September 2020

In this edition:


Welcome from the CEO

Welcome to our spring 2020 update.

Every health profession and most of Australia’s 740,000 registered health practitioners are affected in some way by COVID-19 and the impacts are still unfolding. 

As regulators for this country’s registered health practitioners, responding quickly and pragmatically to the pandemic has been the primary objective of Ahpra and National Boards. We want to enable a flexible and responsive registered health workforce while maintaining patient and public safety. One way we jumped to action was working with jurisdictions to quickly establish a pandemic sub-register to faciliate the safe return to practice of over 35,000 health practitioners, to respond to any surge workforce needs. 

Like so many, we have also had to change our entire ways of working, almost overnight, to respond to the COVID-19 pandemic. National Boards and their committees have been continuing to work on a virtual basis during this time and I’m very thankful to our staff and Board members for their commitment to making sure we continue to function effectively and keep health practitioners registered, informed and supported. 

And in the middle of the pandemic, on 1 July, Ahpra and the National Boards officially turned 10 (with Western Australia celebrating in October). While this has been overshadowed by more pressing issues, it is an important milestone. We produced a booklet to celebrate our first 10 years at the start of this year, which provides a pre-COVID-19 snapshot of some of our work. Ten years of national health practitioner regulation in Australia is a snapshot of memories and achievements and can be downloaded from our website.

Thank you for your interest and continuing support. Please take care and stay safe.

Martin Fletcher

Martin.Fletcher@ahpra.gov.au

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'Taking care' podcast

Have you listened to our Taking care podcast yet? 

Episodes are now available on varied topics including vexatious notifications, the public’s expectations of health practitioners, eliminating racism from the health system, COVID-19 and the view from rural and remote health practitioners. Each episode invites a range of perspectives including public health officers, registered practitioners and more. New episodes are published regularly. Look out for it on your favourite platform or via the Ahpra website

Taking care podcast image July 2020

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Responding to COVID-19

Getting more practitioners back on the register 

The pandemic sub-register was created at the request of Australia’s Health Ministers to enable more health practitioners to quickly return to practice if needed in response to the COVID-19 pandemic. 

In early April, more than 40,000 doctors, nurses, midwives and pharmacists who had recently held general or specialist registration or moved to non-practising registration and met other specific criteria were added to the temporary register on an opt-out basis. Around 5,000 physiotherapists, psychologists, and diagnostic radiographers were added by mid April and there are currently 35,000 registered practitioners remaining on the sub-register. The sub-register has recently been expanded to include Aboriginal and Torres Strait Islander Health Practitioners on an opt-in basis. 

For more information listen to our podcast, Introducing the COVID-19 pandemic sub-register, with guests Alison McMillan, Commonwealth Chief Nursing and Midwifery Officer; Dr Chris Zappala, Vice President, Australian Medical Association, and Brett Simmonds, Chair, Pharmacy Board of Australia.

Profiles

L to R: Alison McMillan, Commonwealth Chief Nursing and Midwifery Officer; Dr Chris Zappala, Vice President, Australian Medical Association; Brett Simmonds, Chair, Pharmacy Board of Australia.

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Changing how we work

In response to the pandemic, National Boards temporarily modified regulatory requirements, particularly in relation to continuing professional development (CPD). Flexibility is required during the pandemic, when so little CPD is available due to changed workforce priorities and cancellation of education opportunities. 

Boards also produced guidance on clinical experience and education and internships and took practical steps like moving face-to-face oral examinations to online platforms to enable students and interns to sit these remotely. Boards and committees also moved to online meetings, as did all Ahpra staff.

Practitioners can now verify and upload documents online, without needing to present in person to one of our offices. This has made a huge difference to international applicants for registration, as well as to Australian applicants.

All our offices closed nationally, following health department advice in each state and territory. Our Perth, Hobart, Adelaide and Brisbane offices have now re-opened to our staff , with appropriate safety measures in place consistent with public health guidance in each state and territory.

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Protecting our health practitioners of the future: clinical education principles

National Boards, accreditation authorities and Ahpra, with the Australian Government through the health and education portfolios, issued national principles for clinical education during the COVID-19 pandemic. This unique multi-sector collaboration to protect Australia’s future health workforce is helping students learning to become health practitioners during the COVID-19 pandemic continue their studies and graduate.

Some student placements have been paused, cancelled or otherwise modified as health services respond to the pandemic. This has led to uncertainty and change for students and educators as education providers, accreditation authorities, clinical supervisors and others explore alternative options for students to progress towards graduation.

The principles aim to provide helpful guidance about how placements can occur safely, taking into account the significant changes across the health and education sectors due to COVID-19. Visit the National principles for clinical education during COVID-19 to find out more.

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Registration renewal for nurses and midwives

This year, 427,006 nurses and midwives renewed their annual registration during the COVID-19 pandemic. The Nursing and Midwifery Board of Australia and Ahpra listened to nurses and midwives and worked with stakeholders to implement immediate changes to renewal requirements and offer a financial hardship payment plan to support practitioners during this time.

While the Board encouraged nurses and midwives to continue to do CPD, it recognised that some might have trouble meeting these requirements due to the challenging circumstances of the pandemic. The Board announced that it would not take action if a nurse or midwife declared that they could not meet their required CPD hours for the 2019-20 registration period, and also reassured registrants that their professional learning on COVID-19, such as reviewing journal articles and doing infection control training, could contribute to CPD hours.

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Countering false and misleading advertising 

Patients and health consumers should always receive accurate and truthful messages so they can make the right choices about their healthcare. While most health practitioners are responding professionally to the COVID-19 emergency and focusing on providing safe care, we have seen some examples of false and misleading advertising on COVID-19. 

We recently reminded registered health practitioners that, other than sharing health information from authoritative sources, they should not make advertising claims on preventing or protecting patients and health consumers from contracting COVID-19 or accelerating recovery from COVID-19. To do so involves risk to public safety and may be unlawful advertising.

It’s also important that health consumers treat any advertising claims about COVID-19 cautiously and check authoritative sources, such as state, territory or Commonwealth health departments, for health information.

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No room for racism in healthcare

The National Scheme’s Aboriginal and Torres Strait Islander health and cultural safety strategy 2020-2025 was launched in February and its work is well underway.

This ambitious strategy from Aboriginal and Torres Strait Islander health experts, regulators and health organisations is endorsed by organisations (including accreditation authorities), academics and individuals. It represents a shared commitment to improving Aboriginal and Torres Strait Islander health outcomes, making patient safety the norm and eliminating racism from the health system.

See the article below for an interview with Karl Briscoe who is the Co-Chair of the Aboriginal and Torres Strait Islander Health Strategy Group.

In response to some examples of racist behaviour by registered health practitioners amid the COVID-19 pandemic, Ahpra and the National Boards reinforced their zero tolerance for racism in healthcare through a statement issued in April. Read the full statement on the Ahpra website.

We also published an opinion piece in Croakey, which reinforced that cultural safety is a requirement for patient safety and we all have a role to play to eliminate racism.

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Policy directions prioritise public protection 

Ahpra and National Boards are working toward full implementation of two policy directions issued by the Ministerial Health Council in January 2020, which reinforce that we are to prioritise public protection in the work of the National Scheme.

Along with National Boards, we have welcomed these policy directions which help us to ensure we meet the expectations of the community and government in protecting the public. Public protection and patient safety have always been at the heart of our work, and we are pleased to see it clearly articulated in these directions.

Consideration of the public when making decisions about regulatory action

The first policy direction provides clarity on the considerations that National Boards and Ahpra must give to the public (including vulnerable people in the community) when deciding whether to take regulatory action about a health practitioner. 

To support the first policy direction, the COAG Health Council has authorised limited sharing of information to employers and state/territory health departments about serious conduct matters by a registered health practitioner.

Consultation with patient safety and consumer bodies on registration standards

The second policy direction requires National Boards to consult with patient safety bodies and consumer bodies on registration standards, codes and guidelines when they are being developed or revised. It also provides that National Boards and Ahpra must consider the impacts of the new or revised registration standard on vulnerable members of the community and Aboriginal and Torres Strait Islander people.

Ahpra and National Boards are developing and consulting on a ‘patient health and safety impact statement’ that will be published with each new or revised registration standard, code or guideline. 

New guide to increase transparency in regulatory decision-making

We have also published a new guide explaining how National Boards and Ahpra apply the National Law* in the management of notifications about a practitioner’s performance, conduct or health. The guide aims to make it easier to understand how and why decisions are made.

The Regulatory guide and an executive summary are available on the Corporate publications page of the Ahpra website. 

*The Health Practitioner Regulation National Law, as in force in each state and territory.

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Changes in regulatory practice since review of the use of chaperones to protect patients

An independent report has found reforms of the regulatory management of allegations of sexual misconduct have had a profound impact.

Ahpra and the Medical Board of Australia commissioned the author of the ground-breaking 2017 Independent review of the use of chaperones to protect patients in Australia, Professor Ron Paterson, to assess what had been achieved and identify what more could be done to improve their handling of sexual misconduct allegations.

Professor Paterson, Professor of Law at the University of Auckland and Distinguished Visiting Fellow at Melbourne Law School, found that Ahpra and the Medical Board have fully implemented ‘nearly all’ his recommendations and made significant changes to regulatory practice.

The report notes the huge changes since 2017 to community and media discussion of sexual misconduct arising from the #Metoo movement and as a result of the Royal Commission into Institutional Responses to Child Sexual Abuse.

Report finds major changes have had a profound impact

The report finds that the National Scheme compares favourably with international health practitioner regulators on this issue and is highly advanced in how it operates in this complex and demanding area. Major changes to regulatory practice made by the Medical Board and Ahpra since 2017 to improve the handling of allegations of sexual boundary violations include:

  • abandoning the use of mandated chaperones and only rarely imposing practice-monitor restrictions
  • centralising the expertise and handling of allegations of sexual boundary violations, and
  • extensive specialised education and training for decision-makers and investigators handling these matters.

Actions to address recommendations

Ahpra and the Medical Board have accepted all Professor Paterson’s recommendations to ensure continuous improvement, including by:

  • improving communication with notifiers and practitioners and reducing timelines
  • improving support for notifiers (especially when cases go to tribunals), and for decision-makers and staff, and
  • applying new ministerial ‘public interest’ guidance to sexual boundary notification decisions.

Sexual boundary violations have a devastating impact on patients. For highlights of our action plan to address Professor Paterson’s recommendations and more information, read the media release.

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Review of confidentiality safeguards for notifiers

In June we welcomed the independent review by the National Health Practitioner Ombudsman and Privacy Commissioner of the confidentiality safeguards in place for individuals making notifications about registered health practitioners.

The Review of confidentiality safeguards for people making notifications about health practitioners was conducted at Ahpra's request following the conviction of a general practitioner for the attempted murder of a pharmacist who had made a notification about his prescribing practices.

It examined Ahpra’s current management of confidential and anonymous notifications and whether there were ways in which safeguards could be strengthened to ensure the safety of notifiers.

The review found that Ahpra’s practices for managing confidentiality and anonymity were reasonable and consistent with the practices of other regulators internationally. However, there were improvements that could be made.

The review makes practical recommendations for strengthening the protection of notifiers while recognising the importance of fairness for health practitioners who are the subject of a notification. We have accepted all ten recommendations and outlined a timeline to adopt these changes. For more information and links to the documents, read the media release

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Learning from tribunal and court outcomes

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 understand the acceptable levels of care and behaviour expected of health practitioners.

In the interest of transparency we also publish links to disciplinary decisions about a practitioner on the online national register of practitioners. The decisions we link to are those which involve adverse findings and which were delivered after the start of the National Scheme in 2010. These decisions are also publicly available on the websites mentioned below.

Below are some examples of decisions published in the past six months. 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.

Further information on tribunal decisions about practitioners in New South Wales is also published on the Health Care Complaints Commission website.

All the matters listed here were referred to the court or tribunal by the relevant National Board.

Examples of outcomes in the past six months

  • The Supreme Court of South Australia allowed Ahpra’s appeal against the sentence imposed on Ms Helena Heaft, a former nurse, for offences against the National Law and resentenced her. On 23 December 2019 the Magistrates Court of South Australia convicted Ms Heaft of 66 charges of holding herself out as a registered nurse in breach of the National Law. Between February and June 2018 Ms Heaft worked as a registered nurse at aged care facilities while her nursing registration was suspended. Ms Heaft pleaded guilty to the charges and the Magistrate imposed a three-year good behaviour bond. Ms Heaft was also automatically required by South Australian legislation to pay a victims of crime levy of $160 per charge, totalling $10,560. Ahpra appealed against the sentence on the grounds that it did not adequately reflect the seriousness of the offending nor maintain adequate standards of punishment for, or deterrence against, such offending. The court found that the initial sentence imposed was manifestly inadequate. Given the significant amount of the compulsory levies, rather than imposing a substantial fine a more proportionate punishment with appropriate severity would be an order for community service. Ms Heaft was sentenced to perform 80 hours of community service within 18 months.
  • The Victorian Civil and Administrative Tribunal reprimanded, suspended for three months and placed conditions on the registration of Dr Sarmin Sayeed, a general practitioner, for inappropriate prescribing of drugs of dependence to three patients between September 2014 and March 2017. The tribunal found that she had engaged in professional misconduct. The tribunal noted that she was under enormous personal pressure from several sources when she engaged in the prescribing and that Dr Sayeed had completed additional self-education, far exceeding the minimum requirements. Dr Sayeed indicated that she now has a much more robust approach to such requests from patients. After the period of suspension, Dr Sayeed’s registration will be subject to conditions requiring her to be supervised, restricting her from prescribing Schedule 8 or 9 medications, and requiring her to undergo education and an audit of her practice.
  • The State Administrative Tribunal in Western Australia disqualified former general practitioner, Mr Ranjit Panda, from applying for registration for 10 years for professional misconduct after he was convicted of indecent and unlawful assault by a court in Western Australia. The Board referred Mr Panda to the tribunal as a result of the criminal convictions and for breaching conditions imposed on his registration which required him to have a chaperone in attendance while conducting physical examinations of female patients. Mr Panda disputed the allegations put to the tribunal, claiming the complaints were made up. The tribunal found these claims to be ‘implausible’. It described his actions as a ‘most grave departure from the standard reasonably expected of a registered health practitioner’ and noted his behaviour was ‘entirely inconsistent with him being a fit and proper person to hold registration in the medical profession’.
  • The Victorian and Civil Administrative Tribunal reprimanded, suspended for one year and placed conditions on Ms Melissa White’s registration for professional misconduct. The tribunal found Ms White, a registered psychologist, allowed a professional relationship with a client to develop into a platonic social friendship, without ensuring that her client/friend was sufficiently protected from the foreseeable collateral impacts of that transition. Associated with this were inadequacies in client care in relation to record-keeping, risk assessments and continuity of care. Ms White had been the subject of prior disciplinary action for boundary transgressions, resulting in supervision conditions being imposed on her registration. Following the suspension, the practitioner will have education and supervision conditions imposed on her registration.

More matters

Since January, we have published 39 other tribunal or court outcomes as news items or media releases on Ahpra and/or National Board websites. Most of these cases have involved medical practitioners and nurses.

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Medical Training Survey: what the results tell us and planning the second survey

The Medical Board of Australia and Ahpra ran the inaugural Medical Training Survey (MTS) in 2019. Nearly 10,000 doctors in training (one in four) took part in the first MTS, creating the first national, comprehensive picture of medical training in Australia.

You can see the responses on the MTS website. The Medical Board prioritised confidentiality and results are only published when there were 10 or more responses. It’s expected that reporting detail will increase year on year, as trainees gain confidence in the MTS’s confidentiality and value. The results are reported directly without commentary.

The results tell the start of an important and emerging national story about the culture and quality of medical training from trainees’ perspectives. The MTS results provide an evidence base that educators, employers and stakeholders across the health sector can use to improve the culture of medicine and further strengthen medical training.

What do the results tell us?

In general, trainees rate their training very highly and there is a lot going well in medical training in Australia. Most trainees rated their clinical supervision and teaching highly. About 75 per cent of trainees work more than 40 hours per week, but many value the training opportunities this provides. Most trainees would recommend their current training post and nearly all intend to continue with their training program. 

However, there are opportunities to improve trainee access to health and wellbeing support programs. Also, more than one in three trainees report having experienced or witnessed bullying, harassment or discrimination. Only one third of those who reported experiencing it, reported it.

There is work to be done to better support Aboriginal and Torres Strait Islander specialist trainees and improve their experience of medical training. Survey findings show Aboriginal and/or Torres Strait Islander trainees are nearly twice as likely to have experienced and witnessed bullying, harassment and discrimination in the last 12 months. Data about their experience is published in a specific report.

Bullying, harassment and discrimination are not good for patient safety, constructive learning or medical culture. Medical practitioners, educators, employers and regulators must redouble their efforts to strengthen professional behaviour and deal effectively with unacceptable behaviour. 

Review of results

The Medical Board is considering the MTS results in the context of the Professional Performance Framework, which among other things, commits the Board to collaborations, like the MTS, that foster a positive culture in medicine and help build a culture of respect.

The Board and Ahpra want the MTS results to be easily accessible and in a usable format. We know that many people are accessing the 2019 MTS results and using the data dashboard to generate individualised and tailored reports. The results should be used as a quality improvement tool, to strengthen medical training in Australia.

See the MTS website for reports of the results and the online data dashboard which enables tailored reporting. 

The Medical Training Survey is back in 2020

The 2020 MTS is running in August and September during the renewal of registration period. Results will build on the findings of the 2019 MTS. The questions for 2020 are being adapted slightly to capture the impact of the COVID-19 pandemic on medical training and get more useful data on bullying and harassment.

We're conducting a Medical Training SurveyMedical Training Survey logo

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In conversation with… 

Karl Briscoe, Co-Chair, Aboriginal and Torres Strait Islander Health Strategy Group

Karl Briscoe, Co-Chair Aboriginal and Torres Strait Islander Health Strategy GroupKarl Briscoe is the CEO of the National Aboriginal and Torres Strait Islander Health Worker Association and a healthcare professional with additional qualifications in public health, public policy, public sector management and practice management. He is a proud Kuku Yalanji man from Mossman–Daintree area of Far North Queensland. He has worked for over 15 years in the health sector at various levels of government and non-government (local, state and national), forming a vast strategic network across Australia.

The Aboriginal and Torres Strait Islander Health Strategy Group consists of Aboriginal and Torres Strait Islander health sector leaders and representatives from accreditation entities, National Boards, Ahpra and the Chair of Ahpra’s Agency Management Committee.

We asked Karl to share his thoughts on the work of the Strategy Group, the issues affecting Aboriginal and Torres Strait Islander people during the current COVID-19 pandemic, and the developing role of Aboriginal and Torres Strait Islander Health Practitioners in our health system.

What are the main objectives of the National Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025?

We want to ensure by 2025 that cultural safety is embedded in Ahpra’s core business to bring about systemic changes. Our ultimate goal is better health outcomes for Aboriginal and Torres Strait Islander Peoples. Our four main objectives are:

  • Cultural safety – a culturally safe health workforce through nationally consistent standards, codes and guidelines across all practitioner groups within the National Scheme.
  • Increased participation – increased Aboriginal and Torres Strait Islander participation in the registered health workforce and across all levels of the National Scheme.
  • Greater access – greater access for Aboriginal and Torres Strait Islander Peoples to culturally safe services of health professions regulated under the National Scheme.
  • Influence – using our leadership and influence to achieve reciprocal goals (such as thought leadership on nationally agreed approaches to measuring ‘merit’ and ‘excellence’, definition of cultural safety, alignment with standards in education and health services).

There are specific strategies and initiatives to achieve these objectives over the long term. 

What issues have been affecting Aboriginal and Torres Strait Islander communities during the pandemic?

The pandemic has tested the interconnectedness that Aboriginal and Torres Strait Islander people have through their extended families and kinship systems. 

Our people over the age of 50 years with chronic conditions are a particularly vulnerable group, as the Commonwealth government has recognised, and this has also raised the stress and anxiety levels within our communities. We saw this in our Aboriginal and Torres Strait Islander Health Practitioner and Health Worker professions, where in some instances this group accounted for over 50 per cent of the workforce. 

In the last few months, how do you believe Ahpra has responded to the pandemic and racism in healthcare?

I think Ahpra’s leadership throughout the pandemic has been second to none. For example, Ahpra responded quickly to the Australian Government’s request to set up the pandemic response sub-register of health practitioners and achieved this in a timely manner. This was a huge task in terms of the data that had to be collected and organised and the communication campaigns to retired practitioners to recruit them to the sub-register.

We also witnessed great leadership in a very challenging environment by making a stance against racist behaviour toward Aboriginal and Torres Strait Islander Peoples who were seeking COVID-19 testing and culturally appropriate healthcare. The CEO led by example in calling out racism and encouraging health practitioners and communities who may have experienced racism to bring this to Ahpra’s attention by making a notification.

What issues would you like to see addressed for the Aboriginal and Torres Strait Islander Health Practice profession?

During the COVID-19 pandemic we have consistently called for the standardisation of each state and territory Drugs and Poisons Legislation. This will allow Aboriginal and Torres Strait Islander Health Practitioners to supply and administer medications to Aboriginal and Torres Strait Islander patients, specifically to those who are our most vulnerable. The drug supply and administration will be done in a safe manner with an order from doctor or nominated health practitioner.

What are the key strengths of Aboriginal and Torres Strait Islander Health Practitioners?

I believe the Aboriginal and Torres Strait Islander Health Practitioners’ role is vital if we are to have any impact in Closing the Gap. We need to recognise that this isn’t achievable without the involvement of this profession. Their skills include having a unique cultural insight into the lived experiences of families and community, and this is supported by their knowledge of cultural beliefs, practices and protocols. This is an essential skill base that has relevance at all levels of healthcare provision across the full healthcare service spectrum. The work they do ensures that culture is central to and embedded in our everyday work practices, which I believe is a prerequisite if we are to Close the Gap in health outcomes. 

It’s most important to gain greater recognition of and respect for the profession’s unique social and cultural strengths that enable better health for our peoples into the future − we know that Aboriginal and Torres Strait Islander Health Practitioners possess a cultural intellect that cannot be replicated by non-Indigenous clinicians.

You’ve been on the Strategy Group since 2017, what are you most proud of the partnership achieving to date? 

The launch of The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025 in February 2020 gave us a unique insight into the power of partnerships. I believe one of the major elements that has helped in implementing the strategy is a culturally safe governance process. The formation of the Strategy Group Caucus gives us a culturally safe space in which Aboriginal and Torres Strait Islander members can carry out their business before engaging with the wider Strategy Group. Without the Caucus we would have had a tough time in formulating a collectivist view. 

Reaching the agreed definition of ‘cultural safety’ was also a key activity that solidifies the power of partnerships, specifically that with the National Health Leadership Forum. The Forum is a collective partnership of national organisations who represent a united voice on Aboriginal and Torres Strait Islander health and wellbeing with expertise across service delivery, workforce, research, healing and mental health and social and emotional wellbeing.

As Co-Chair of the Aboriginal and Torres Strait Islander Health Strategy Group, what would you like to see Ahpra achieve in the next 12 months?

One of the really important objectives in the next year is Ahpra’s implementation of cultural safety training across the agency. This is crucial to help enable systemic changes and to ensure Ahpra leaders and staff, and the National Boards, understand and embrace cultural safety.

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Page reviewed 18/12/2020