In this edition:
Welcome to this issue of AHPRA Report, which highlights the work of both AHPRA and National Boards and shares progress on health practitioner regulation in Australia.
It’s been another big year for AHPRA with a number of major initiatives underway in support of our strategic priorities. You can read highlights in our recently released Annual Report for 2016-17, including broad range of data on our work over the past year. The information in the report provides a unique insight into our performance as a regulator as well as the registered health practitioner workforce across Australia. We have a continued focus on how we use these unique data to learn, collaborate with partners and improve the way we work to promote patient safety.
Over the past few months we have made good progress on a number of important initiatives: our Indigenous health strategy, preparation for paramedicine becoming a nationally registered profession, continued progress on our advertising compliance and enforcement strategy and our new online portal for graduates applying for registration.
We are very pleased to be working with Aboriginal and Torres Strait Islander health sector organisations and leaders, accreditation authorities and National Boards to develop the National Registration and Accreditation Scheme’s first ever Aboriginal and Torres Strait Islander health strategy. Together, members of this group have a broad reach and influence across the National Scheme and can effect real change to close the gap on health outcomes for Indigenous Peoples. We will continue to report on this important work through our website, including publishing communiques from the strategy group’s meetings.
We are working with the newly established Paramedicine Board of Australia in preparation for national registration of paramedics which is expected to start in late 2018.
We launched our advertising compliance and enforcement strategy in April and continue to work with consumers, professional associations, insurers and other regulators to help keep health service consumers safe from false, misleading and deceptive advertising.
Our new online portal is helping Australian graduates apply for registration quicker and without needing to provide hard copy forms. The graduate portal is part of our work to enhance our digital services and make it easier for people who deal with us to share documents and keep track of queries.
Our partnerships with consumers and representatives of the professions are important in informing our work. We continued to partner with advisory groups such as the Community Reference Group and Professions Reference Group to improve our engagement with consumers and the regulated professions.
Last month, we co-hosted the International Congress on Professional and Occupational Regulation with the Council on Licensure, Enforcement and Regulation (CLEAR) in Melbourne. Regulators from a wide range of sectors across the world gathered to share and learn about best practice regulation to better protect the public. We were also pleased to host delegates to share ‘a day in the life of AHPRA’ at our offices in the lead up to the event.
We look forward to making further progress on our strategic priorities in the year ahead.
Best wishes this holiday season.
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Being uniquely placed to collect information about Australia’s registered health practitioner workforce, we are proud to be able to share our annual report. The report includes information about the different registered health professions and, by virtue of being a multi-profession regulator, a clear view of the registered health practitioner workforce in Australia as a whole.
From these data we can see that 0.7 per cent of Australia’s registered health practitioners identify as Aboriginal and/or Torres Strait Islander, ranging from 100 per cent of Aboriginal and Torres Strait Islander health practitioners (being Indigenous is one of the requirements of registration in that profession), to 0.2 per cent of pharmacists. Having visibility of these statistics will help further our work on the Aboriginal and Torres Strait Islander health strategy, which you can read more about later in this issue.
The report also includes data about our regulatory activities, including investigations and prosecutions, and our performance in delivering the National Scheme.
To find out more, read our published annual report and its supplementary tables. These are available on our website now, and summaries for each profession and state and territory will also be published soon.
The national registration of paramedicine has moved a step closer with the appointment of the first Paramedicine Board of Australia. Health Ministers announced the nine-person board at the Council of Australian Governments (COAG) Health Council meeting held on 19 October 2017.
Board Chair Mr Stephen Gough says the introduction of registration standards for paramedics to regulate the profession under the National Scheme will ensure greater public protection.
‘The paramedic profession has seen monumental change in practice over recent decades and now has a comprehensive set of skills and technologies to provide world class services to Australian communities. Registration will ensure that the public can be confident that expected standards are being met by those practising as paramedic healthcare professionals,’ he said.
Paramedics will be able to register once and practise anywhere in Australia. The title ‘paramedic’ will also become a protected title under the National Law1 – only people registered with the Board will be able to call themselves a paramedic. Registration of paramedics is due to start in late 2018.
Find out more from the Board’s website.
Our new online portal is helping Australian graduates apply for registration quicker and without needing to provide hardcopy forms. This will help smooth the path to registration for the more than 26,000 graduates we expect to apply for registration by April 2018.
As well as making the process easier for applicants, it also enhances the identity-check component of an application by linking directly with the Australian government agencies who provide them.
The graduate portal is part of our work to enhance our digital services and make it easier for people who deal with us to share documents and keep track of queries. Other improvements to the online portal will be rolled out in the next 12 months including an application tracker so individual graduates can monitor the progress of AHPRA’s assessment of their registration application.
You can find out more on the graduate applications page.
The Medical Board of Australia (MBA) has released its Professional Performance Framework to ensure that all registered medical practitioners practise competently and ethically throughout their working lives.
The Professional Performance Framework will support doctors to take responsibility for their own performance and encourage the profession collectively to raise professional standards and build a positive, respectful culture in medicine that benefits patients and doctors.
‘We have designed a framework that will justify and strengthen the trust that the Australian community has in their doctors. It is focused on patient safety and will support doctors to provide high quality care throughout their working lives,’ Board Chair Dr Joanna Flynn AM said.
The framework, which is evidence-based, integrated and builds on existing initiatives, has five pillars:
It will be implemented progressively, with some elements already in place and others requiring significant planning, consultation and development.
‘Nothing is going to change tomorrow for individual doctors. We will be consulting widely and seeking expert advice on many elements of the framework,’ Dr Flynn said.
The framework and supporting information is available on the MBA website.
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We launched our advertising compliance and enforcement strategy in April and continue to work with consumers, professional associations, insurers and other regulators to help keep health service consumers safe from false, misleading and deceptive advertising (to find out more about the first time a corporation has been charged and convicted for advertising breaches, read our court and tribunal summary below).
AHPRA and National Boards recently hosted a forum for stakeholders interested in supporting responsible advertising in healthcare. The online media landscape has changed how healthcare providers and practitioners advertise. With a broad range of attendees, the forum encouraged debate around current issues for advertising regulated health services and discussion on the early experiences with the advertising strategy.
Discussions focussed on how to support those advertising regulated health services to comply with their obligations, broadening the discussion across the National Scheme about achieving responsible advertising by all registered health practitioners and building on work to support informed healthcare choices by consumers, including collaboration with stakeholders to support responsible advertising practices.
A range of resources, including videos of the panel discussions and a forum report, are available on our website.
Following the Independent review of the use of chaperones to protect patients in Australia, which was undertaken by Professor Ron Paterson in August 2016, we recently released a status report on the Medical Board of Australia (MBA) and AHPRA’s work to implement the review’s recommendations.
Accepting the report’s recommendations has set out a path for real change for the National Scheme. The MBA has worked with AHPRA to change the way it deals with allegations of sexual misconduct. As part of this work, a new specialist MBA National Sexual Boundaries Notifications Committee is up and running and new AHPRA National Specialist Investigation and Compliance Teams are investigating these matters and monitoring practitioners’ compliance with any resulting restrictions.
For further information, see the update on the website.
On 14 November 2017, in partnership with the Australian Sports Anti-Doping Authority (ASADA), AHPRA announced a Memorandum of Understanding (MOU) designed to enhance cooperation in investigative activities between both bodies.
ASADA’s role is to protect clean sport. This aligns with the National Scheme’s role to protect the public when performance enhancing drugs (PEDs) are provided by registered health practitioners without genuine therapeutic need. The MOU identifies areas where we can cooperate as regulators to work better together to protect the public, while meeting our respective statutory responsibilities. The MOU follows recent liaison between the agencies and will enable closer cooperation in relation to investigations involving registered health practitioners providing PEDs without therapeutic need.
Speaking about ASADA’s relationship with AHPRA, CEO David Sharpe said: ‘This partnership is a critical step in helping ASADA to better target the facilitators of doping and protect the health of Australian athletes.
‘Cooperation with AHPRA helps us to identify those athletes seeking unfair advantage, as well as ensuring those registered health practitioners whose conduct is unprofessional are kept away from sport.’
AHPRA CEO Martin Fletcher said: ‘This MOU will help us ensure the public remains protected against practitioners who fail to meet their professional obligations. It identifies areas where we can cooperate as regulators to work better together to protect the public, while meeting our respective regulatory responsibilities.’
The MOU took effect on 4 September 2017 and does not diminish existing legislative responsibilities for privacy and confidentiality in the management of information by each agency.
The most serious matters under the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law), are heard by the relevant tribunal in each jurisdiction. These matters may be referred by the relevant National Board or by an individual health practitioner. AHPRA can prosecute individuals when someone pretends to be a registered health practitioner or fails to meet the obligations when advertising a regulated health service 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 practise within.
The court and tribunal decisions summarised below highlight some firsts for AHPRA and the National Boards. 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.
In an Australian-first, Wellness Enterprises Pty Limited, which traded as Australian Male Hormone Clinic, has been fined $127,500 plus costs after being found guilty and convicted of 17 charges related to unlawful advertising of regulated health services.
Charges brought by AHPRA followed advertisements the business published in newspapers around Australia between February and August 2017 for treatment of testosterone deficiency.
This is the first time that a corporation, not an individual health practitioner, has been charged by AHPRA using its regulatory powers under section 133 of the National Law.
AHPRA, on behalf of the Nursing and Midwifery Board of Australia (NMBA), has prosecuted a student nurse for claiming to be a registered nurse when she was not and a registered nurse for playing her part in supporting the student nurse to do so.
This is the first time AHPRA has prosecuted an individual for holding another person out as a registered health practitioner.
Since January, we have published 42 other tribunal or court outcomes as news items or media releases 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.
A significant event in the National Scheme was establishing the Aboriginal and Torres Strait Islander Health Strategy Group and appointment of Associate Professor Gregory Phillips, CEO of ABSTARR Consulting and Dr Joanna Flynn AM as co-Chairs (as selected by the group).
The strategy group has been formed to develop the National Scheme’s first ever Aboriginal and Torres Strait Islander health strategy, with a view of closing the gap on health outcomes for Indigenous Peoples.
The strategy group is a partnership with mutual obligations between Aboriginal and Torres Strait Islander health sector organisations and leaders, accreditation authorities, National Boards and AHPRA, who together have a very broad reach and influence across the regulatory scheme for health practitioners.
The group’s vision is:
Patient safety for Aboriginal and Torres Strait Islander Peoples is the norm. We recognise that:
Associate Professor Phillips and Dr Flynn agree that partnerships are fundamental in this work.
‘With almost 700,000 Australians registered by the National Boards and a commitment from Aboriginal and Torres Strait Islander Leaders and the National Scheme to work collaboratively, there is a unique opportunity for real change to the health outcomes of all Australians,’ Associate Professor Phillips said.
‘We are grateful for the strong relationships we have with our partners in this work, particularly the expert guidance we have received from Aboriginal and Torres Strait Islander health sector leaders. This work cannot be done with National Boards acting in isolation and I am looking forward to making this new strategy a reality through my role as co-Chair,’ Dr Flynn said.
As reported in our annual report, the percentage of registered health practitioners who identified as being Aboriginal and/or Torres Strait Islander in 2016/17 was only 0.7 per cent, much lower than the 2.5 per cent of the population who identify as Aboriginal or Torres Strait Islander.
Communiqués are published after each meeting, which are available on the Advisory groups page of the AHPRA website.
Find out more about Co-Chair Associate Professor Phillips later in this issue.
Professor Michael Woods recently published the draft recommendations from his independent review of the accreditation systems in the National Scheme, which was commissioned by Health Ministers. A number of the reforms proposed in his draft report would, in their current form, require changes to our legislation and how we manage the accreditation of courses leading to registration, as well as assessment of internationally qualified practitioners.
In response to the draft recommendations, AHPRA and National Boards provided a joint submission to the review. AHPRA and National Boards welcomed the opportunity to comment on the substantial reform proposals in the draft report. The 38 detailed recommendations in the draft report and their progress following the review are of significant interest and impact to our mission and work and that of our partners and stakeholders. In developing our joint submission, we focused on the potential to achieve maximum benefits for minimal cost, regulatory burden, complexity and time.
In summary, it proposed that a more effective and efficient approach would be to make changes to roles of AHPRA, National Boards and Accreditation Councils, rather than create new regulatory bodies with the likely cost and complexity this could create. Instead, our submission proposes to build on the existing bodies and governance mechanisms in the National Scheme rather than establishing new bodies. We believe that this approach would deliver much of the desired reform for much less complexity and cost. A key aspect of our proposal is to establish clear accountability and responsibility for progressing desired reforms to address a current gap in governance which has constrained improvements.
The joint submission includes additional responses from four participating National Boards – Chiropractic, Medical, Optometry and Psychology. The Pharmacy Board made a separate submission.
AHPRA and National Boards look forward to the Review’s final report and Health Ministers’ response in due course.
Some changes have recently been made to the National Law. In addition to the necessary amendments to allow for paramedicine becoming a regulation profession (see the article in this issue), new measures that strengthen public protection are being introduced, and nursing and midwifery will be recognised in the National Law as two separate professions regulated by the Nursing and Midwifery Board of Australia.
Importantly, the amendments include powers for more transparent communication with notifiers (people who make a complaint about a registered health practitioner) and broadening the grounds by which a National Board may take immediate action against a health practitioner or student if it reasonably believes it is in the public interest.
Implementation of these changes is likely to occur in a staggered process over the coming year, as decided by Health Ministers
Last month, we co-hosted the International Congress on Professional and Occupational Regulation with the Council on Licensure, Enforcement and Regulation (CLEAR) in Melbourne. The event provided a forum for over 200 regulators from across the world and from a wide range of sectors to get together to share and learn about best practice regulation to better protect the public.
There were many fruitful discussions over the two days of the congress, including how to ensure fair representation of the diverse communities regulators are there to protect, how best to assess international qualifications and skills without taking a ‘one size fits all approach’, ways to engage with communities and consumers and whether this needs to be a formal or informal interaction, and how to overcome the increasing mistrust of institutions and regulators.
In the lead up to the conference we were delighted to host delegates from all over the world to share ‘a day in the life of AHPRA’ where staff presented their work and had an opportunity to connect with their regulatory peers from a range of sectors. We were overwhelmed by the positive response to the day and look forward to being able to share more with other agencies who share our work in protecting the public.
The presentations from the congress are available on the CLEAR website.
We recently hosted a joint research seminar with the UK’s multi-professional health and social care regulator, the Health and Care Professions Council (HCPC).
The seminar looked at how we learn from data to improve regulatory effectiveness, patient safety and professional standards internationally and was part of the HCPC and AHPRA’s collaborative research relationship striving for regulatory improvements in the UK and Australia. This is the largest regulatory research collaboration of its kind, using data from both jurisdictions to provide evidence on how health practitioner regulators can keep patients safer.
The seminar showcased research updates in areas such as risk-based regulation to prevent harm and using behavioural insights in regulation. In attendance were international researchers, regulators, accreditation authorities and practitioners. Check out the AHPRA Twitter and Facebook feeds for interviews with seminar attendees.
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.
AHPRA and National Boards hold a forum about responsible advertising in healthcare.
2016/17 Annual Report for AHPRA and National Boards published.
Quarterly registration data released.
Published a presentation by Board Chair, Professor Charlie Xue, at the May 2017 Australasian Acupuncture and Chinese Medicine Annual Conference.
Released a new position statement on advertising.
Published a revised Nomenclature compendium of commonly used Chinese herbal medicines.
Quarterly registration data released.
Published vodcasts of self-reflection forums held by the Board.
Predatory chiropractor will never practise again.
Published presentations from Chiropractor Board practitioner forums.
Published a revised list of recognised dental specialties, related specialist titles and definitions.
Communiqué published about a meeting with the Australian Dental Association to discuss how notifications are managed in the National Scheme.
Proceedings by a former registered dentist against the Dental Board dismissed by a tribunal.
New fact sheet on the use of teeth whitening products by dental practitioners released.
A medical practitioner based in Western Australia was disqualified by a tribunal from applying for registration for 10 years and fined $5,000 for professional misconduct.
Medical Board joins forces with Australian Medical Council to survey interns.
A former psychiatrist has been permanently disqualified from applying for registration as a medical practitioner.
A revised registration standard for specialist registration comes into effect from 15 February 2018.
Issued a joint statement on compounded medicines with the Pharmacy Board.
Published new codes of conduct for nurses and midwives.
A nurse in South Australia had her registration cancelled by a tribunal for engaging in an improper sexual relationship with a patient’s spouse.
An occupational therapist was reprimanded, disqualified from applying for registration for six months and ordered to pay a fine of $5,000 after admitting to engaging in professional misconduct.
Published an update about progress on the review of endorsement for scheduled medicines for optometrists.
Released revised guidance about the compounding of sterile injectable medicines which will take effect from 1 February 2018.
Recognised the various roles of pharmacists on World Pharmacists’ Day.
A registered pharmacist has been reprimanded, and may be required to undergo psychiatric assessment and supervised practice should he seek re-registration, after findings of professional misconduct.
Physiotherapist successfully held to account for health insurance and Medicare claim fraud.
Published an update on animal physiotherapy.
Recognised special day for physiotherapists – World Physical Therapy Day.
Launched a video for patients to help them understand what infection prevention and control measures to expect when visiting their podiatrist or podiatric surgeon.
Published an updated infection prevention and control self-audit tool.
Recognised the important role of podiatrists in the community during Foot Health Month.
The Supreme Court of Western Australia dismissed an application for judicial review of a decision by the Podiatry Board to caution a podiatrist and podiatric surgeon over his practise of the profession.
Published updated guidelines for the 4+2 internship program.
Court fined a Victorian man holding himself out as a registered psychologist.
Victorian woman fined $20,000 for posing as a psychologist and a general practitioner.
The Aboriginal and Torres Strait Islander Health Strategy Group has been brought together to develop the National Scheme’s first ever Aboriginal and Torres Strait Islander health strategy.
Associate Professor Gregory Phillips, CEO of ABSTARR Consulting, is Co-Chair of the group and has worked for over 20 years in healing, addiction, youth empowerment, medical education, health workforce and Aboriginal affairs. He is from the Waanyi and Jaru Peoples, and comes from Cloncurry and Mt Isa in North-West Queensland and was recently awarded the IAHA Allied Health Professional of the Year Award.
We spoke to Associate Professor Phillips about the group’s main areas of focus.
A critical focus of the strategy is building a culturally safe registered health workforce and being leaders in achieving workforce outcomes to improve the health of Aboriginal and Torres Strait Islander Peoples. What progress have health professions made to date?
Nationally we’re seeing some great development in some professions. Some have done quite a bit of work in accreditation and their education standards, while others have done a bit, and some very little. What we need to do is create consistency and clarity about Aboriginal and Torres Strait Islander health and cultural safety across all professions, at all levels of accreditation, education and registration. We’re using a definition of cultural safety that includes learning about Aboriginal and Torres Strait Peoples and their cultures and historical experiences (‘the other’), learning about critical race theory, racism and reflexive self-awareness (‘the self’), and learning about the institutional power relations that affect Aboriginal and Torres Strait Islander health outcomes.
How can we increase Aboriginal and Torres Strait Islander peoples’ participation in the registered health workforce?
AHPRA and the National Boards have a lead role in influencing accreditation and education standards. What are the barriers we can remove? That involves a practical discussion about merit and entry standards, and the criteria for excellence. That doesn’t mean reducing standards, we want to improve them, but we need to understand cultural safety is a critical part of clinical safety and patient safety, not an addition to it.
Health professions can understand and influence change in the workplaces in which practitioners work. The next discussion is engaging health service providers, professional associations, unions, and employers who are often operating in systems that are under strain. If we get the connections right, it will have a better flow on effect for all Australians in delivering patient-centred care, and it will affect Aboriginal Australians markedly.
What needs to be done to better understand how Indigenous communities access the National Scheme, and coordinating a consistent approach across the scheme in building access and participation?
There’s an engagement piece to be done so Aboriginal and Torres Strait Islander Peoples know about AHPRA and what it does. Then it’s a question of getting Aboriginal and Torres Strait Islander Peoples people on state and territory boards, to have careers with AHPRA and within the National Scheme. A workforce development initiative would help Aboriginal communities see AHPRA is for them as well.
I think this is also about hearts and minds. An increase in cultural safety helps all Australians. If we had 700,000 practitioners upskilled in Indigenous training and cultural safety, that would have a huge flow on effect on families and communities.
We are catching up, if you consider that very few people previously took part in Aboriginal studies in primary, secondary or tertiary study. Now we’re very slowly seeing it become the norm in the education system. And it can’t be sugar coated. German students learn about the holocaust, it’s seen as part of being a mature nation. We need to have that deeper understanding and continue the conversation here too.
The Aboriginal and Torres Strait Islander Health Strategy Group publishes communiqués of its work. These are available on the Advisory groups page of the AHPRA website.
If you have any comments or suggestions about AHPRA report, please send them to firstname.lastname@example.org
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