The Final Report for the Overseas Health Practitioner Regulatory Settings Review, also known as the Kruk Review (named after Ms Robyn Kruk AO who led the Review), was published last week on the 6th of December 2023. The review investigated regulatory settings for international health practitioners seeking registration in Australia and the Final Report makes 28 recommendations for reform. The review consulted with over 100 stakeholders.
Background to the Kruk Review:
- The Kruk Review started back in September 2022 after the government commissioned a review of Australia’s regulatory settings for overseas health professionals.
- It looked at registration and qualification recognition processes for overseas trained health professionals and international students who have studied in Australia.
- It was initially developed to make recommendations that would help to ease health workforce and skills shortages in Australia, reduce costs (to the applicant, employer, health system and economy), and maintain high quality and safe standards of care for patients.
- The Final Report follows an Interim Report, released earlier this year in April 2023.
- The review needed to analyse whether regulatory settings for international health practitioners were fit for purpose, comparable to similar countries like NZ or Canada, and whether they imposed unnecessary barriers or costs on migrants and employers.
- The review focused on opportunities to streamline and simplify health practitioner regulation, which in turn would help to ease skills shortages in critical health professions.
A Summary of the Recommendations in the Final Report:
The Final Report included 28 recommendations covering five broad areas. Below is a summary of the recommendations by area.
Improve the applicant experience – recommendations such as:
- Removing duplication.
- Aligning evidentiary requirements.
- Information sharing across agencies.
- Removing unnecessary costs and barriers from the visa process.
- Automating the issuance of Medicare Provider numbers.
- Providing a quicker, easier and more transparent pathway to permanent residency for suitable international health graduates who have studied in Australia.
- Broadening the age exemption for skilled visas.
Expand ‘fast track’ registration pathways – recommendations such as:
- Removing the requirement for employers to advertise for domestic applicants in areas of shortage.
- Providing greater visa flexibility by enabling key health professionals to undertake additional duties without a new visa nomination.
- Expanding expedited pathways to registration for all professions, in acknowledged areas of shortage.
Better workforce planning – recommendations such as:
- Centralising back-end support within jurisdictions, and front-end support across jurisdictions
- Development of a single portal to improve efficiencies and reduce costly competition for the same workforce.
- Quantifying workforce, skills, and distributional issues, factoring in changing models of care and making it easier to determine the extent of workforce shortages. This should encompass analysing needs in aged and disability care.
Greater flexibility, while supporting safety – recommendations such as:
- Ensuring registration assessment recognises skills and experience in addition to qualifications and training pathways.
- Providing applicants with greater flexibility in demonstrating their English language competency.
- Expanding applicant access to online and offshore assessment.
- Addressing maldistribution of the workforce, including evaluating the effectiveness of existing IMG support structures in rural settings.
- Creating networks and connections between metropolitan and regional health services
- Improving Specialist IMG assessment processes, especially in relation to timeframes and fees.
- Making supervised practice or training more flexible and innovative, and expanding the use of workplace-based assessments where appropriate.
Enhanced regulator performance and stewardship - recommendations such as:
- Health Ministers communicating expectations and best practice regulatory principles to all registration and accreditation entities, and enhancing publicly available performance standards.
- Using the National Health Practitioner Ombudsman (NHPO) to review accreditation procedures.
Reporting and responses to the Kruk Review – Final Report:
The Australian Health Practitioner Regulation Agency published its AHPRA statement in response to the Kruk Review final report. They stated:
- From 18 December overseas-based applicants would no longer be required to undertake in-person identity checks in Australia before their registration is granted.
- AHPRA had already made reforms of the registration process which have cut the average assessment time for international applications from 29 days down to just 10 days.
- AHPRA will continue with reforms to fast-track international practitioner registration.
- AHPRA has developed clearer information for employers and international applicants on their website.
- They have increased exam places for internationally qualified nurses, and opened a new purpose-built centre in Melbourne for clinical skill assessment of internationally qualified nurses and midwives.
- The 2022/23 AHPRA annual report showed a 92 percent increase in new overseas registrants compared to the previous financial year.
The Royal Australian College of General Practitioners have published their media release Let’s cut red tape holding back overseas GPs and this news article IMG assessment push softened in final Kruk Review. RACGP reported:
- They had already demonstrated leadership and committed to simplifying their own processes for overseas doctors, such as reducing the minimum time on the Specialist Pathway from six months to three, simplifying comparability assessments, and widening the type of applicable training.
- They agreed with the report’s number one recommendation on streamlining processes and reducing duplication across agencies and regulators so that applicants only needed to provide information and meet requirements once.
- RACGP President, Dr Nicole Higgins remained ‘strongly opposed’ to AMC involvement in comparability assessments, but acknowledged that while the Interim report (April 2023) suggested assessments should shift to the Australian Medical Council (AMC), the final report suggested assessments could remain with the colleges if agreed timeline expectations were met. (See recommendation 13 of the Final Report).
- RACGP will carefully consider all 28 recommendations and welcomed more details.
Other insights:
The report suggests by putting in place the recommendations, the Australian economy could be better off by up to $850 million each year, and it would improve Australia’s ability to attract and recruit for the health workforce.
The report drew comparisons with other comparable health systems in New Zealand and the United Kingdom, highlighting alternative approaches and models adopted by international peers to fast track internationally qualified health professionals.
Last week, the government announced in a media release that it will fund a further $1.2 billion package of Strengthening Medicare measures – including the implementation, with states and territories, of the recommendations from the Kruk Review.
By implementing the recommended actions of the Kruk Review, it is hoped a more efficient and effective end-to-end regulatory journey for overseas health practitioners will result, with a reduction of regulatory costs – including time, money and effort –for employers and applicants alike.
