SIRA frameworks for non-treating health practitioners

Next steps

Following consideration of all the submissions, SIRA will produce a framework for IMCs. SIRA will also consider feedback on how an appointment and regulatory framework for AHPs may operate, including relevant guideline provisions.

Outcomes for Authorised Health Practitioners

Outcomes for Injury Management Consultants

Authorised Health Practitioners

Background

From 1 March to 12 April 2019 the State Insurance Regulatory Authority (SIRA) published two proposed frameworks, one for the appointment and regulation of Authorised Health Practitioners (AHPs) working in the NSW CTP scheme, and the other for approval and regulation of injury management consultants (IMCs) working in the NSW workers compensation system.

The feedback in relation to AHPs is contained in this section.

Specific questions

At the beginning of the proposed AHP framework document, SIRA posed five questions. The purpose of those questions was to help guide stakeholders’ responses and to gather specific feedback to assist with guideline development. The questions were:

1. To which medical matters should the authorisation requirements in section 7.52 of the Act relate? For example, should it be for all medical matters referred to in the Regulation, be limited to a specific medical matter (e.g. permanent impairment), or a combination of matters? Why?
2. Should there be specific criteria in respect of the giving of evidence in different medical matters?
3. Are there any particular criteria for appointments to ensure high quality medicolegal evidence?
4. Should something similar to the Expert Witness Code of Conduct be incorporated in the Motor Accident Guidelines in respect of any expert witness engaged to provide evidence in the Dispute Resolution Service?
5. Are any additional criteria appropriate in respect of the Expert Witness Code of Conduct for inclusion in the Motor Accident Guidelines?

Question One

To which medical matters should the authorisation requirements in section 7.52 of the Act relate? For example, should it be for all medical matters referred to in the Regulation, be limited to a specific medical matter (e.g. permanent impairment), or a combination of matters? Why?

[2 x medical] If it is about impairment, then a medical specialist in that particular field may be best suited, provided that all medical issues are considered when giving the opinion (such as causation, etc.).

[1 x medical] If the decision is about functional capacity then AHPs would have the capability to make these assessments.

[1 x medical] suggested that practitioners in current clinical practice are not best suited to conduct impairment assessments as they are too busy to remain up to date on interpretations and implementation of the guidelines, and these types of assessments are better conducted by consultant practitioners.

[2 x medical, 1 x insurer, 1 x legal] AHPs should be authorised to comment on all medical matters of the Act, which minimises the need for multiple examinations.

[1 x insurer] AHPs should be able to assess all matters, providing the pool is of sufficient size and diversity. Otherwise, any medical matters relating to treatment should be removed from the Regulation as these are time sensitive and should not result in delays as this may cause distress to people who are injured and impact on their recovery.

[1 x insurer] Authorisation should be aligned with, and limited to, the AHPs’ area of expertise, accreditation and training, for which they should provide evidence upon application. This means that some AHPs will be able to assess all matters while others are only able to assess particular matters. This could be published on the SIRA website.

Question Two

Should there be specific criteria in respect of the giving of evidence in different medical matters?

[1 x medical] AHPs would be able to give evidence in proceedings in relation to functional capacity, adaptations, and rehabilitation.

[1 x medical] General principles of treatment can be addressed by all AHPs, however in some instances it may be more appropriate for the practitioner to be in current clinical practice (e.g. whether one should have a stent versus a coronary bypass, which should be assessed by a cardiologist in current practice). For treatment matters, practitioners should be in current clinical practice.

[1 x medical] Practitioners should be trained in the appropriate body parts for impairment assessments.

[2 x medical] AHPs should be able to offer an opinion based on their specific approved field or based on their clinical skills/interest.

[1 x legal] The EWCOC is comprehensive in respect of giving evidence.

[1 x insurer] For permanent impairment and earning capacity opinions, the AHP should demonstrate rigour, including clear documentation of the methods of assessment that align with peer reviewed literature.

[1 x insurer] For treatment matters, the AHP should reference the current evidence base for said treatments.

[1 x insurer] There is scope to have specific criteria for each medical matter type.

[1 x insurer] A framework for earning capacity decisions should be developed similar to what has been developed for permanent impairment, once the scheme matures. Once this has been developed all AHPs should be trained and demonstrate competency in this area.

[1 x insurer] All AHPs in the field of Occupational Medicine who assess earning capacity should be required to be a Fellow of the AFOEM and have 5 years’ clinical experience, to ensure consistency.

[1 x medical] All opinions given should be outcome-driven.

Question Three

Are there any particular criteria for appointments to ensure high quality medicolegal evidence?

[1 x medical] SIRA specific training (e.g. completing modules, WPI updates, workshops, etc.)

[1 x medical] An accrued point system over a time period (e.g. 3 years) showing educational currency pertaining to the requirement of the position.

[1 x medical] Providing ongoing medical evidence-based updates to maintain standards, as is required by all medical boards in each medical discipline.

[1 x medical, 1 x insurer] The proposed criteria are sufficient and gives some assurance of quality and competency to the general public, provided that the specialty and expertise is relevant to the injury.

[1 x medical] AHPs need to be registered members of a College; they should be involved in continued educational programmes and even consider being in active clinical practice. AHPs should also be considered for appointment as an IME in the workers compensation system.

[1 x insurer] All AHPs should hold a current Working with Children Check number to avoid insurers referring to unsuitable providers.

[1 x legal] Prior experience in the provision of medicolegal reports in similar jurisdictions (such as the District Court, CARS, or the Workers Compensation Commission) or if no prior experience the submission of sample medicolegal reports based on a hypothetical assessment problem/assessment set by an experienced medicolegal report provider.

[1 x medical] Treatment and permanent impairment matters require different skills sets, so particular criteria should be set to ensure quality.

[1 x insurer] Some recency of practice (not just recency of training) should be part of the eligibility criteria, provided that this does not restrict the size of the pool to such an extent that assessments can’t be completed in a timely manner.

[1 x insurer] Applicants should provide evidence of completed training, professional development in their specialty, and de-identified medicolegal reports that they have prepared.

[ 1 x medical] Collegiate functioning should also be included. This could include clinical meetings under the overall guidance of SIRA or group peer reviews of reports, provided the author has a right of reply.

[1 x medical] A training programme specific to each specialty should be a mandatory requirement of appointment to ensure high standard decision making and ongoing gaining of expertise in understanding the new system.

[1 x medical] AHPs should demonstrate that they are not closely aligned with any one particular party, and should be happy to accept referrals from either, to encourage impartial assessments to be made purely on the facts rather than on satisfying a referral base.

[1 x medical] indicated that AHPs should be trained in taking a forensic approach to assessments, including causation and prognosis, which could form part of SIRA’s ongoing forums for practitioners. Training should also include professional ethics, assessing comorbidity, and other tailored modules.

Question Four

Should something similar to the Expert Witness Code of Conduct be incorporated in the Motor Accident Guidelines in respect of any expert witness engaged to provide evidence in the Dispute Resolution Service?

[1 x medical] This seems pragmatic.

[1 x medical] A statement that the practitioner agrees to the EWCOC suffices.

[3 x medical, 2 x insurers] It should be incorporated into the Guidelines.

[1 x legal] It should be incorporated into the Guidelines, subject to references to ‘the court’ being amended where necessary.

[1 x insurer] The EWCOC should be incorporated into the terms of appointment rather than the Guidelines, to provide simplicity and potentially be easier to make amendments when required.

Question Five

Are any additional criteria appropriate in respect of the Expert Witness Code of Conduct for inclusion in the Motor Accident Guidelines?

[1 x medical] Practitioners of specific disciplines may make commentary in areas that are not their area of expertise. The matters to be arbitrated should be clearly defined and the appropriate medical person allocated.

[1 x medical, 1 x insurer, 1 x legal] The EWCOC is sufficient.

[1 x insurer] The EWCOC, if adopted, should also include reference to the medical matters for which the AHP is authorised.

[1 x medical] An accreditation process to demonstrate a clear understanding of the CTP legislation and aims and goals of the scheme.

Other themes

In addition to the five specific questions posed, there were a number of other themes in the feedback received. Those themes and the feedback that relates to them are recorded below.

The role of the IMC in the CTP scheme

Four separate stakeholders [three medical practitioners and one insurer] enquired as to whether the IMC role would be adopted in the CTP scheme in the same way, or similar, to how it worked in the workers compensation system. One practitioner confirmed that this was already happening in an unofficial capacity with a degree of success. There were also two requests for it to be expanded in the CTP scheme to include not only doctors but physiotherapists and psychologists.

[1 x medical] suggested that if the IMC role were to be created in the CTP scheme then it could be helpful to have a network of providers that treating practitioners could tap into.

Whilst this was outside the scope of the framework consultation, it appears to have some port and may be worth considering as part of SIRA’s broader framework for non-treating health practitioners.

Bias

SIRA was commended for trying to address the issue of bias [2 x medical].

[1 x medical] commented that AHPs should be required to have special expertise in undertaking fair assessments.

[1 x medical] submitted that AHPs should act without bias and there should be no qualification of this statement. [The framework referred to acting without bias and in a way that does not give rise to apprehension of bias; this appears to be misunderstood as it was quoted as being ‘appreciation of bias’.]

[1 x medical] commented that a long-standing issue was doctors who were providing biased opinions that other doctors knew was not correct and those doctors need to be weeded out.

[1 x medical] agreed that it was difficult to overcome the subconscious pull to act in the interests of the person who was paying for the service, but that this was less the case when giving evidence.

[1 x medical] applauded SIRA for trying to address the issue of ‘mavericks’ in the system.

Performance monitoring

[1 x medical, 1 x insurer] stated that performance monitoring was positive and stakeholders recognised the benefits of having consistency in this area across all non-treating health practitioners.

[1 x insurer] suggested that performance monitoring should focus on potential bias and the quality of medicolegal reports.

[1 x insurer] suggested that SIRA provide high level feedback on AHPs’ performance in the DRS scheme.

[1 x medical] requested that it would be appropriate to ‘introduce a clause indicating the capacity and desirability of continuously improving the framework with the advent of further important factors in the future. There should also be encouragement for feedback to SIRA by AHPs to facilitate progressive improvement.’

[1 x medical] submitted that de-identified reports be used to evaluate performance, with the emphasis on quality rather than quantitative evaluation. This could be done through peer review.

Complaints

It was recognised [1 x medical] that a complaints process was very important, but that it was possible that it could be used for when a party does not favour the outcome of an assessment. A review process in addition to a complaints process was suggested as an alternative, similar to what is used for Medical Assessors.

Another [1 x medical] suggested that there was likely to be a higher complaint rate for practitioners undertaking medicolegal work as there will be vexatious complaints from parties who did not agree with the outcome of an assessment. Prior complaints should be promptly evaluated on a case-by-case basis and exclusion should be warranted.

Another [1 x medical] submitted that a complaints process was important but that it was tricky to get right as there would always be accusations of bias.

[1 x insurer] suggested further clarification would be needed for the process for checking for complaints and queries whether it would be streamlined. This includes whether SIRA intends to distinguish between different types of complaints and their severity, as per health legislation, whether SIRA intends to distinguish between established/validated complaints and those that have been dismissed, whether any type of complaint against a health practitioner excludes them from being appointed, and what happens while complaints are being investigated.

AHPRA registration

[1 x insurer] commented that SIRA should include a requirement for an AHP to notify SIRA within 10 working days if there is a change to their AHPRA registration.

[1 x insurer] suggested that further clarification is needed in relation to how SIRA intends to monitor conditions and reprimands on practitioners.

Education and information

[1 x medical] recognised that it was important for non-treating health practitioners to inform injured people of the practitioner’s role and setting expectations of what to expect in an examination/consultation.

[4 x medical] called for a peer review system to be implemented, including such methods as clinical meetings under the overall guidance of SIRA, group review of reports (provided the writer has a right of reply) or using de-identified reports.

[1 x medical] proposed that insurer case managers need to be better educated as to the mechanism of injuries, and the role of practitioners in recovery. SIRA could take a role in this education, provided it was pitched at the senior network within insurers.

Training, qualifications, and skills

[1 x medical] submitted that motor accident injuries are primarily managed by GPs and allied health professionals on a sporadic basis. Therefore, having five years’  experience will be a difficult condition for some practitioners to meet, unless they are obtaining referrals from solicitors.

[1 x medical] commented that there should be some form of advanced formal training and certification other than a basic medical degree, as motor accidents are complex assessments.

[1 x insurer] questioned what ‘good communication skills’ would look like and how this would be assessed given its subjective nature. The suggestion was that guidelines should be provided to outline what this means.

[1 x medical] suggested that SIRA run training programmes specific to each specialty to ensure high standard decision-making and ongoing gaining of expertise in understanding the system.

[1 x insurer] highlighted the importance of AHPs being in clinical practice, ‘with the credibility of the role being maximised if this is set as a part of the minimum criteria’.

[1 x medical] emphasised the importance of having both treating practitioners and consultant practitioners who are not in clinical practice.

[1 x medical] suggested that practitioners in current clinical practice are not best suited to conduct impairment assessments as they are too busy to remain up to date on interpretations and implementation of the guidelines, and these types of assessments are better conducted by consultant practitioners.

[1 x medical] commended SIRA on setting a minimum standard that clinical experience is required and not allowing medicolegal opinion to be given by those who are inexperienced or newly graduated.

[1 x medical] indicated that AHPs should be trained in taking a forensic approach to assessments, including causation and prognosis, which could form part of SIRA’s ongoing forums for practitioners. Training should also include professional ethics, assessing comorbidity, and other tailored modules.

[1 x medical] agreed with SIRA’s approach for setting standards to attract the right people, but argued that the other component is ensuring that there is formal and informal involvement of senior doctors in the scheme.

[1 x medical] suggested that it may be helpful to appoint health practitioners who were members of colleges or had other affiliations as this would demonstrate that they had the confidence and support of their colleagues.

Selection of candidates

[1 x medical] suggested that it would be appropriate for applicants to know who reviews their application and the appropriate qualifications of those persons, including that at least one is a medical practitioner.

[1 x medical, 1 x insurer] suggested that full and transparent reasons be provided to applicants who were not successful in being appointed as AHPs, or who had their authorisation revoked, with the medical respondent also suggesting a mechanism for a face-to-face meeting with a senior officer of SIRA as part of its complaints handling process.

[1 x medical] agreed with SIRA’s approach for setting standards to attract the right people, but argued that the other component is ensuring that there is formal and informal involvement of senior doctors in the scheme.

Evidence

[1 x insurer, 1 x medical] called for applicants to provide de-identified medical reports which would assist in determining their level of communication skills and standard of their evidence.

[1 x insurer] suggested providing guidelines about how SIRA would be satisfied that an AHP has not breached any legislation, guidelines, or fee schedules. These guidelines would include materiality thresholds, whether isolated incidents of breaches would be considered and when this needs to be reported.

Fee schedules

[1 x medical] commented that the fee schedule needs to be addressed to recognise the differing complexities and time taken for particular injuries or areas of health involved.

Whilst this was outside the scope of the framework consultation, it aligns with previous feedback received by SIRA and will be considered when the fee schedule is being reviewed later this year.

Commentary on current processes

[3 x medical] commented that there was a need for a formal criterion regarding spinal surgery approval process, a review of radiology processes, and general inappropriate and costly treatment expenses for insurers.

Feedback [1 x medical] requested that the permanent impairment assessment versions used across CTP and workers compensation be aligned. Currently CTP uses AMA4 and workers compensation uses AMA5. Whilst this was outside the scope of the framework consultation, this feedback will be passed on to the relevant teams.

Working with Children Checks

[1 x barrister] suggested that all AHPs should hold a current Working with Children Check so that all AHPs can assess minors.

General feedback

Most [7 x medical, 2 x insurers] of the feedback was positive. The framework was described as ‘sensible and reasonable’ [medical], ‘positive … more transparent and user friendly’ [medical]. The framework was praised for providing for practitioners to use their extensive experience and eliminating the problem of ‘vested interest’ [medical], for ‘reducing administrative costs’ [medical], and for ensuring that opinions are ‘of a high standard and provided by practitioners who have the requisite skills’ [medical]. It was described [1 x medical] as a positive step as it addresses competency, with the proposed criteria giving some assurance of quality and competency to the general public [medical].

One respondent [medical] commented that the process for appointing AHPs should be done faster than the last time.

Injury Management Consultants

Background

From 1 March to 12 April 2019 the State Insurance Regulatory Authority (SIRA) published two proposed frameworks, one for the appointment and regulation of Authorised Health Practitioners (AHPs) working in the NSW CTP scheme, and the other for approval and regulation of injury management consultants (IMCs) working in the NSW workers compensation system.

The feedback in relation to IMCs is contained in this section.

Application for approval or re-approval

Process

[Union x 1] comment that SIRA’s proposed description of the previous process as a regulatory burden, is not supported nor successfully argued by SIRA. All parties must have confidence that the approval process remains disciplined and transparent. Recommend SIRA establish and support a tripartite body to approve IMC’s via consensus.

[Union x 1] supports the conditions of approval but would like to view the application form to see how the application form ensures the conditions of approval [eligibility conditions] are met. Concerned that we do not have enough information regarding the proposed changes around the application process for stakeholders to provide appropriate feedback.

Referees

[Unions x 2, Medical x 3] supported retention of referee checks for approval.

[Unions x 1] recommended referee checks be retained for re-approval. Retain 3 referees (at least 2 must not to be insurers, brokers or claims agents).

[Medical x 1] questioned what relevance reducing the mandatory nature of referee checks had to increased objectivity and if they were supplied who should the referees be?

Period of approval

[Medical x 2] agree on three-year period of approval.

[Medical x 1] agrees with the process SIRA has outlined for approval and regulation of IMC providers, the only suggestion raised being that there should be consideration of the initial evaluation, leading, if fully compliant with SIRA’s requirements, immediately to three-year certification for those who had been performing IMC evaluations already for some time.

[Medical x 1] period of approval should be variable based on performance criteria.

[Unions x 1] accept a three-year period of approval however recommend that during the 3 years if a noncompliance occurs: approval is to be limited to 12 months for a less serious contravention; suspension for a serious contravention, both will require formal review; and if further contravention occurs then disqualification will occur.

[Unions x 1] recommend retaining the 12-month probationary period.

[Medical x 1] if all approvals expire at the same time, this will create a large peak in processing for SIRA and may lead to waiting periods and delays.

Performance Monitoring and quality assurance

[Medical x 2] Agree this is clearly a step in the right direction and likely to be helpful.

SIRA needs to consider IMC performance from a patient’s perspective. SIRA should be actively monitoring what is happening to patients and the relationships between IMCs, IMEs and insurers. Treating patients with respect and allowing NTDs to be the principal agents deciding treatment should be a relevant criterion.

The monitoring does appear to be unlimited and care would need to be applied in monitoring all the information provided by all of the bodies mentioned. If feedback were provided to the practitioners confidentially (and using the parameters mentioned) I believe this would have an effect on their behaviour which SIRA would find useful.

[ Unions x 1] would like further information on how SIRA intends to monitor the adherence to all conditions of approval. Would suggest some greater transparency in the monitoring process particularly in serious cases of misconduct.

Complaints about an IMC

[Insurer x 2] Request a time frame for complaints investigation process. Suggest that SIRA may, at its absolute discretion, stand down or suspend the work of the practitioner in workers compensation system while the complaint is being investigated.

What is the process for checking for breaches in all Australian jurisdictions and will this be streamlined?

Does SIRA intend to distinguish between different types of complaints and their severity, as per health legislation (for example, will a privacy complaint carry different consequences than an allegation of misconduct)?

Does SIRA intend to distinguish between established/validated complaints versus those that have been dismissed?

[Unions x 1] Requesting oversight of complaints by a tripartite body (SIRA, Unions and Employer). Complaints about an IMC must form part of the monitoring regime for an IMCs ongoing approval. This should be considered by the tripartite body.

[Medical x 1] agreed that a complaints framework was necessary but that it was tricky to get right as there were issues with accusations of bias. Confirmed that there would always be a subconscious pull to act in the interests of the person who was paying, but that this was perhaps not the case when it came to giving evidence.

Revocation

[Insurer x 1] agrees with the change, subject to it being made clear that SIRA can revoke approval for any reason and at its absolute discretion. This will reduce the risk that an injury management consultant (IMC) who has not performed well or appropriately early on can continue to provide services for up to three years.

Conditions of approval – eligibility conditions

[Medical x 1] I am unsure what this laundry list of conditions means.  Presumably it will give more grounds for withdrawal of approval. This is not a bad thing, provided it involves a real performance-based regulatory role, not merely more boxes to be ticked in a periodic bureaucratic exercise.

AHPRA registration

[Unions x 2, Medical x 1] agree with AHPRA registration with no restrictions, conditions or reprimands.

[Insurer x 1] suggests clarification is needed in relation to how SIRA will monitor practitioners’ registrations with the Australian Health Practitioner Regulation Agency (AHPRA) and conditions, undertakings, reprimands, limitations or restrictions on a practitioner’s registration.

Qualifications/memberships

[Medical x 1] all new and re-approved IMCs need to be a registered fellow of a college, such a RACGP or college of Physicians. This ensures continual educational activities, to maintain a standard of excellence expected of this position.

[Unions x 1] The IMC must be a peer of the injured workers treating practitioner, who they are to engage with in solving injury management problems (that is, they must be a member of the same college).

[Medical x 1] GPs are sometimes reluctant to accept a third party ringing them telling them what to do.

If the IMCs were more from a special group of GPs with a special interest in occupational medicine, getting a phone call from a peer from the same background would be more acceptable. Otherwise they feel that they are ‘being told how to suck eggs’.

[Psychologist x 2] recommending psychologists be able to apply to be an IMC for psychological claims.

[Medical x1] AFOEM should not have special mention in the qualifications section.  Their expertise as stated in their College criteria certainly used to be that they had the same clinical competence as a competent GP.  

[Medical x 1] could also consider Rehabilitation Physician.

Current clinical practice

[Medical x 1] IMC's should still be actively involved in acute injury management to be able to understand the practical aspect of the IMC and not just a theoretical basis to management. This will ensure the IMC’s are not only active in the role but are maintaining or enhancing their particular skill set in line with current thinking / evidence-based medicine.

[Unions x 1] recommend an emphasis upon contemporary treating practise for their qualification. IMCs must be billing for treatment in the NSW workers compensation scheme under the relevant codes for treatment. IMCs must be treating more patients than they see for IMC referrals.

[Medical x 1] suggest it is more important that the IMCs are in active practice in the area on which they are making decisions, and not venturing into areas where they lack expertise, particularly if they are involved in treatment denials.

Extensive working knowledge of NSW workers compensation

[Unions x 2] agree however seek clarification on how the competency will be assessed.

High level communication and negotiation skills

[Unions x 1] recommends that the emphasis should be on mediation and facilitation skills not negotiation. Seek clarification on how the competency will be assessed along with maintenance of competence.

[Unions x 1] agrees a high level of communication and negotiation skills in this role is crucial. The change requires the applicant having demonstrated this in a challenging injury management/return to work environment. How does SIRA intend to determine this?

[Insurer x 1] suggests consideration be given to how an IMC would demonstrate that they meet the minimum standard; whether completion of the mediation/negotiation training is sufficient to demonstrate the minimum standard has been met? This requirement is subjective and therefore open to complaint if an IMC is dissatisfied with SIRA’s decision.

[Medical x 1] negotiation is not appropriate. The reason given that the IMC requires high level negotiation ‘to overcome barriers to recovery at work’ suggests that the problem is seen as a question of persuading reluctant workers or NTDs to agree to return to work.

Complaint history eligibility condition

[Medical x 1] vague provision, does not provide an explicit benchmark, only those complaints that have been sustained?

[Unions x 1] agrees with the implementation of checks and balances regarding complaints relating to applicants.

[Medical x 1] supports that SIRA now at least intends to take complaint history into account, but the idea that this is limited to certain bodies of whom patients may not be aware, or may be unable or frightened to complain to is not enough. SIRA has had a very bad record of accessibility to complainants.

There needs to be active surveys of patients, and monitoring of sites like www.ratemd.com, not merely passive waiting for complaints that have to navigate unfriendly websites.  It might be noted that there are still many people who are not computer literate, and this is particularly in disadvantaged and non-English-speaking groups who are the most injury-prone.

[Insurer x 1] asks whether SIRA intends to distinguish between established/validated complaints versus those that have been dismissed.

Are there any types of complaints against a health practitioner that excludes them from being appointed?

Conditions of approval - ongoing

Conflicts of interest

[Unions x 1] recommend that IMCs must declare conflicts of interest. Where there is complaint history between the workers treating practitioner and any of the proposed IMCs, the IMC/s must declare and exclude themselves. Workers treating practitioners should declare any issues as well.

[Medical x 1] also maintain independence from employers and any stakeholders

Some IMC's work as GP's/or other treating providers or are the workers NTD. These treating providers can at times confuse their roles.

Training

[Unions x 2] recommend training in mediation and facilitation. The change from undertaking training in mediation/negotiation skills arranged by SIRA, to complete any training to the standard required by SIRA is vague and does not provide enough information for stakeholders to comment. Given the aim of the system is to return injured workers to work, the capacity of all involved in the system to work with the injured worker without causing further harm is crucial.

[Medical x 1] increased training in this area may be useful, but I note the change so as to put costs onto the IMC.  If the IMC has a medication [mediation] role within the WC or CTP system, surely the cost of their training should be met from the WC and CTP administrative budget.

Re-approval

[Unions x 1] agrees with the changes to increase the number of consultations over a twelve-month period.

[Unions x 1] believe IMCs must demonstrate legitimate compliance with the NSW workers compensation legislation inclusive of these guidelines and the IMC referral guidelines. Revision of outcome must be obtained from 3 referees (at least 2 must not to be insurers, brokers or claims agents).

[Unions x 1] would like further information on how SIRA intends to monitor the adherence to all conditions of approval.

[Medical x 1] sounds reasonable but depending on the individual IMC situation could be difficult for a proportion of the IMC’s. However, in principle think this is a good change nevertheless.

[Medical x 1] wants clarification of whether the 5 injury management consultations include file reviews.

Other themes

Stakeholders to understand role of IMC

This is out of scope of the Approval and regulatory framework. SIRA are aware of these issues and is planning to develop strategies to address.

[Medical x 1] Education is needed for IMEs and practitioners generally for them to explain and understand what the role of an IMC is. Asked if the concept of IMCs were likely to be applied to CTP.

[Medical x 1] For all practitioners who are not treating the patient, it is important that the clinician explains to the patient why they are there, what they’ve been asked to do, and so on.

Functions of an IMC in Guidelines and referral to IMC

These are out of scope of the Approval and regulatory framework as they are set by the Workers Compensations Guidelines, Standards of Practice (Standards) and Practice notes for insurers.  SIRA is working to address these issues through review of the Guidelines and Standards. These issues have been raised outside of the consultation feedback.

[Unions x 1] provided feedback regarding concerns about the Guidelines and referrals. Need to include mediation back into the definition. More transparency with referral and report for all IMCs. Desktop reviews must no longer take place. If they do, alternatives provided for case conference to address problems before referral.

[Medical x 2] concerns re requirement to talk to worker for an IMC file review and consent to talk to worker.