Compared to 2017/18, we:
Any person or entity can notify us when they have a concern about a registered health practitioner.
When a notification is made about a practitioner, we assess the information in the notification together with practice information, practice-setting information and historical data known about that practitioner.
When this assessment indicates that there is a potential risk to the public, higher than the inherent risk associated with health practice, a National Board can act.
In the National Scheme, a concern raised about a registered health practitioner or student is called a notification. They are called notifications because an individual or entity can notify us about their concern.
AHPRA manages notifications in partnership with the National Boards. Most of the notifications we receive about individual practitioners are managed through Part 8 of the National Law. Decisions made in response to a notification can affect a practitioner’s registration.
The National Law says some acts are offences. That is why concerns about some acts are treated differently under the National Law. AHPRA can prosecute individuals who commit these offences.
Anyone can notify us about a registered practitioner’s health, performance or conduct.
We receive most notifications (52.3%) from patients, their families and friends, and other members of the public.
We also receive notifications (18.4%) from health practitioners and employers.
Registered health practitioners and employers have mandatory notifications obligations in addition to the capacity to make voluntary notifications about other registered health practitioners.
Standards of clinical care continue to be the primary issue notified. The proportion of notifications that were made about this issue increased by 5%.
We also receive notifications about students who are enrolled in programs of study that lead to eligibility for registration as a practitioner. Usually, these notifications are made by education providers or places at which students do clinical training. The number of notifications we received about students increased. The proportion of the notifications that resulted in conditions or undertakings affecting the student’s registration was similar to last year.
AHPRA does not manage all notifications made about health practitioners in Australia. Our data reflect this. We report on only those notifications received and managed by AHPRA and the National Boards, unless otherwise stated.
The notification process is different in NSW and Queensland:
In Queensland, OHO receives all health complaints, including those about registered practitioners. OHO decides whether the complaint:
We are committed to improving the timeliness of the notification process.
Every notification we receive is important and assessed as quickly as possible. Our assessment starts with a review of the concerns raised in the notification. We usually clarify those concerns in a conversation with the notifier (the person who made the notification).
We consider practice information and the practice setting of the practitioner.
look back at the practitioner’s registration, and any notification and compliance history, to understand whether there have been previous issues, to help analyse and consider risks to patient and public safety.
Usually, we seek a response from the practitioner who has had a concern raised about them.
Often notifications can be closed after this initial assessment without the need for regulatory action. If we need more information, we can investigate.
At any time, when we identify that a practitioner poses a serious risk or there is a strong public interest in limiting a practitioner’s right to practise, there are interim actions that a National Board may take quickly to protect the public.
We recognise the practice of healthcare is not risk-free. Practice in each of the regulated professions potentially poses risks to the public. That is why the professions are regulated.
A National Board's registration standards, codes and guidelines set out what is expected of practitioners when practising their profession.
When concerns are raised about the professional standards of practice of an individual practitioner, or possible impairment, a National Board decides, based on assessment of risk, whether regulatory action is needed to assure patient safety in the future.
Most notifiers are raising a genuine concern. Most practitioners try to do the right thing and are accountable and rectify problems when they arise. When a practitioner’s own response to problems is not enough, others also play a part in assessing and responding to risks. Employers and system regulators play a part in thinking about how to minimise the likelihood of similar risks arising with the practitioner, or a different practitioner. A National Board takes these attitudes, behaviours and actions of practitioners and any employer organisations into account when determining whether it needs to act as the regulator.
When another entity such as a state or federal police service or a coroner is investigating a practitioner or has charged a practitioner with a criminal offence, a National Board may wait for the conclusion of those proceedings before it makes a final decision about a practitioner. This would not prevent a National Board taking interim action to protect the public in the meantime, for instance suspending a practitioner’s registration, until the criminal proceedings have finished.
Since 2016, we have been asking notifiers and practitioners to tell us about their experience of the notifications process through surveys and interviews. We received 2,201 responses to our post-notifications surveys, 64% of which were from practitioners.
One of the key concerns for both notifiers and practitioners is the length of time taken to complete notifications. We have made the following improvements this year to address the concerns of practitioners and notifiers.
We centralised the intake and assessment of notifications, from seven to two locations. A single, national team based in Adelaide and Melbourne is now responsible for the assessment of all new notifications about health practitioners.
With the introduction of our national intake and assessment team, we have changed the way practitioners first hear that they are the subject of a notification. One strong message we receive from notifiers and practitioners is that they would like a more personal approach and appreciate it when we call. So, we’re acting to do that.
first step in most notifications is to pick up the phone and call. We also often speak with notifiers early on to better understand their concern and what they are hoping to achieve.
We prioritise direct contact with notifiers and practitioners whenever possible.
We have continued to update our letters in response to practitioner and notifier feedback.
Both groups told us that simple, brief information in our first correspondence would help them understand what to expect, what are the common outcomes, and how long it would take. We produced a series of ‘postcards’ to accompany our first letters, reducing complex information to a brief page of facts. See Understanding your experience.
We implemented changes made to the National Law during 2018. These enable us to provide more information to a notifier when we close a notification. We published a Common protocol – Informing notifiers about the reasons for National Board decisions.
We work hard to improve the content and presentation of reasons for the decision. Feedback about our work shows improvement in understanding the reasons for decisions by notifiers. Calling practitioners and notifiers before sending the final outcomes letter can also help explain the reasons for the decision.
We have made improvements to our website:
We’ve posted a series of short, accessible information videos featuring AHPRA staff talking about the notification process (see Further information).
We’ve improved website layout to make it easier for practitioners and notifiers to find the information they need.
We began sharing stories of practitioners who have been through a notification process. These first-hand, unfiltered accounts of what the notification experience is like are posted in video format to our website (Understanding your experience). They tell a first-person story about getting through the notification experience in the best way possible.
On our website and in our written and oral communication, we are paying more attention to the welfare of both practitioners and notifiers by informing them of support services available.
We are working with Lifeline and other services, including through a new wellbeing and support program for all our staff, to ensure they are better supported and equipped to respond to distressed notifiers and practitioners.
We have significantly increased our team of medical clinical advisers.
We recruited to these roles through open expressions of interest and were heartened by the number of practitioners keen to help us do the work that we do.
Our national network of medical clinical advisers now reviews every notification within their profession within a few days of receipt. We are rolling out a model of clinical advisers to the five professions with the largest volume of notifications. Clinical advisers help us to understand clinical issues associated with a notification before it is considered by a National Board.
Expressions of interest for clinical advisers have now been sought from other professions. In 2019/20 we will continue to embed clinical input as a cornerstone of our work.
Changes to the National Law in 2018 require a practitioner to tell us about their practice information when requested to do so. This change broadens the nature of information we can require. It now includes requirements to inform us of being self-employed; or working as an employee, contractor, or in a voluntary or honorary capacity. To help practitioners meet their obligations, AHPRA published the Guideline: Informing a National Board about where you practise (as an example, see the Medical Board's Codes Guidelines Policies).
These changes also mean that we are required to inform a broader range of practice entities of regulatory action taken.
This year, AHPRA received more notifications than we have ever received in a single year. A total of 9,338 notifications were received, 28.3% more than the number we received in 2017/18 (7,276 notifications) and 35.4% more than in 2016/17 (6,898 notifications).
Some of the increase arose from standardising the way we record complaints raised with a health complaints entity (HCE), assessed by AHPRA as required under the National Law and retained by an HCE. When we adjust the data to account for this standardisation, the adjusted increase was 14.3% (not 28.3%) more notifications than we received in 2017/18.
The percentage of all registered health practitioners with notifications made about them was 1.7%. This percentage was 1.6% in 2017/18 and 2016/17.
During the year we received 57 notifications about students.
All registered health practitioners, their employers and education providers have mandatory reporting responsibilities under the National Law.
Interim action can be taken as a precaution when serious concerns are raised about a practitioner. These actions, called immediate actions under the National Law, protect the public while more information is obtained, or other processes conclude.
It is an interim measure that a Board takes only in cases where the Board believes there is a serious risk to the public or it is otherwise in the public interest to limit a practitioner’s registration while it seeks further information.
National Boards took immediate action on 384 occasions, which is 7.2% (30) fewer than in 2017/18. The proportion of notifications where immediate action was taken was 4.1% of the notifications received.
This is down slightly on previous years (5.7% in 2017/18 and 4.6% in 2016/17).
Of the notifications finalised by a National Board this year, 68.1% were closed on assessment and did not require investigation (up from 62.6% in 2017/18).
The proportion of notifications that progressed from assessment to investigation was 29.6%, less than in previous years (33.1% in 2017/18 and 33.0% in 2016/17).
The decrease is, in part, due to changes to the National Law that provide National Boards with new decision options at the assessment stage.
In all, 2,859 notifications about 2,357 practitioners were referred for investigation. Deciding to investigate does not indicate that an allegation made in a notification is true. We investigate a practitioner when more information is necessary to make an informed risk assessment. A decision to investigate gives us power to require individuals to provide us with information.
During an investigation, information can be gathered from sources such as:
We completed almost 26.4% more notifications than in 2017/18. This represents the highest number of closures (8,979) since the start of the National Scheme.
Of the notifications that were closed, 17.5% resulted in regulatory action against a practitioner.
As at 30 June 2019 there were 4,546 notifications currently being managed by AHPRA and remained open.
Nearly half of all notifications are closed in less than three months. The majority (68.2%) were completed in less than six months. This is an improvement on previous years (64.5% in 2017/18 and 64.9% in 2016/17).
AHPRA manages a range of regulatory litigation and associated legal services, including:
There were 305 notifications open in the tribunal stage as at 30 June 2019, compared with 321 at the same time last year. Of the 174 notifications closed by tribunals in the year, 96% of matters resulted in some form of disciplinary action taken and in one matter the practitioner surrendered their registration. The tribunal decided to take no further action in just five individual matters, which is consistent with the previous year. A further two matters were referred to other regulatory entities. This demonstrates that the National Boards continue to appropriately identify the thresholds for referring a matter to a tribunal to protect the public.
Since 2010, all practitioners who have had their registration cancelled by a court or tribunal, been disqualified from applying for registration, or prohibited from using a specified title or providing a specified health service appear on the cancelled health practitioners register. See the Registers of practitioners.
We also publish summaries of tribunal outcomes.
All National Boards now publish links to disciplinary decisions by courts and tribunals on the public Register of practitioners where there has been an adverse finding about a registered health practitioner, unless a tribunal or court has issued a suppression order.
A National Board has the power to establish two types of panels depending on the type of notification:
Under the National Law, panels must include members from the relevant health profession as well as community members. All health panels must include a medical practitioner. Each National Board has a list of approved people who may be called upon to sit on a panel.
Recruitment to the list of approved panel (LAP) members was carried out by National Boards during the year, and successful applicants were appointed for a three-year term starting 1 July 2019.
Of the 39 National Board matters decided by panels during the year, more than 75% resulted in some form of regulatory action being taken.
The National Law provides a mechanism of appeal to a tribunal against a decision by a National Board in certain circumstances, including decisions to:
Decisions may also be judicially reviewed if there is a perceived flaw in the administrative decision-making process, as opposed to a concern about the merits of the individual decision itself.
There were 62 appeals lodged nationally about decisions made by National Boards. The number of appeals lodged annually has varied over recent years as follows: 62 appeals in 2018/19, 28 appeals in 2017/18 and 82 appeals in 2016/17.
The majority of these appeals related to the professions with higher regulatory decision volumes, such as medical practitioners (30), and nurses (15). There were 59 appeals finalised.
There were 45 appeals not yet decided as at 30 June 2019.
The National Law includes criminal offences which relate to conduct that can put individuals and the community at risk. Criminal offences may be committed by a person (including registered health practitioners and unregistered individuals) and/or corporate entities.
Criminal offences predominantly relate to title protection, unlawful claims as to registration, restricted acts, and advertising of regulated health services.
Up until 30 June 2019, offences under the National Law were summary offences and could be tried by a judge alone and penalties were limited to fines. From 1 July 2019, several offences have now become indictable offences and can be tried by a judge and jury. Indictable offences under the National Law have increased penalties including increased maximum fines and up to three years' imprisonment. Indictable offences can be heard summarily, which means that the offence can be dealt with by a judge alone in the Magistrates' or Local Court.
On 26 February 2019, the Queensland Parliament passed the Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2018 (Tranche 1A Amendments). In addition to amendments about the mandatory notification framework, the Tranche 1A Amendments have the effect that:
These Tranche 1A Amendments regarding the offence provisions and penalties began on 1 July 2019. The new offence provisions will apply in all states and territories, except Western Australia. The amendments to offence provisions do not apply to advertising offences. From 1 July 2019, the Statutory Offences Unit (SOU) was renamed the Criminal Offences Unit.
AHPRA recorded 551 new offence complaints.
Most jurisdictions experienced a decrease in offence complaints received when compared with the previous year. Victoria and NSW continue to receive the largest number of offence complaints and this year accounted for 34% of all new offence complaints. These jurisdictions accounted for 38% of new offence complaints in 2017/18. (This percentage was incorrectly reported as 68% in last year’s annual report.)
Of the offence complaints received nationally, 67% related to concerns about alleged unlawful use of title and unlawful claims to registration. This year 481 offence complaints have been closed.
As at 30 June 2019, there were 238 criminal offence complaints under review, up from 189 at 30 June 2018, which is a 25.9% increase in open offence complaints.
Criminal offences are managed with a risk-based approach, focusing on protecting the public and ensuring the timely resolution of all complaints. All new offence complaints are risk assessed, and this dictates the course of action required to ensure public safety.
As required, serious-risk offence complaints are investigated by an inspector. This may include applying to the court for a warrant to search premises and seizing evidence.
AHPRA, in consultation with the relevant National Board, will prosecute offences against individuals and/or corporate entities where there is a legitimate public interest in doing so. See Prosecution guidelines.
We have published Guidelines for advertising regulated health services to help anyone advertising regulated health services to do so appropriately. In turn, AHPRA and the National Boards have published and implemented an Advertising compliance and enforcement strategy that outlines the risk-based management of offence complaints, particularly advertising complaints. Both documents are available on the AHPRA website, see Advertising guidelines and Legislation guidelines.
There have been several significant prosecutions this year that demonstrate the importance of the criminal offence function for the protection of the public.
AHPRA completed 15 proceedings in the courts for offences under the National Law across five jurisdictions. All prosecutions resulted in findings of guilt; and in all cases the individual or entity was convicted. These outcomes demonstrate that AHPRA continues to identify appropriate thresholds for referring offence complaints for prosecution to protect the public.
A further seven prosecutions are ongoing before the courts as at 30 June 2019.
The National Law creates certain offences which include (but are not limited to) restrictions on use of protected titles, unlawful claims to registration, restricted acts and unlawful advertising. AHPRA's published Prosecution guidelines outline that we will start a prosecution only where there is a reasonable prospect of a conviction, and the prosecution is in the public interest. Offences may be committed by a person (including registered health practitioners and people who are not registered) and/or corporate entities. The Criminal Offences Unit has a very important role in investigating and prosecuting offences under the National Law, as this type of conduct can put individuals and the community at risk. Some examples of cases successfully prosecuted before the courts in 2018/19 are set out below.
On behalf of the National Boards, AHPRA monitors health practitioners and students with restrictions (conditions or undertakings) placed on their registration, as well as those with suspended or cancelled registration. By identifying any non-compliance with restrictions and acting swiftly and appropriately, AHPRA supports Boards to manage risk to public safety.
Restrictions are placed on a practitioner’s registration through several mechanisms, including as an outcome of a notification, or when a practitioner applies for registration or renewal of registration.
Each monitoring case is assigned to one of five streams.
A practitioner or student is being monitored because they have a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence).
A practitioner is being monitored to ensure they practise safely and appropriately while demonstrated deficiencies in their knowledge, skill, judgement or care in the practice of their profession are addressed.
A practitioner is being monitored to ensure they practise safely and appropriately following consideration of their criminal history, or they have demonstrated a lesser standard of professional conduct than expected.
A practitioner is being monitored because they:
A practitioner or student is being monitored because they:
This year, the number of active monitoring cases nationally decreased by 23.6%. The cases monitored by AHPRA relate to 3,826 (5,005 in 2017/18) individual practitioners and the majority were in relation to monitoring of eligibility/suitability requirements.
All monitoring cases in the suitability/eligibility stream were reviewed this year when monitoring responsibility moved from the registration division to the compliance division.
The primary reason for the significant reduction in cases monitored is because the majority of the 925 practitioners in the suitability/eligibility stream had limited and provisional registration with conditions imposed that duplicated the requirements in the relevant published registration standard Limited registration for area of need registration standard and Limited registration for postgraduate training or Supervised practice registration standard. These registration standards are available on the Medical Board's Registration Standards.
The requirements imposed by the registration standards continue to be monitored by a team within the registration division.
Since the introduction of compliance performance reporting in 2015/16, we have continued our focus on managing risks associated with monitoring cases and identifying opportunities to improve the quality, timeliness and accuracy of our compliance work, including in reporting. Improvements have been made to our ability to report at the level of restriction categories for each compliance case.
For the first time, we can report the top 10 restriction categories (5,534 restrictions) by volume monitored by AHPRA. Although 3,869 cases were being actively monitored by AHPRA, each case may have more than one restriction category requiring compliance by the practitioner.
66.7% of restrictions imposed (3,689) in the top 10 restriction categories by volume were as a result of the routine process of a health practitioner obtaining or renewing registration with a National Board.
33.3% (1,845) of the restrictions in the top 10 restriction categories by volume were imposed as a result of a finding made by a National Board, panel or tribunal about a practitioner’s health, performance or conduct.
The top 10 restriction categories are:
Restriction on practice and employment
A requirement, imposed at registration or renewal, requiring the registrant to do or refrain from doing something in connection with their profession. This category would include practitioners who may only practise in certain locations, such as international medical graduates with limited registration working in a regulated area of need.
Requirement for supervision
A requirement, imposed at registration or renewal, requiring the registrant to do a certain amount of supervised practice. This restriction is often imposed where a practitioner is re-registering in the profession after an absence.
A requirement, imposed at registration or renewal, requiring that a registrant, at some point in the next registration period, undergoes an assessment of their performance in the profession.
A requirement that a registrant attends and completes a defined education course, training or up-skilling activity.
Attend treating practitioner
A requirement that a registrant attends treating health practitioners(s) for management of identified health issues.
Restriction on scope of practice
A requirement, imposed at registration or renewal, requiring a registrant to restrict the type of practice they undertake.
Prohibition on practice
A restriction category used to manage cases for registrants who are prohibited from practising, including a practitioner whose registration is suspended.
Restriction on workplace location
A restriction on the location or the position in which a registrant may practise their profession.
A requirement that a registrant complete a prescribed amount of continuing professional development activities.
Restriction on work type
A restriction on the type or manner of work a registrant may undertake.
In 2015, the National Restrictions Library (NRL) was launched. This is an important national resource and documents common restrictions (e.g. conditions on registration) used across the regulatory functions of the National Boards to support:
A quality review of the NRL conducted last year was favourable in terms of improved efficiencies, and further work was done to improve consistency in the wording of restrictions. In addition, the NRL was expanded this year to include a new category of ‘suitability’ stream restrictions.
Next year, a major review of all restrictions used in the NRL is scheduled, including a plain English review of the restriction text.
AHPRA’s compliance and legal divisions manage the enforcement aspects of the Advertising compliance and enforcement strategy. The advertising compliance team is responsible for the triaging of all offence complaints, the assessment of all advertising offence complaints and the ongoing management of low-risk and moderate-risk advertising complaints under this strategy.
Responsible advertising is a professional and legal obligation. We recognise that most health practitioners want to comply with the law and their professional obligations, and we aim to make compliance as easy as possible.
In 2018/19, 515 low-risk to moderate-risk advertising complaints about registrants were received under the strategy. In 2017/18, 820 low-risk to moderate-risk advertising complaints were received (incorrectly reported as 911 in last year’s report). The reduction of 37.2% in these types of advertising complaints received this year is likely the result of work we have done with one stakeholder, who previously made bulk complaints, and who has now stopped that practice.
The data in 2018/19 confirm that nearly 50% of registrants become compliant in response to the initial letter about the advertising breach. The remainder become compliant when the imposition of advertising restrictions is being considered and the practitioner is issued with the show cause notice where each breach and its location is specified. This demonstrates the effectiveness of the strategy in educating practitioners about their professional obligations and ensuring timely remediation of inappropriate advertising for the benefit of the public. There were no instances of continued non-compliant advertising that required regulatory action through the imposition of advertising restrictions.