In this edition:
There is a raft of positive change happening in the National Registration and Accreditation Scheme, with ensuring access for all Australians to a safe registered health workforce at its core. Following the establishment of the Paramedicine Board of Australia last year, all Health Ministers have recently approved the registration standards for the paramedicine profession, enabling paramedics across Australia to register for the first time later this year. All paramedics will have to meet the same nationally consistent standards to meet the requirements for national registration.
We’re doing more to improve consumer access to information. The national online Register of practitioners is already a great resource for consumers to check a registered health practitioner’s registration details including if there are any restrictions on their practice. Following the independent review of the use of chaperone conditions published in 2017, the Medical Board of Australia, supported by AHPRA, has implemented the final recommendation from that review. The online Register of practitioners now progressively includes links to published court and tribunal decisions for registered medical practitioners. Consumers will have easier access to information that is already public, so they can make an informed decision about their healthcare.
As a crucial part of our developing Aboriginal and Torres Strait Islander health strategy, we will launch our first Reconciliation Action Plan (RAP) in July 2018. The RAP is an important formal statement of our commitment to work in partnership with Aboriginal and Torres Strait Islander Peoples to achieve patient safety for all Australians. In particular, our first RAP outlines what we, AHPRA, will do to start addressing the imbalance in health outcomes between Aboriginal and Torres Strait Islander Peoples and other Australians.
Our commitment to best practice and learning from others has received a boost, with an official designation from the World Health Organization (WHO) as a Collaborating Centre for health workforce regulation.
You’ll find more about these topics in our newsletter, along with other examples of collaboration and innovation across the National Scheme. We welcome your feedback on our activities.
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AHPRA and the National Boards have welcomed the 700,000th health practitioner to be registered in Australia since the start of national regulation in 2010, Victoria-based enrolled nurse Alison Tregeagle.
Ms Tregeagle graduated in March 2018 as a mature-aged nursing graduate. Her registration with the Nursing and Midwifery Board of Australia was confirmed and published this month on the national Register of practitioners. While Alison was studying for her Diploma in Nursing, she was working in part-time and casual jobs at an aged care facility, a hospital and a pharmacy and is excited about embarking on her new career as an enrolled nurse.
‘I am very excited to get my career in nursing started. Getting my registration is the final step in what feels like the culmination of 20-plus years of trying to find a job that I love doing. I came to nursing later in life. My grandmother, aunt, mother and sister were or are all nurses, but at first I didn’t follow in their footsteps. I worked in the healthcare sector in various roles, and enjoyed the flexibility this gave me to support my family life with my three children, but always felt I should have or could have been doing something more gratifying.
‘Once the timing for my family was right, I decided to take the plunge into nursing. I started testing the waters by getting my Aged Care Certificate. Studying to be an enrolled nurse was the next step to getting into the career I really wanted. I found I love nursing, I love being part of a caring and trusted profession, and I love being able to use whatever skills I have, whether it’s something I’ve learned or just who I am to make people feel better, even if it’s just by momentarily putting a smile on their face. It’s so refreshing and rewarding to have ended the week not having ticked off the tasks set by a manager or achieving a sales number, but by feeling I have actually made a difference to someone, however small that difference may have been. Today I can say I am an enrolled nurse – and I’m really proud of that fact,’ she said.
Reaching the 700,000th registered practitioner milestone comes almost eight years after the launch of the National Scheme on 1 July 2010, when AHPRA and the National Boards for 10 health professions began their regulatory partnership governed by a nationally consistent National Law.1
In 2010, the registration of over half a million health practitioners transferred to the new National Scheme, with a further four health professions joining in 2012 and growing the number of registered health practitioners to more than 590,000 for the year to 30 June 2013. This year the number will grow further as paramedics join the National Scheme in late 2018.
Our first annual report showed there were slightly more than 530,000 registered health practitioners across Australia as at 30 June 2011 so hitting 700,000 represents significant growth over that time. It demonstrates that regulation is enabling the growth and mobility of a registered health workforce to support the delivery of health services to Australians.
Read more in our media release.
1The Health Practitioner Regulation National Law, as in force in each state and territory (the National Law).
New national registration standards for paramedics have been released in readiness for the national registration of all paramedics, which is expected late this year.
Paramedicine Board of Australia Chair, Associate Professor Stephen Gough ASM said, ‘I urge all paramedics across Australia to visit the Board’s website and read the registration standards, as they will apply to all paramedics, regardless of where they work.’
When paramedicine becomes a regulated profession under the National Scheme later this year, the title ‘paramedic’ will become a protected title under the National Law. This means that only people who are registered with the National Board will be able to lawfully call themselves a paramedic
To register, paramedics must demonstrate that they meet the five mandatory registration standard
The National Board has also released a time-limited grandparenting registration standard, which temporarily provides a path to registration for current paramedics who don’t have an approved or accepted qualification, but can demonstrate their competency via other training, qualification and/or experience.
You can find out more about the registration standards on the Board’s website. Or, to receive the latest news on our progress towards implementing the national regulation of paramedics, you can sign up for the Paramedicine e-News update.
The standards were approved by Health Ministers at the Council of Australian Governments (COAG) Health Council meeting held on 13 April 2018.
National registration for paramedics is expected to open later in the year, at a date determined by Health Ministers.
Profession summary reports for each of the professions regulated under the National Law and state/territory reports have been published online. These reports draw on data from the 2016/17 annual report published by AHPRA and the National Boards, and offer unique insights into the profile of registrants for each profession and jurisdiction.
The summary reports also document the number of complaints and concerns that were lodged with AHPRA throughout the year to 30 June 2017, including the number of matters opened and closed throughout the year per profession, types of complaint, and segmentation of data by state and territory.
Individual annual report summaries for each state and territory, offering insights into how the National Scheme is operating across Australia, have also been published online.
Information includes applications for registration by profession, outcomes of criminal history checks and segmentation of the registrant base by gender, profession and specialty.
Notifications information includes the number of complaints or concerns received by profession, types of complaint, matters involving immediate action, monitoring and compliance, panels and tribunals, and statutory offence complaints.
To download any or all of these reports, or the complete 2016/17 annual report, visit our micro-site.
The Medical Board of Australia, supported by AHPRA, has updated the information that is published on the Register of practitioners, which was one of the recommendations from the independent review of the use of chaperone conditions in 2017.
The national online register contains accurate, up to date information about the registration status of all 678,938 registered health practitioners in Australia. The information we publish can help consumers know more about the registered health practitioners they may choose to receive care from. It is an important way the National Scheme helps keep the public safe.
The online register now includes links for individual medical practitioners to published court and tribunal decisions. This is an important development for consumers as it will give them easier access to information that is already public, so they can make an informed decision about their healthcare.
Initially we published links to disciplinary decisions involving medical practitioners since February 2017 to the present day; however, work continues to progressively add decisions about medical practitioners dating back to the start of the National Scheme in 2010. To find out more, read our media release.
We have been working on making it easier to understand the legal obligations of advertising a regulated service, which apply to registered practitioners and people who are not registered, as well as corporate entities.
The latest resources we have published are a self-assessment tool that helps practitioners and advertisers check and correct their advertising and a testimonial tool to help them understand why testimonials can’t be used in advertising.
The self-assessment tool asks users to consider some questions about their advertising, which can help them understand if it is in breach of the National Law and if changes must be made.
The testimonial tool includes information and flow charts to help users understand why testimonials are not allowed and which reviews or feedback can be used in advertising.
The aim of both resources is to support practitioners and other advertisers in ensuring their advertising of a regulated health service complies with the National Law.
The tools are part of our broader strategy – an Advertising compliance and enforcement strategy for the National Scheme – which was launched in April 2017 in response to a large increase in complaints about health practitioner advertising.
Early indications are that our strategy of educating practitioners and working closely with professional associations and other stakeholders to support better understanding of the requirements appears to be working. We are seeing positive results: when advised that their advertising does not comply with the National Law, practitioners have made the necessary corrections without the need for further action.
The resources and support materials published since the strategy was launched have helped to create an environment that supports voluntary compliance and builds community confidence in regulation.
An evaluation of the advertising compliance strategy will be carried out later this year.
Earlier this year, we launched the research framework for the National Scheme: Optimising our investment in research. The framework was developed to best focus our research efforts and guide the use of National Scheme data for developing evidence-based regulatory policy.
The framework aims to transform health practitioner regulation through research to improve patient safety by setting our research priorities and principles. The end-goal is to maximise the public benefit from the data we hold. The framework also looks to provide better innovation, coordination, and effective translation of findings into action across the National Scheme.
The new framework is paving the way for exciting research relating to the National Scheme and work of National Boards. Current and proposed research activities include specific notifications data analyses for several National Boards, a study of the effectiveness of regulatory interventions across all National Boards, including cautions and conditions on registration, as well as the development of a general regulatory taxonomy (classification system) for the National Scheme.
We receive many requests each year to access data and/or proposals for research. These include requests to contact registered health practitioners and requests data. Unfortunately, many requests are not able to be filled due to privacy legislation and rules about how we manage practitioner information in the National Law.
There is a substantial amount of data publicly available. Information on this is published on the Data access and research section of our website. Anyone requesting data for the purpose of research can read the National Scheme’s Data access and research policy and the research framework. Requests that involve research or evaluation activities using our data are assessed by AHPRA’s Research Evaluation Committee (REC). To submit an application to access National Scheme data, or for further information, email email@example.com.
The most serious matters under the National Law are heard by the relevant tribunal in each state and territory. These matters may be referred by the relevant National Board or by an individual health practitioner. AHPRA can prosecute individuals in some instances and these cases are heard by the relevant Magistrates’ Court.
Court and tribunal outcomes are independent and public. We publish summaries of these outcomes on the AHPRA and National Boards websites, as well as in our newsletters. This is important as it helps both registered practitioners and members of the public to see the acceptable levels of care and behaviour that health practitioners are expected to meet.
A number of tribunal decisions are summarised below. For more information, follow the link in the summary, 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.
A former Victorian medical practitioner who practised the profession after being suspended by the Medical Board of Australia has been fined $100,000 for breaching the National Law.
Mr Mohamad Anwar pleaded guilty through his legal representation and was convicted of four charges of ‘holding himself out’ as a registered medical practitioner when he was not. The charges were laid following an investigation by AHPRA.
AHPRA has successfully prosecuted a man in Queensland for unlawful use of the protected title ‘chiropractor’ and holding out as a registered health practitioner.
Following an investigation, AHPRA filed charges against Mr George Zaphir, from Queensland, in March 2017 alleging six offences in contravention of sections 113 and 116 of the National Law. Mr Zaphir pleaded guilty to all six charges and was fined $12,000 and ordered to pay costs of more than $3,500.
The Victorian Civil and Administrative Tribunal (the tribunal) has increased the supervision period for a dental practitioner following his request for a review.
Dr Dragan Popovski sought review of a decision by the Dental Board of Australia in 2015 to impose supervisory conditions on his registration following an investigation into his professional conduct. The tribunal granted the review, however it confirmed the Board’s decision and increased the supervision period from 12 to 18 months.
A tribunal has disqualified a former nurse from applying for re-registration, after she made false declarations about her criminal history.
The State Administrative Tribunal of Western Australia found Mrs Jane Nicole Trigg behaved in a way that constitutes professional misconduct and disqualified her from applying for re-registration as a nurse for seven months.
The New South Wales Civil and Administrative Tribunal (the tribunal) upheld a decision by the Psychology Board of Australia to refuse an application for provisional registration as a psychologist because the applicant did not meet the English language registration standard (ELRS).
The tribunal dismissed Ms Derya Han’s appeal on the basis that the ELRS was validly made and neither the Board nor the tribunal had the power to grant her an exemption from complying with it. The tribunal was unable to grant Ms Han the registration she sought and encouraged her to consider meeting the ELRS by undertaking the English language examination.
Since January, we have published 12 other tribunal or court outcomes as a news item or media release on AHPRA and/or National Board websites, including:
To access the summaries for these matters, please go to the Court and tribunal decisions page on the AHPRA website.
We will launch our first Reconciliation Action Plan (RAP) in the second half of the year. The RAP is an important formal statement of our commitment to work in partnership with Aboriginal and Torres Strait Islander Peoples to achieve patient safety for all Australians.
AHPRA’s RAP is also a key initiative under the overall Aboriginal and Torres Strait Islander health strategy developed in partnership with Aboriginal and Torres Strait Islander health sector leaders, National Boards and accreditation authorities. Our shared vision is:
Patient safety for Aboriginal and Torres Strait Islander Peoples is the norm. We recognise that:
The National Scheme is uniquely placed in being able to directly contribute to, and significantly influence, real change to improve patient safety for Aboriginal and Torres Strait Islander Peoples in Australia’s health system. This is also true for all of us working within the Scheme, including AHPRA, the 15 National Boards and accreditation authorities.
This RAP outlines what we, AHPRA, will do to start addressing the imbalance in health outcomes between Aboriginal and Torres Strait Islander Peoples and other Australians.
Our commitment to best practice and learning from others has received a boost, with an official designation from the World Health Organization (WHO) as a Collaborating Centre for health workforce regulation. This designation means that AHPRA, in partnership with National Boards, will work with WHO and its Member States in the Western Pacific to strengthen regulatory practice across the region.
Crucial to the work of the Collaborating Centre is establishing a network of regulators across South East Asia and the Western Pacific. The network is expected to work on improving regulatory standards.
The designation as a Collaboration Centre is timely, with the Australian Government Department of Health and WHO recently beginning a four-year Cooperation Strategy. Strengthening regulation in health services, health workforce, radiation, food safety and health products is an identified priority for the joint work in this Cooperation Strategy. You can access the Cooperation Strategy on WHO’s information-sharing site. Queries about AHPRA’s work as a Collaboration Centre can be directed to WHO_CC_HWR@ahpra.gov.au.
An independent research report looking at vexatious complaints within the context of health practitioner regulation has found there is more risk from people not reporting concerns than from making dubious complaints.
It also found that while being on the receiving end of a complaint is tough – the complaint is much more likely to be vexing than vexatious.
We commissioned the research from the University of Melbourne to find out the size of the problem of vexatious complaints and identify how they can be better prevented, identified and managed. The work comes off the back of our commitment to the Senate Affairs Reference Committee inquiry into the medical complaints process in Australia.
The report found that the number of vexatious complaints dealt with in Australia and internationally is very small, less than one per cent, but they have a big effect on everyone involved. The research also confirmed that the risk of someone not reporting their concerns is greater than if the complaint turns out to be vexatious.
The report will be used to inform best practice for reducing, identifying, and managing vexatious complaints and helps to identify opportunities to work with others to help reduce their frequency and adverse consequences.
More details about the research and its findings can be found in the report. See our research framework story in this issue for further information on National Scheme research.
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.
Published a consultation paper on future accreditation arrangements from mid-2019, when the current term of assignment of accreditation functions ends.
Published a consultation paper on the draft guideline for informing a National Board about where you practise.
Published a self-assessment tool to help practitioners and advertisers check and correct their advertising so it complies with their professional and legal obligations.
Quarterly registration data released.
Published a consultation paper on draft revised registration standards.
Published its report for 2016/17.
Announced the continuation of its Registration and Notifications Committee and Policy, Planning and Communications Committee.
Published a presentation about the Board and its regulatory work.
Man in Queensland successfully prosecuted for unlawful use of the protected title ‘chiropractor’ and holding out as a registered health practitioner.
Published a consultation paper on the Continuing professional development registration standard and guideline.
Published a statement about its strong support for evidence-based regulation and how it regularly looks at trends found in National Scheme data when making decisions about registration and notifications (complaints).
Published a consultation on proposed changes to the Scope of practice registration standard and Guidelines for scope of practice.
Published an update on revalidation and ‘professional assurance’ for dental practitioners.
Medical practitioner’s registration cancelled for inappropriately prescribing medications.
Medical practitioner suspended for failing to maintain professional boundaries.
Board consults on proposed changes to guidelines on sexual boundaries.
Revised registration standard for specialist registration takes effect.
Revised registration standard for AMC certificate holders comes into effect.
Medical practitioner convicted of fraud has registration suspended by tribunal.
Register changes improve consumer access to public information.
Tribunal reprimands medical practitioner and imposes gender-based restrictions.
Board publishes report of external review of the specialist medical colleges’ assessment of international medical graduates.
Tribunal reprimands nurse and imposes registration conditions for providing false information.
Monash University to develop outcomes-based assessment for internationally qualified nurses.
Tribunal suspends nurse for three months for professional misconduct.
NMBA and CATSINaM release joint statement on culturally safe care.
Tribunal reprimands nurse for professional misconduct.
Tribunal upholds board-imposed conditions on nurse’s registration.
Tribunal disqualifies nurse for six months for professional misconduct.
Tribunal suspends nurse’s registration for misuse of medication.
Tribunal disqualifies former nurse for false criminal history declarations.
New codes of ethics in effect for nurses and midwives.
New codes of conduct take effect for nurses and midwives.
Vodcast presentation on the new nursing and midwifery codes of conduct.
Cultural safety: Nurses and midwives leading the way for safer healthcare – Joint statement.
Nurses and midwives due to renew registration soon.
Tribunal disqualifies former nurse for professional misconduct.
Tribunal reprimands former nurse for professional misconduct.
Midwife standards for practice released.
New competency standards published for occupational therapists.
Published a consultation paper on the draft revised continuing professional development registration standard (and related guidelines).
Invitation to early career optometrists in South Australia to meet the Board on Wednesday 25 July 2018.
Published a consultation paper on the draft revised Professional capabilities for osteopathic practice.
Webinar recording on the proposed registration standards all paramedics will have to meet to practise in Australia later this year.
Pharmacist disqualified from reapplying for registration for professional misconduct.
Pharmacy Board and APC make joint announcement regarding the assessment of pharmacy interns against the revised competency standards.
Revised guidance in effect – Compounding of sterile injectable medicines – and two new FAQ published.
Published a physiotherapy regulators and stakeholders diagram.
Revised registration standard for endorsement for scheduled medicines and association guidelines published.
Board ordered to pay cost of disciplinary proceedings after tribunal dismisses referral.
Published Public consultation paper 31: Reducing regulatory burden: Retiring the 4+2 pathway to general registration.
Woman fined for holding out as a psychologist.
Published Consultation Paper 30: Review of Professional indemnity insurance arrangements registration standard.
Psychologist successfully appeals Board conditions.
Psychologists: be aware of hoax email which pretends to be from AHPRA.
Victorian man fined $10,000 for claiming to be a clinical psychologist.
New national psychology examination curriculum released.
Psychology graduate refused registration.
In January 2017, Susan Biggar joined AHPRA as our first National Engagement Adviser tasked with looking at how we can better engage with practitioners and the public and how we can continue to improve their experience with AHPRA, particularly through the notifications process.
‘Listening to notifiers and practitioners has proven to be a significant part of my role, to learn what worked well for them and what didn’t when they engaged with us,’ Susan said.
‘With that in mind, I then turn my mind to thinking creatively about ways that we could work differently to give them a more positive experience.’
Susan’s role requires her to be a good listener.
‘I spend a lot of time conducting interviews with notifiers and practitioners which provides great insight and in turn has enabled me to consider appropriate resources and provide advice to AHPRA staff on the engagement side of tricky notifications matters.
‘I also give a lot of talks to National Boards, and to anyone else who will listen to me talking about improving the notifier and practitioner experience!’
Susan has recently dedicated considerable time to collaborating with a working group on revising regular notifications correspondence to make it clearer and less legally based, non-bureaucratic and more empathetic.
‘There have been lots of phone calls with colleagues excited by this work because they recognise that making a complaint or being the subject of one can be a stressful time for everyone involved ̶ and they want our correspondence to recognise that.
‘I’ve seen a real openness among staff and board members to hearing feedback about the notifier and practitioner experience, even though some of it is quite sad and confronting.
‘The reality is that we are dealing with people whose lives have been affected by a poor health experience, or by the complaint about that – and the issues involved are often important and personal and emotional. That’s overwhelming at times. But with that openness I have also found an enormous appetite for improvement, I see it at all levels of AHPRA, and it’s very encouraging.’
Susan is not new to AHPRA’s processes. In 2014, she co-authored the Health Issues Centre report, AHPRA: Setting things right: Improving the consumer experience of AHPRA. Commissioned by AHPRA, the report focused on the experience of Victorian notifiers but its recommendations applied nationally.
‘Our recommendations focused on improved written and oral communication; more phone interactions with notifiers, particularly early on in the process; improved cooperation with health complaints entities (HCEs) to make certain that notifiers are in the “best place” for their concern and their hoped for outcomes; and greater use of data to better understand the needs of notifiers.
‘It takes significant courage to ask people what they think about your organisation when you know that much of the feedback might be hard to hear. I have enormous respect for the willingness of AHPRA’s senior leadership to face this head on and try to make things better. Many organisations, particularly those with a history of being publicly criticised, might try to ignore it and just hope the critics go away.’
Before joining AHPRA, Susan was working as a senior manager at the Health Issues Centre in Melbourne, managing a broad range of consumer engagement projects relating to the Victorian health system. Susan is particularly passionate about patient-centred care. Since 2014 she has trained over 3,400 health practitioners in patient-centred care and consumer engagement.
While health organisations such as AHPRA have a role to play in healthcare and practitioner regulation, Susan firmly believes that the community must also take responsibility for how it engages with health practitioners.
‘Firstly, and most importantly, as patients and families we all need to take responsibility for our own health and healthcare. A passive approach to health – seeing it as the health practitioner’s domain – is not particularly helpful – or healthful!
‘In fact, there is now good evidence that the more knowledgeable, active and engaged a patient is, the safer their healthcare will be. I strongly support taking care of yourself and having an empowered approach to your own healthcare. And then when things go wrong, for whatever reason, I think we have a responsibility to try to resolve it with our clinician first.
‘Sometimes making a formal complaint, to the hospital or the regulator, is necessary but I think in terms of achieving resolution there are usually other steps that could be taken first.’
As a mother of three sons, two of whom have cystic fibrosis (CF), Susan has had significant interactions with the health system. While born and raised in San Francisco, she has lived in six countries over 25 years and been exposed to many different health systems.
‘CF is a serious genetic condition that impacts on a numbers of organs but most importantly on the lungs. It can be exceptionally challenging and we’ve experienced different approaches to CF care. For the most part we have had phenomenal healthcare and are incredibly grateful that our sons are generally well.’
Susan has been raising money for CF research for over 20 years and six years ago founded an annual 65km walk in Melbourne with two other mothers of children with CF.
‘It’s always an amazing event – people can walk anything from 6.5km to 65km. We have now raised about $680,000 over the six events, which is testament to the remarkable generosity of our community.’
Susan is still active in volunteer roles working for a more patient-centred health system.
‘The way people are treated ̶ all of us ̶ is fundamentally important. I believe that the mark of a healthy organisation is one that treats people – both its staff and stakeholders – with respect and dignity.’
If you have any comments or suggestions about AHPRA Report, please send them to firstname.lastname@example.org
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