important resolutions involving topics essential to improving the quality of medical regulation and public protection worldwide:

IAMRA Statement on Accreditation of Postgraduate (Specialist) Medical Education Programs

IAMRA Statement on Independence of Regulation: the primacy of patient safety

Developing Guidelines on Good Prescribing Practices

The conference also marked the end of Dr Humayun Chaudhry’s chairmanship of IAMRA, which is now passed to Dr Kgosietsile Letlape, President of the Health Professions Council of South Africa (HPCSA). Dr Letlape will serve

as Chair of IAMRA until October 2020. Dr Heidi Oetter, Registrar of the College of Physicians and Surgeons of British Columbia, was elected as IAMRA’s new chair-elect.

Dr Letlape announced that the next IAMRA conference will take place in Cape Town, South Africa in October 2020. A promotional video for the 2020 conference can be viewed here

To find out about how to become an IAMRA member and take advantage of special member rates at future conferences, visit the IAMRA website (www.iamra.com) or email the secretariat on secretariat@iamra.com.

New IAMRA management committee

Hank Chaudhry, Susan Goldsmith, Martin Fletcher (CEO, AHPRA) and Patricia King (Chair, Federation of State Medical Boards) in a panel session on ‘Medical Regulation of Doctors in Training - a case study’.

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Australia: WHO Collaborating Centre for health workforce regulation across the Western Pacific

In a move to promote best practice and learning from others, the Australian Health Practitioners Regulation Agency (AHPRA) in collaboration with the World Health Organisation (WHO) have established a Collaborating Centre for health workforce regulation. This designation means that AHPRA, in partnership with the Australian National Boards, will work with WHO and its 37 member states in the Western Pacific to strengthen regulatory practice across the region.

Crucial to the work of the Collaborating Centre is establishing a network of regulators across South East Asia and the Western Pacific. The network is expected to work on improving regulatory standards.

The designation as a Collaboration Centre is timely, with the Australian Government Department of Health and WHO recently beginning a four-year Cooperation Strategy. This strategy will look at strengthening regulation in health services, health workforce, radiation, food safety and health products. You can access the Cooperation Strategy on WHO’s information-sharing site. Queries about AHPRA’s work as a Collaboration Centre can be directed to WHO_CC_HWR@ahpra.gov.au.

Nursing Now! update

Nursing Now has officially launched its worldwide website with activities now running in more than 40 countries. To find out what is going on in your country, including newly established regional and national groups please follow this link. A three-year global campaign, Nursing Now is run in collaboration with the International Council of Nurses and the World Health Organisation.

Nursing Now will be hosting its first ever conference on 25-26 October at the Global Conference on Primary Health Care in Astana, Kazakhstan. Run in coordination with the International Council of Nurses, the conference will look at the essential contribution of nurses in achieving the goals of global primary health care.

The conference is an opportunity for Nursing Now to engage with Heads of State and Ministers of Health from

across the world to ensure that nurses and midwives are put at the centre of primary health care. For more information or to follow the Nursing Now movement please follow this link.

Australia: Vexing not vexatious – research finds more risk in not reporting

Independent research commissioned by the Australian Health Practitioners Regulation Agency (AHPRA) has looked internationally at vexatious complaints, finding incidents are rare and that there is more risk from people not reporting concerns than from making complaints in bad faith. Vexatious complaints are defined as ones intended to cause annoyance, frustration, or worry, rather than genuine complaints.

The report found that the number of vexatious complaints dealt with both in Australia and internationally is very small, less than one per cent, but they have a big effect on everyone involved. The research also confirms that the risk of someone not reporting their concerns is greater than if the complaint turns out to be vexatious.

Most of Australia’s 700,000 registered health practitioners provide great care, but patients also have the right to make a complaint when things don’t go so well.

The best available evidence suggests that truly vexatious complaints are very rare, and that under-reporting of well-founded concerns is likely a far greater problem.

There is a common misconception that a complaint must have been vexatious if it resulted in no regulatory action. However, a decision by a National Board not to take regulatory action does not mean that the complaint was unfounded or made in bad faith. For example, a risk to the public may have been adequately addressed between the time the complaint was made and when the investigation concluded.

The report will be used to inform best practice for reducing, identifying, and managing vexatious complaints and helps to identify opportunities to work with others to help reduce their frequency and adverse consequences.

Two kinds of intervention reduce doctor burnout

According to a review article published recently in the Journal of Internal Medicine, more than half of doctors internationally struggle with burnout. The researchers identified five primary drivers for physician burnout: excessive workload, work inefficiency, work-home balance, loss of control, and loss of meaning from work. The review found that addressing physician burnout requires both organisational and individual interventions, but that the former have the highest potential to ease burnout.

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Upcoming events

25-26 October 2018 Nursing Now! Global Conference on Primary Health CareParis, France

09-10 November 2018 CPME Board and General Assembly meetingGeneva, Switzerland

26 November 2018 European Network for Medical Competent Authorities (ENMCA) meetingVienna, Austria

04 February 2019 HPCB conference 2019Dublin, Ireland

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