Australian Health Practitioner Regulation Agency
 

June 2016

In this edition:


Welcome from the CEO

Health practitioner regulation exists to protect the public. We all have the right to access safe, quality care from registered health practitioners. It is reassuring to know that the overwhelming majority of registered practitioners meet their legal obligations and provide safe care to patients and clients.

The work of National Boards and AHPRA involves work on many fronts on a daily basis. Since the start of this year, we have:

  • answered 170,625 phone calls and 18,826 email inquiries 
  • registered 22,572 health practitioners for the first time 
  • renewed the registration of 345,557 nurses and midwives (92% of the 376,902 due to renew by 31 May), and renewed 4,287 limited and provisional registrants for the other 13 professions 
  • monitored 5,562 practitioners with imposed restrictions on their registration 
  • investigated 377 practitioners 
  • finalised 318 of those investigations, of which 54 led to restrictions on a practitioner’s registration, and 
  • referred 59 of the 377 matters to either a health or performance assessment, panel or tribunal hearing.

In this edition of AHPRA report we highlight a number of important initiatives to improve our services. One focus area is providing better and more comprehensive information on what the National Registration and Accreditation Scheme (National Scheme) does and its role in protecting all of us.

We are publishing more data and information describing our work and our performance. This includes regular quarterly performance reports, annual summaries of our work in each state and territory and profession specific summaries. All of these publications aim to improve community understanding of how regulation works.

Thirdly, we are running an information campaign to help practitioners and employers understand their obligations under the National Scheme. Please share this information widely, as it is important that practitioners and employers understand their legal obligations.

Martin Fletcher
Martin.Fletcher@ahpra.gov.au

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Focus on enhancing public safety

Learning from tribunal and court outcomes

When a serious concern about a registered health practitioner is heard by a court or tribunal, the decisions are usually public. We publish media releases and summaries of these outcomes as they provide important learning opportunities for practitioners about their obligations under the National Law.

A core role of National Boards and AHPRA is to protect the public and manage risk to patients. One of the ways that we do this is by taking regulatory action after a complaint has been investigated through a referral to a tribunal by a National Board on the most serious matters. There are independent tribunals in each state and territory.

This happens only when the allegations involve the most serious unprofessional conduct (professional misconduct), when a Board believes suspension or cancellation of the practitioner’s registration may be warranted. AHPRA can prosecute individuals in some instances and these cases are heard by the relevant Magistrate’s Court. At the end of proceedings a tribunal will make a final decision or orders based on the Board’s referral and this outcome is binding and legally enforceable.

This year, we have so far published 26 summaries about medical practitioners, nurses and/or midwives, psychologist, a dental practitioner, a pharmacist and a unregistered individual. They provide useful and timely reminders about issues that have led to complaints and notifications.

A selection of tribunal decisions are summarised below. For more information, follow the link in the heading, go to the Court and tribunal decisions page on the AHPRA website or access the full tribunal decisions on the Australian Legal Information Institute’s (AustLII) site.

Fake nurse jailed for four years

AHPRA prosecuted a South Australian woman who had falsely claimed to be a registered nurse. Ms Jennifer Anne Reed pled guilty to seven counts of deception for falsely claiming to be a registered nurse and was jailed for four years with a non-parole period of 14 months. Ms Reed gained employment at six different aged care facilities across South Australia and New South Wales and dishonestly received more than $340,000 in wages.

Tribunal reprimands medical practitioner for professional misconduct

The Medical Board of Australia referred Dr Andrew Carl Schneider to the Victorian Civil and Administrative Tribunal (VCAT) for providing paramedics and police with inaccurate information. This resulted in a man initially receiving care for a stroke, when he had sustained a gunshot wound. VCAT found that Dr Schneider, an anaesthetist, engaged in professional misconduct. VCAT reprimanded Dr Schneider and affirmed that conditions imposed by the Board adequately protected the public.

Tribunal reprimands psychologist, finds unprofessional conduct

The Psychology Board of Australia referred Ms Dianah Cameron to the Queensland Civil and Administrative Tribunal (QCAT) after she was convicted of various offences related to driving without a licence or under the influence of alcohol. Due to the repeated and serious nature of the offences, Ms Cameron served terms of imprisonment. The Board alleged that Ms Cameron had engaged in professional misconduct for failing to disclose her criminal history when she applied to renew her registration, as she was required by law to do. The Board also alleged that Ms Cameron had failed to advise the Board within seven days of being charged and convicted of an offence punishable by 12 months imprisonment, as she was also required by law to do. QCAT found that Ms Cameron had engaged in unprofessional conduct, reprimanded her and ordered her to pay the Board’s legal costs.

Tribunal reprimands and removes dentist from register

The Dental Board of Australia referred dentist Mr Graham Raynes to the Health Professional Review Tribunal in the Northern Territory because of concerns he had failed to provide adequate care and treatment to six patients at his practice at Nhulunbuy, Northern Territory and Newman, Western Australia. The Board alleged that Mr Raynes failed to complete dental treatment that had been started and/or paid for in a timely manner, or at all. The tribunal reprimanded Mr Raynes, removed his name from the register of practitioners and banned him from reapplying for registration for two years.

Tribunal reprimands surgeon for unsatisfactory professional conduct

The Medical Board of Australia referred Dr Christopher Joseph Bourke, a specialist general surgeon and paediatric surgeon to the Queensland Civil and Administrative Tribunal (QCAT). QCAT found that Dr Bourke engaged in unsatisfactory professional conduct. Dr Bourke was reprimanded by QCAT for failing to appropriately clinically manage a patient prior to surgery in July 2008. QCAT reprimanded Dr Bourke, and ordered that the reprimand is to be noted on the register for a period of 12 months.

Dealing with complaints about advertising offences

Our work in dealing with complaints about advertising has attracted considerable media comment over the past few months, especially in relation to advertising by chiropractors.

Harmful or misleading content in advertising regulated health services is against the law and may be a risk to the public. The legal requirements for advertising regulated health services apply to everyone, not just registered health practitioners, including individuals and corporations.

Advertising offences are managed by AHPRA, on behalf of the National Boards. We are currently responding to over 600 complaints relating to chiropractic advertising. 

All advertising complaints are considered and assessed; this work is co-ordinated and managed by AHPRA’s statutory offences team. Our staff look at each advertising complaint on a case-by-case basis, and consider the overall impression of the advertisement as well as the likely impact the advertisement may have on a member of the public. They will consider what conclusions a member of the public can reasonably infer from material contained within an advertisement and whether the material is likely to mislead or deceive or breach other parts of the National Law.

AHPRA’s process for managing advertising offences is to first send correspondence to the practitioner, requiring them to amend their advertising to ensure it complies with the National Law. All correspondence is followed up to ensure action occurs.

If the practitioner does not change their advertising, AHPRA may refer the matter to the relevant National Board to consider possible disciplinary action for failing to comply with their professional obligations and the advertising requirements. AHPRA also refers matters to the National Boards to consider disciplinary action when the advertising raises concerns about the health, performance or conduct of the relevant practitioner. National Board’s and AHPRA will, in the most serious cases, prosecute practitioners who are breaching their legal obligations.

If you have concerns about the advertising of regulated health services, let us know.

The legal obligations for advertising

The advertising restrictions in the National Law, including the prohibition on using testimonials, apply to anyone advertising a regulated health service (a service provided by a health practitioner as defined in the National Law) or a business providing a regulated health service. The same advertising requirements apply to all health professions in the National Scheme.

Registered practitioners must not advertise health benefits of their services when there is not clear evidence or proof that these benefits can be achieved. This is because such advertising statements are likely to be misleading or deceptive. Advertising that is false, misleading or deceptive, or advertising that is likely to be misleading or deceptive, is banned under the National Law.

The National Law also prohibits advertising that creates an unreasonable expectation of beneficial treatment. The claims of beneficial treatment can range from unsubstantiated scientific claims through to ‘miracle cures’. National Board Guidelines for advertising regulated health services outline the requirements for practitioners to advertise their services.

Statutory offences - an example of the National Law working to protect the public

An example of where a registered chiropractor has been the subject of tribunal or court findings about breaches of advertising requirements is the case of Dr Malcolm Hooper, a formerly registered chiropractor.

In this case, the Board used its powers under the National Law and referred Dr Hooper to the Victorian Civil and Administrative Tribunal (VCAT).

VCAT found that Dr Hooper’s claims on his website about hyperbaric oxygen treatment were misleading and deceptive because he did not present a balanced view about the effectiveness of hyperbaric oxygen treatment for specified conditions, including that such treatment was not conventionally used in Australia and in western countries with a comparable health service culture and was not supported by medical and scientific evidence.

As a result of the tribunal decision, his registration was cancelled and his name was removed from the public register of registered practitioners on 30 August 2013. Dr Hooper is now listed on the List of cancelled practitioners.

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New projects and programs

Legal obligations for employers and practitioners: national awareness campaign

Increasing awareness of the legal obligations of registered health practitioners and their employers under the National Law is the current focus of a national campaign. These obligations are designed to ensure that the public have access to safe health care, no matter where they live.

The first phase (www.knowyourobligations.com) focuses on ensuring employers’ obligations to:

  • check the register before employing a health practitioner 
  • stay up to date with any changes to their employees’ registrations, and 
  • make sure they meet mandatory notification obligations.

The second phase (www.notsosmallprint.com) focuses on practitioners’ awareness obligations to:

  • understand and make a mandatory report when required 
  • meeting the advertising requirements, and 
  • staying up to date with changes to registration standards.

The third and final phase of the campaign is aimed at patients and health consumers and will be launched later this year.

Video explaining the National Scheme

Would you like to learn about how the National Scheme works and who does what? Check out our new video.

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Reporting on our work and performance

Supporting graduates to register and practitioners to renew

Each year we receive more than 30,000 applications for registration from graduates of approved programs of study, and renewal applications from more than 630,000 registered practitioners across the 14 National Boards. Applying for, and renewing, registration can be an anxious time for applicants, with rigorous national requirements and deadlines. Making these processes easier to understand and comply with has been a big focus for us this year.

Improving the application process for graduates

We encourage graduates of approved programs of study to apply for ‘pre-registration’ online, four to six weeks before completing their studies. They must also post hard copies of documents supporting their application to AHPRA. We are trialling a new checklist and updated correspondence for graduates applying for general registration.

Our goal is to reduce the number of incomplete graduate applications received by our registration team and get graduates registered and practising sooner.

Mid-year applicants, who generally apply for registration around May/June, will be the first graduates to receive a revised and refreshed Next steps checklist. Improvements to the checklist include:

  • better clarification about what hard copy supporting documents must be posted to AHPRA 
  • links to more helpful online information to help graduates gather and prepare their supporting documents in the required format, and 
  • a redesign of the checklist email so it can be printed off and the second half used as a coversheet to the required supporting documents.

The first half of the checklist email is kept by the graduate as a reference document that records their application number and outlines what happens next after AHPRA receives the supporting documents.

For more information, visit the Graduate applications page.

Refreshing the renewal correspondence for nursing and midwifery

Nursing and midwifery have one of the highest online renewal user rates of all the health professions in the National Scheme. Last year, 97.5 per cent of nurses and midwives renewed their registration online - a 2 per cent increase in the renewal rate for 2014.

We have had some great feedback on our recently revised renewal correspondence that aims to make renewal reminders clearer, more helpful and easier to follow. A new video on online renewal for nurses and midwives is also helping to show how quick and easy online renewal is. As at 27 May, 281,921 or 75 per cent of the more than 370,000 nurses and midwives due to renew their registration with the Nursing and Midwifery Board of Australia by 31 May have already done so.

Feedback received about the revised correspondence throughout the various stages of the campaign will be applied to the other professions’ renewal campaigns later in the year.

Performance reporting - a new era

We recently published our first quarterly performance reports, by state and territory, for AHPRA and the National Boards. The reports cover our main areas of activity; managing registration, managing notifications and offences against the National Law, and monitoring health practitioners and students with restrictions on their registration. The reports are available on the AHPRA website. We invite your feedback on the reports via email to reportingfeedback@ahpra.gov.au.

Publication of our state and territory and profession summaries

State/territory and profession-specific summaries of the 2014/15 annual report are available on the AHPRA website. The reports provide useful workforce data and trend analysis, as well as national comparisons.

Our state and territory reports show the National Scheme working locally.

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AHPRA in numbers

 7.4m website visits in the past 12 months.44 million page views in the past 12 months. 4849 followers on Twitter. 9924 likes on Facebook.

32% of notifications finalised in 2014/15 resulted in a National Board taking regulatory action. 377 investigations completed in quater three of 2015/16.5562 practitioners with imposed restrictions on their registration (and March 2016).

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Health workforce update

The information we collect about registered health practitioners provides a unique and important data set for heath workforce mapping and planning nationally. You can view our quarterly registration data on our Statistics page. 

652958 registered health practitioners as at 31 March 2016. Top professions by growth from June 2015 to March 2016. Aboriginal and Torres Strait Islander health practitioners up 45.8%. Occupational therapists up 5.6%. Podiatrists up 5.5%.

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Sharing learning opportunities with international regulators

Risk-based regulation - the challenges facing medical regulation around the globe

As the paediatric nephrologist Sir Cyril Chantler noted in 1999 in The Lancet, ‘Medicine used to be simple, ineffective and relatively safe. It is now complex, effective and potentially dangerous.’1 In a recent article for the Journal of Medical Regulation, Niall Dickson, Chair of the General Medical Council, UK, discussed preventing harm and promoting competence in an era of change.

Niall points out that in an environment of significant change in healthcare all over the world, the regulation of doctors is under more pressure than at any time in its history. Longstanding models of professional regulation are being challenged from many directions, in recognition that medicine and healthcare systems are increasingly complex. Reliance on an older, reactive regulatory model that largely responds only when something goes wrong is not sustainable in this new environment.

Consumers are becoming better informed, more digitally engaged and more likely to raise concerns about their medical treatment. At the same time, the availability of data about doctors’ performance and medical care is on the rise, and doctors are becoming increasingly mobile and likely to move from one jurisdiction to another. These factors create the need for medical regulators to create an intelligence-led and risk-based system that enables them to be more proactive, seeking to prevent harm before it occurs.

The traditional view that all the regulator has to do is register the doctor at the start of their career, and only intervene when they commit some transgression, is being challenged all over the world. A more realistic model is one in which regulators are committed to preventing harm, promoting and defending standards of good practice and seeking ongoing assurance that every doctor is competent to practise safely and effectively.

This model is informing AHPRA’s approach to regulatory decision-making and regulatory policy, making sure it is proportionate to the risk posed. This has been supported by a set of common regulatory principles across the National Boards and AHPRA.

To read the full text of Niall’s article, see Journal of Medical Regulation, Vol 101, No 3, 2015. Niall is also Chair of the International Association of Medical Regulatory Authorities (IAMRA).

IAMRA international conference on medical regulation, September 2016

In our last issue, we highlighted the forthcoming IAMRA 12th International Conference on Medical Regulation, which will be held on 20-23 September 2016 in Melbourne. 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.

For more information and to view the program, visit the IAMRA website. The Medical Board of Australia and AHPRA are hosting the conference.


1Cyril Chantler. The role and education of doctors in the delivery of healthcare. The Lancet, Volume 353, Issue 9159, 1178-1181. 1999.

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Research news

Reporting of health practitioners by their treating practitioner under Australia’s national mandatory reporting law

Melbourne researcher Marie Bismark and her colleagues have recently published an analysis of reports about health (medical) practitioners made by their treating practitioners under Australia's new mandatory reporting system. The results challenge some frequently expressed assumptions.

They used retrospective case-file review and analysis of treating practitioner reports received by AHPRA between 1 November 2011 and 31 January 2013, and of the outcomes of the completed investigations of these reports to November 2014.

Their main outcome measures were the characteristics of treating practitioners and reported practitioners; nature of the care relationship; grounds for report; and regulatory action taken in response to report.

Of 846 mandatory reports about medical practitioners, 64 (8%) were by treating practitioners. A minority of reports (14 of 64) were made by a practitioner-patient's regular care provider; most (50 of 64) arose from an encounter during an acute admission, first assessment or informal corridor consultation.

The reported practitioner-patients were typically being treated for mental illness (28 of 64) or substance misuse (25 of 64). In 80% of reports (50 of 64), reporters described practitioner-patients who exhibited diminished insight, dishonesty, disregard for patient safety, or an intention to self-harm.

Conclusions

The nature and circumstances of the typical treating practitioner report challenge assumptions expressed in policy debates about the merits of the new mandatory reporting law. Mandatory reports by treating practitioners are rare. The typical report is about substance misuse or mental illness, is made by a doctor who is not the patient's regular care provider, and identifies an impediment to safely managing the risk posed by the practitioner-patient within the confines of the treating relationship.

The full report is available online: Reporting of health practitioners by their treating practitioner under Australia’s national mandatory reporting law - Marie M Bismark, Matthew Spittal, Jennifer Morris, David Studdert: Medical Journal of Australia, January 2016.

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National Board news

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.

Aboriginal and Torres Strait Islander Health Practice Board of Australia

Call for applications for appointment to the Aboriginal and Torres Strait Islander Health Practice Board of Australia as a practitioner member from Western Australia, closed 18 April 2016.

Chinese Medicine Board of Australia

Information forums in Adelaide (February 2016) and Melbourne (March 2016) for Chinese medicine practitioners, students and stakeholders.

Chiropractic Board of Australia

Statement on advertising released March 2016.

Dental Board of Australia

Information on changes to overseas-trained dental specialist applications.

Medical Board of Australia

Revised registration standards on continuing professional development and recency of practice.

Revised guidelines on supervised practice for international medical graduates.

New doctors’ health service arrangements launched. Doctors and medical students in NSW, the ACT, SA, and the NT will have access to expanded doctors’ health services from 1 May 2016.

Medical Radiation Practice Board of Australia

Updated equivalent qualifications list.

Revised registration standard on recency of practice.

Nursing and Midwifery Board of Australia

Stakeholder information forums for nurses and midwives to learn more about the changes to the NMBA’s registration standards, standards for practice and guidelines that will come into effect on 1 June 2016.

Video on renewal of registration explained for nurses and midwives.

Revised registration standards and standards for practice.

Revised registration standard and safety and quality guidelines for midwives.

Occupational Therapy Board of Australia

Update on the development of threshold competency standards for Australian occupational therapists

Optometry Board of Australia

Call for applications for appointment to the Registration and Notification Committee of the Optometry Board of Australia, closed 11 April 2016.

Osteopathy Board of Australia

Webinar on CPD audit and changes to the PII registration standard.

Tips to help prepare osteopaths for practitioner audit on continuing professional development (CPD), and reminder about their obligations as audit starts.

Update on the revised Professional indemnity insurance arrangements registration standard.

Pharmacy Board of Australia

PowerPoint presentation to help students understand regulation of pharmacists.

Infographic showing the obligations of a registered pharmacist.

Physiotherapy Board of Australia

Revised registration standard for recency of practice.

Podiatry Board of Australia

Revised guidelines on infection prevention and control obligations.

Revised registration standard for recency of practice.

Psychology Board of Australia

Updated guidelines for the National Psychology Exam.

Revised registration standard for general registration and additional information.

Revised registration standard for recency of practice and a revised policy for recency of practice requirements.

New supervisor services portal for current Board-approved supervisors.

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

National Board recruitment - how to get involved

Whether you are a health practitioner or a community member, there are opportunities to play a role in health practitioner regulation by joining the National Scheme’s Boards, committees and panels.

If you would like to help protect the health and safety of the public, maintain public confidence and ensure standards of practice are upheld, we encourage you to consider seeking appointment.

Your contribution may involve:

  • setting national standards of practice for the regulated health professions 
  • developing guidance for practitioners on their scope of practice 
  • managing complaints/notifications about a practitioner’s health, performance or conduct, or 
  • other functions as delegated by a National Board.

More information about current opportunities and the recruitment process can be found on the:

You can also find out more from Board members.

To register your interest, please contact Statutory Appointments from your preferred email address, advising which professions or roles you are interested in.

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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 is a recent campaign focussing on improving community knowledge and health literacy.

Choosing Wisely Australia campaign: five questions to ask your healthcare provider

In March, the Choosing Wisely Australia campaign released 61 recommendations centred on the theme ‘five things clinicians and consumers should question’.

The recommendations aim to help consumers start a conversation with their healthcare professional about the kind of healthcare they are receiving, including whether imaging and screening is necessary, when to use antibiotics and how to start a conversation on how to improve end of life and palliative care.

The campaign is part of a global Choosing Wisely healthcare initiative and the recommendations are the collective advice of 14 Australian colleges, societies and associations.

The Choosing Wisely Australia website provides a number of useful tools that you might want to share with your friends and family including a fact sheet on ‘5 questions to ask your doctor or healthcare provider’, which has been translated into 10 languages.

AHPRA has posted links to the Choosing Wisely campaign on Facebook and Twitter.

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In conversation with…

Mark Bodycoat, Chair of the AHPRA Community Reference Group

Mark Bodycoat.

Our commitment to work with the community has continued to grow over the past three years with the increasing involvement and contribution of our Community Reference Group (CRG).

Established in June 2013, the CRG provides feedback, information and advice on strategies for building better knowledge in the community about health practitioner regulation. 

In May 2015, we welcomed six new members to the CRG and we’re looking forward to their contribution to the work of the National Scheme.

The CRG Chair, Mark Bodycoat, is also a recent arrival. Mark chaired his first meeting in March 2016. We asked him about his background in the National Scheme and his thoughts about his new role.

Mark’s background is in law, which he studied at the University of Western Australia. After stints in private and government legal practice, he joined the Ministry of Fair Trading in WA as its Principal Legal Officer, and later acted for an extended period as Commissioner for Consumer Affairs. Between 2000 and 2007, Mark was the Commissioner for Consumer Affairs in South Australia, and then was South Australia's Public Trustee between 2007 and 2010.

Mark has been involved with the National Scheme almost since the start. He joined the South Australian Board of the Medical Board of Australia in 2011, and was later appointed to the Podiatry Board of Australia.

As he explains, ‘I’m currently a member of the South Australian Board of the Nursing and Midwifery Board of Australia and a member of the Medical Board of Australia. The work of AHPRA and the Boards offers a wide and stimulating variety of challenges, and represents a substantial component of professional regulation and service standard-setting for the community.’

We asked Mark how he became interested in consumer/community issues.

‘One of my early jobs was working as a lawyer in consumer affairs,’ he said. ‘For several years I was involved in the legal and policy framework of occupational and professional regulation, and in a range of the disciplinary litigation that flowed from that.’

’Since then, a major part of my working life has been focussed on consumer issues, particularly the role of information in addressing imbalances between service providers and service users, and on the legal and policy structure of occupational licensing and professional regulation. It seemed like a natural progression to continue my interest in these things when the opportunity to join the National Scheme came up.’

Mark has strong views on why community groups are important to organisations such as AHPRA.

‘The main objective of professional regulation in schemes like National Scheme is maintaining public safety. To do this properly, regulatory schemes must be relevant, responsive and effective. It is vitally important that there is the opportunity for community input, but our community is diverse and is not consistently or cohesively represented by a single, well-organised and well-supported association or interest group,’ he says.

Mark believes that community groups help to focus on issues of importance as they affect the wider community, and their input helps to ensure that regulatory schemes are focussed on the right concerns. A body like the CRG provides a consistent channel by which issues of significance to the community can be heard and addressed.

As Chair, Mark has clear ideas about how the work of the CRG should progress.

‘As the National Scheme matures, there is the opportunity for community input to be focussed and incorporated in its business in a strategic way. I would like to ensure that the community voice continues to be an important component of strategic decision-making, and is routinely incorporated and acknowledged,’ he told us.

With his deep interest in the role of information in addressing imbalances, Mark also sees the opportunity for AHPRA and the Boards to communicate better to and with the community. ‘I would like to see the quality and availability of information for the community to continue to improve, and to build on the initiatives already underway in this area,’ he concludes.

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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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