Verify credentials nationally once; keep the scope of practice decision local
Credentialing bundles two different things: verifying that documents are genuine, and deciding what a clinician should do at a particular facility. Only the second is local, and only the first is repeated at every hospital a clinician ever works at.
Steps this would change
Rationale
A specialist who has been registered by the Medical Board -- which required primary source verification of their qualifications -- then supplies substantially the same evidence to the health service that hires them, and again to the next one, and again to every additional site they work at. Locum, visiting and rural relieving specialists carry this cost several times a year.
The step also waits on a committee cycle, which is why it is classified
scheduling in the database: a complete file arriving the day after a meeting
waits for the next one, and a query raised at a meeting waits a further full
cycle to be answered.
The separation this proposal asks for is clean:
- Verification -- is this person who they say they are, do they hold what they claim to hold, is their registration current, is there anything adverse in their history? These questions have one correct answer nationally. They have already been answered by Ahpra. Answering them again at each hospital produces the same result more slowly.
- Scope of clinical practice -- given this facility's theatre capability, its intensive care, its staffing and its case mix, what should this practitioner do here? This genuinely cannot be decided centrally and this proposal does not touch it.
A national credentialing record, held once, that a health service draws on and then adds its own scope decision to, would leave the second judgement entirely intact while removing the first from every repetition after the first.
Who acts: health ministers collectively, through the Commission and Ahpra. This is not a Commonwealth decision and cannot be delivered by one government.
What is being traded away
Two objections, and the first is the one clinical governance people will raise immediately.
A national record can go stale, and staleness in credentialing kills people. The value of local re-verification is not only that documents are checked; it is that they are checked now, by someone accountable for this hospital. A national record queried at a point in time is only as good as its currency and its integrity, and a health service that stops looking because a central system said yes has outsourced a duty it cannot outsource. Any version of this needs the record to be live rather than periodic, and needs the health service to remain the accountable party in law.
Consolidating verification creates a single point of failure. Today, a falsified qualification has to defeat several independent checks. Afterwards it has to defeat one. The history of credentialing scandals in Australian hospitals is largely a history of impersonation and forged qualifications getting through, and each such case is an argument for redundancy rather than efficiency. That argument deserves a direct answer, not an efficiency estimate: the answer is that the checks are not currently independent in any meaningful sense -- they are the same check, repeated against the same documents -- but that claim should be tested by someone who has run a credentialing committee before it is relied on.
Precedent
The Australian Commission on Safety and Quality in Health Care already publishes a national model for credentialing and defining scope of clinical practice. Ahpra already performs primary source verification of the same qualifications at registration. The components exist; they are simply not connected.
Sources
- Australian Commission on Safety and Quality in Health Care, national model and updated guidance for credentialing and defining scope of clinical practice
- National Safety and Quality Health Service Standards, clinical governance standard