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Australian Health Practitioner Regulation Agency
 

December 2015

In this edition:


Welcome from the CEO

Welcome to our final AHPRA report for this year. AHPRA report aims to bring you interesting and relevant information about the work of National Boards and AHPRA as part of the National Registration and Accreditation Scheme (the National Scheme).

In this edition, we cover highlights from our 2014/15 Annual report. We also outline our continuing focus for the coming year on streamlining our operational processes, improving our service delivery to, and increasing our engagement with, health professions and the community. Other stories include the latest public safety issues, what we’ve learned from interaction with international regulators and our new projects and programs.

We welcome your feedback on the issues and updates we cover in this newsletter. We publish AHPRA report three times a year. Look out for the next issue in the first part of 2016.

Martin Fletcher
Martin.Fletcher@ahpra.gov.au

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Reporting on our work and performance - highlights from 2014/15

We recently published detailed information in the 2014/5 Annual report about our work in partnership with the 14 National Boards to implement Australia’s regulatory scheme for registered health practitioners.

The report outlines the huge steps taken to ensure we are fulfilling our core purpose of protecting the public in the most effective and efficient ways possible. Over the past year we have placed a significant emphasis on the analysis of our in order to ensure that we take an evidence-informed approach to regulatory decision-making and regulatory policy that is proportionate to the risk posed. This has been supported by a set of common regulatory principles across the National Boards and AHPRA.

I am pleased to share some highlights of our work here.

Registration

National Boards now register over 637,000 health practitioners in Australia across the 14 professions. Registrant numbers have consistently grown each year since the start of the National Scheme in 2010. In 2014/15, AHPRA assessed and managed 61,517 applications for registration across all professions, and conducted 51,947 domestic and international criminal history checks.

Our work to promote online registration renewals continues to grow practitioners’ use of this service. For the May 2015 renewal period for nurses and midwives, 97% of registrants renewed online.

Notifications (complaints)

We continue to improve the way we manage notifications (complaints). A focus has been to reduce the length of time it takes to assess and investigate notifications and we report that we have nearly halved the time it takes to close a matter following assessment.

We have also continued to improve the way we communicate information about the notifications process to both notifiers and practitioners. We have also worked closely with health complaints entities and co-regulatory partners in each state and territory to ensure a smooth interface.

We received 8,426 notifications in 2014/15, down from 10,047 in 2013/14. However, this year, due to changes to how notifications are received in Queensland, our notifications data only reflect matters that have been referred to us by the Office of the Health Ombudsman (OHO) in Queensland. We are working with the OHO to be able to report more complete national data in future years.

Overall, around 1.3% Australia’s registered health practitioners were the subject of a notification.

Medical practitioners, who make up 16% of total practitioners, were the subject of 54% of all notifications received. This has been a consistent pattern since the start of the National Scheme.

There was a 27% decrease in mandatory notifications received, with variations across states and territories. Overall, mandatory notifications are more likely to require regulatory action on the part of a Board.

Auditing practitioners’ compliance with registration standards

In 2014/15, we carried out audits across all 14 professions. For all audits initiated in the financial year, 96% showed full compliance with the registration standards audited. Only 1% of all audited practitioners were cautioned by National Boards in 2014/15, reflecting a high level of compliance with registration requirements. Audit is an important means by which we provide assurance to the community that registration standards are understood by registered health practitioners.

Statutory offences

Statutory offences are breaches of the National Law, committed by registered health practitioners and unregistered individuals or companies. The National Law sets out types of statutory offences including: unlawful use of protected titles; performing a restricted act; holding out (unlawful claims by individuals or organisations as to registration), and unlawful advertising. Statutory offences can put individuals and the community at risk so action on these breaches is another important way we protect the public.

During 2014/15, AHPRA received 506 offence complaints, including:

  • 171 about title protection offences 
  • 17 about practice protection offences 
  • 300 about advertising offences
  • 7 about directing or inciting unprofessional conduct/professional misconduct, and 
  • 11 in relation to other offences.

The total number of complaints received (506) was 40% less than in the previous year (846). This is largely attributed to the decrease in the number of advertising complaints from 547 to 300. This suggests greater awareness of the advertising requirements of the National Law.

AHPRA has successfully prosecuted nine individuals for offences under the National Law across a number of jurisdictions in the Magistrates’ Court.

Monitoring compliance with restrictions on registration

AHPRA, on behalf of the National Boards, monitors health practitioners and students with restrictions placed on their registration, or with suspended or cancelled registration. By identifying any non-compliance with restrictions and acting swiftly and appropriately, AHPRA supports Boards to manage risk to public safety. Restrictions are placed on registration through a number of different mechanisms, for example as an outcome of a notification or of an application for registration or renewal of registration.

Since 1 July 2014, the number of monitoring cases in the health performance and conduct streams has increased by 5.5%, the majority of these being an increase in performance cases. To help us manage risk and ensure we are using the most up-to-date approaches for testing for drug and alcohol misuse, an expert panel was established in November 2014. It provides advice on the AHPRA drug and alcohol screening protocols, testing methodologies, the schedule of drugs to be tested for, cut-off limits for testing, and any necessary additions to the schedule.

Following a competitive procurement process, Scientific Diagnostic Services was successful in being appointed to provide a national collection and pathology service, which has collection arrangements in all capital cities and across regional centres in each state and territory.

Our focus for 2015/16

The registered health workforce continues to grow and the regulatory and health environment continues to evolve. In the coming year we will keep working on being responsive, flexible and agile in the face of these changing needs. Our core focus is on protecting the public by regulating health practitioners cost-effectively to facilitate access to safer healthcare.

The National Boards and AHPRA will actively build on the outcomes of the Independent Review of the National Scheme to continue to improve the ways we work in the public interest. The strong partnership between the National Boards and AHPRA is an important foundation for this work.

We will continue to reach out to the community and the professions to engage with us on important regulatory issues. Our work on improving the notifier and practitioner experience will also continue as an important focus.

AHPRA will also continue to improve its performance to ensure the quality, timeliness and responsiveness of our delivery of regulatory services to the community. This will include exploring further ways to organise and streamline our services nationally to improve effectiveness and efficiency.

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Focus on enhancing public safety

Infection prevention and control in the dental profession forum

Opportunities for supporting better infection prevention and control in the dental profession were canvassed at a forum in October.

The forum was a collaboration between the Dental Board of Australia, which sets professional standards for dental practitioners, and AHPRA, as well as the NSW Dental Council, a range of professional organisations and health department representatives.

The forum provided an opportunity for all involved to develop new partnerships, and build on existing ones, to gain a better understanding of how to support dental practitioners to practise effective infection prevention and control. The overall goal is to minimise the risk to the public of transmission of healthcare-associated infections during dental treatment.

Participants recognised the value in listening to each other’s views, which will result in better outcomes for patients. The Dental Board will follow up with further targeted consultation on infection control, in preparation for its review of its infection control guidelines.

The forum followed the release of a fact sheet outlining the current infection control requirements and self-audit tool for dental practitioners. As well as targeting practitioners with information, the Dental Board also published Tips for dental patients to help patients make sure they are getting safe dental care.

Tribunal outcomes and the lessons they can teach

AHPRA publishes media releases and summaries of the outcomes of tribunal and court decisions relevant to health practitioner regulation under the National Scheme. They provide useful and timely reminders about issues that have led to complaints and notifications and tribunal and court action in relation to practitioners. These summaries are the most popular content that we share on Twitter.

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New projects and programs

Board-specific videos for graduates and exam candidates

AHPRA is utilising various digital platforms to build awareness about the National Scheme, including having our own YouTube channel to promote the work of AHPRA and the National Boards. The Podiatry, Pharmacy, and Osteopathy Boards have all published videos aimed at graduates of approved programs of study.

A Medical Radiation Practice Board video about practitioner obligations in the scheme and a Psychology Board video about the national psychology exam will be published soon.

Two videos about the scheme and across-board regulation are nearing completion. The ‘overview’ video is a high impact message aimed at people who might use health services and includes reference to the online register. The ‘renew’ video explains the registration process and will help registered health practitioners when they renew registration for the first time.

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AHPRA in numbers

 10.6m website visits in the past 12 months. 52 million page views in the past 12 months. 4,285 followers. 3,409 likes.

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Health workforce update

The data we collect on registered health practitioners is important for heath workforce mapping and planning nationally. You can view our quarterly registration data on our Statistics page. 

632,488 registered health practitioners.  Top professions by growth in 2015/16.

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Sharing learning opportunities with international regulators

CLEAR Forum

In September professional and occupational regulation was centre stage at the Council for Licensure, Enforcement and Regulation (CLEAR) annual forum in Boston, USA.

For regulatory leaders looking for the chance to examine how global trends in professional and occupational regulation impact their own organisations, CLEAR’s Forum offers an interactive and dynamic forum to explore the most salient issues for the international regulatory community.

The annual forum brings together those involved in regulation across health and other sectors, mainly from the United States of America (USA) and Canada. AHPRA is a member of CLEAR, and has in the past participated in a number of these forums both within North America and internationally.

This was the first CLEAR Forum attended by AHPRA CEO Martin Fletcher, who presented the Australia regulatory context to the international audience in attendance. AHPRA’s participation referenced an overview of the National Scheme; a comparator with the US, Canada and Scotland; information on AHPRA’s approach to risk-based regulation and discussion on comparisons across Australia and Canada about regulation and migration employment outcomes.

This event generated much interest in Australia’s regulatory approach from both Canada and the USA. For the Canadians, with similar federated system of government, the interest is in how Australia has achieved and implemented an approach which is both national and multi-professional. There was also discussion about the title protection nature of Australian legislation; governance arrangements; and Australia’s legislative focus on workforce as well as public protection.

Participants at the forum were interested in AHPRA’s approach to risk-based regulation and use of data to promote evidence-informed regulatory decision-making and interventions where there is great potential for future development.

APHRA will be hosting the biennial international CLEAR Forum in 2017 in Melbourne. For more information, visit the CLEAR website.

IAMRA international conference on medical regulation, 2016

The Medical Board of Australia and AHPRA are pleased to be hosting the International Association of Medical Regulatory Authorities’ (IAMRA) 12th International Conference on Medical Regulation on 20-23 September 2016 in Melbourne.

Held biennially, this conference has become a thought-provoking forum where around 350 international medical regulators, policy makers, government delegates and academics from more than 30 different countries share ideas and experiences and learn from each other to promote international best practice in medical regulation. It is recognised as the pre-eminent international meeting for medical regulators.

A diverse program of international and local speakers will underpin IAMRA’s purpose - to protect, promote, and maintain the health and safety of the public by ensuring proper standards for the profession of medicine.

The call for abstracts is now open and a draft program is available. For more information, visit the IAMRA website.

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Research news

AHPRA to remove the requirement for FOI application fees

Members of the public who apply to AHPRA for access to documents and personal data under the Commonwealth Freedom of Information Act (the FOI Act) currently pay an application fee of $30. They may also have to pay additional internal review fees.

We are now preparing to remove the fees to make applications simpler for both applicants and AHPRA, and prepare AHPRA for the transition to the FOI Amendment (Reform) Act.

For further information on FOI, visit our Freedom of information page. For AHPRA’s information and data access policy, see our Data access and research page.

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National Board news

Renewal campaigns run smoothly for all professions

After five years, annual renewal of registration is now well and truly a quick and easy process for more than 630,000 health practitioners.

Online renewal rates get higher each year while the number of hard copy applications being submitted has steadily dropped since the start of the National Scheme. Online renewal is easier for health practitioners and saves money because of reduced printing and postal costs.

Renewal campaigns for all 14 regulated professions produced strong results in 2015. Highlights include the following:

  • Of the 12 professions due to renew by 30 November, more than 94% of renewals have been received, which compares favourably to last year; 98.8% of renewals have been submitted online. Practitioners in these 12 professions are now in the late renewal period and have until 31 December to apply to renew. Practitioners who apply after 1 January must lodge a new application for registration. 

  • 98% of medical practitioners had responded to the renewal campaign by the end of the late period in October 2015 with more than 97.7% of medical registrants renewing online. 

  • The cost of the nursing and midwifery renewal campaign was reduced for the fourth year running, despite about 8,000 more nurses and midwives being due to renew than in 2014. A total of 368,200 nurses and midwives were invited to renew their registration in 2015 with over 97% renewing online.

Publications and projects roundup

The National Boards publish regular e-newsletters and communiqués on their activities, which you can read on their websites. Recent publications and projects are listed below.

Many Boards have also published revised registration standards on continuing professional development and recency of practice.

Boards also consult regularly on draft registration standards, guidelines and other publications and projects. There are no current consultations, but in the New Year we will link to new consultations in this newsletter.

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What’s new in our sector

There are many relevant publications available on the websites of other regulators, related bodies and professional journals, here and overseas. Here are links to several recent ones.

Regulation and workforce mobility

A step towards evidence-based regulation of health practitioners - Marie Bismark, Martin Fletcher, Matthew Spittal and David Studdert (abstract only): Australian Health Review, March 2015

Doctors on the move: National estimates of geographical mobility among general practitioners in Australia - Soumya Mazumdar and Ian McRae: Australian Family Physician, October 2015

Patient complaints and concerns

Listening to complaints - A qualitative review of complaints received by the Medical Council 2008–2012 and doctor’s responses and Listening to complaints - Learning for good professional practice 2008–2012Medical Council, Republic of Ireland

Patient concerns - Alice O’ ConnellLaw Institute Journal, November 2015

Improving diagnosis and patient safety

Improving diagnosis in health care - the next imperative for patient safety - Hardeep Singh and Mark L. Graber: The New England Journal of Medicine, 11 November 2015

Building respect, improving patient safety

The Royal Australasian College of Surgeons has released its action plan to address discrimination, bullying and sexual harassment in the practice of surgery: DBSH Action Plan, 30 November 2015

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In conversation with…

Samantha Gavel, National Health Practitioner Ombudsman and Privacy Commissioner

Photo of Samantha Gavel.

The National Health Practitioner Ombudsman and Privacy Commissioner (NHPOPC) role was established in 2010 to act as an independent and impartial third-party reviewer in relation to complaints about aspects of the National Scheme. This includes the administrative actions of AHPRA and the 14 National Boards that regulate health professionals.

‘Health touches everybody’s lives,’ elaborates Samantha Gavel, who has been the Ombudsman and Privacy Commissioner since late 2014. ‘I think that in this space, the reputational risks are high as well - I see the office as very important in terms of promoting confidence in the work that AHPRA and the National Boards do.’

The NHPOPC provides an accountability mechanism to the National Scheme, addressing individual complaints and assessing systemic issues seen through the complaints.

In 2014-15, almost half (47 per cent) of complaints were lodged by members of the public about how their notification about a health practitioner was handled; 23 per cent were from health practitioners about a notification that was made about them; and 24 per cent were from health practitioners about problems with their registration.

‘In the past, some of the systemic issues contributing to complaints have included the length of time taken to investigate notifications and communication with notifiers and health practitioners,’ Ms Gavel says. ‘AHPRA has done considerable work in the past year on improving the quality of its communications and is continuing to work on improving investigation timeframes. This work appears to have contributed to a decline in complaints to the NHPOPC in 2014-15.

‘Usually the system works very well; the ombudsman is there to help on the occasions when it doesn’t,’ says Ms Gavel.

Before joining the NHPOPC, Ms Gavel was the Private Health Insurance Ombudsman for six years, so she has a strong understanding of the role and of healthcare in Australia. She has found the work involves a lot of variety and is interesting and challenging on a daily basis.

‘My role as the National Health Practitioner Ombudsman is challenging because the sort of complaints that we get are complex and difficult matters, with people who might be very upset or grieving.

‘Our work is very varied, and often involves discussing within our team how to address a particular complaint, talking about some of the issues we’ve seen across complaints, and sometimes meeting with complainants to get more information from them.

‘Over the past year, the office has reached a number of really important milestones: we’ve cleared a significant backlog of complaints, so now we are able to address complaints as we receive them. We’ve also built our team and are starting to look at improving how we communicate what we do and how we are set up,’ she said.

Ms Gavel said that she looks forward to continuing the real progress her office has made since early 2014.

‘Health is a complex area to work in, and the National Law is very complex. We have quite a well-defined role but a narrow jurisdiction: we are here to help the public and practitioners to have confidence in the regulatory system.’

Over the next 12 months, Ms Gavel hopes to further engage with the NHPOPC’s stakeholders across Australia.

‘Since starting in the role, I’ve felt that we have worked really well with AHPRA and the National Boards. It’s great to see that AHPRA is open to feedback and responsive to issues we have raised – the ombudsman is part of the system, and everyone wants to see it work well.

‘What I really want the office to do is to contribute to ensuring AHPRA and the National Boards are effective regulators, acting in the best interests of the public and practitioners,’ she concludes.

You can find out more about the National Health Practitioner Ombudsman and Privacy Commissioner on the NHPOPC’s website, where you can also view the NHPOPC annual report.

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Tell us what you think

If you have any comments or suggestions about AHPRA report, please send them to newsletters@ahpra.gov.au

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Page reviewed 12/07/2016