Without transparency, standards are just a series of empty words.
In our July edition, in an article examining the governance of AGPAL (How Transparent is AGPAL?), we pointed to the potential conflict of interest for longstanding AGPAL board chair Dr Richard Choong and AGPAL’s implied endorsement of Health Engine through an AGPAL Partnership. We wanted the AGPAL CEO Stephen Clark to outline how his organisation dealt with potential conflicts of interest, amongst other things. He declined to comment.
Not deterred and seeking greater transparency, we approached each of the eight governing organisations listed on AGPAL’s website.
The response from five organisations was primarily ‘no comment’.
We learnt that Dr Choong was an AMA nominee, that the National Association of Medical Deputising Services had ceased involvement with AGPAL four years earlier, and the representative for RDA endorsed Health Engine without looking at how she was (incorrectly) profiled by that provider.
Representatives of the Australian Association of Practice Managers and Australian Primary Health Care Nurses Association occupy board positions and both organisations have partnership arrangements with AGPAL, which is a potential conflict that must be managed.
There are still no financials on the AGPAL website to reassure the 81% of GPs we surveyed (August edition) who considered it important that GPs were informed of how the accreditation fees AGPAL collected were spent. We could find no reference to this matter on the AGPAL website.
We have been told AGPAL spends 1,100 Euro a year as an institutional member of an Irish accrediting body ISQua. This body accredited AGPAL in 2013 for four years, including its governance and its application of accreditation standards.
We asked ISQua CEO Peter Carter to indicate if the transparency and accountability standards of AGPAL were worthy of ISQua endorsement. He referred us to generalities in the accreditation documentation. QIP standards (owned by AGPAL) were re-accredited by ISQua this year.
When we last looked, Gary Smith on the AGPAL Board was an ISQua surveyor and Stephen Clark, CEO of AGPAL, was listed as an ISQua expert. So the two organisations have multiple links.
AGPAL CEO Stephen Clark appeared for the first time on the AGPAL website after we asked questions of ISQua.
We believe that standards and guidelines account for much more when they are accompanied by full transparency and accountability, especially for organisations like AGPAL that are entrusted with applying the RACGP’s accreditation standards to general practices and, in doing this, it says it places importance on its own transparency.
In our dealings with General Practices, it appears that the incentive payments from government that are dependent on successful accreditation are a major motivating factor for practice principals. But we are hearing more that practices feel the increasing red tape of accreditation and the costs of compliance make the financial benefits received ‘a line-ball’.
Accreditation is ingrained in the psyche of most practice managers and GPs as a compulsory three-year cycle. The big question is do practice staff enjoy and welcome this yardstick of performance?