Overview

The regulated health workforce in 2018/19

• 744,437 registered health practitioners
• 1 in 17 people working in Australia is a registered health practitioner

Number and percentage of registered health practitioners in each state and territory

Relative size of registered health professions

What the data tell us

• 1 in 17 people working in Australia is on the register of health practitioners, meaning that 5.8% of the Australian workforce are registered health practitioners.
• 91.4% of applications received were approved for registration, enabling these applicants to join their health profession.
• The Paramedicine Board of Australia registered 17,323 paramedics for the first time.
• We approved 84,205 new applications for registration, contributing to the public having access to the services provided by 5.9% more registered health practitioners than in 2017/18.
• 94.7% (665,310) of health practitioners registered at 30 June 2018 renewed their registration.
• Most health practitioners practise safely and well: 98.3% of all registered health practitioners did not have any concerns reported about their conduct, health or performance.
• The number of notifications increases each year, but so does the number of registered practitioners. The percentage of practitioners with notifications made about them is about the same, 1.7% this year, 1.6% in 2017/18 and 2016/17.
• The single biggest type of complaint made about health practitioners is about clinical care.
• With 5,359 notifications, the medical profession received the highest number of complaints, accounting for 57.4% of complaints received. Nursing received 1,751 complaints, dental 749, psychology 535 and pharmacy 398.
• Improving communication skills, obtaining written consent, maintaining boundaries, and safe prescribing are recommended ways a practitioner can mitigate the risk of having a notification made about them.
• 77 practitioners (less than 1%) who had a notification made about them to a National Board had their registration cancelled or suspended by a tribunal.
• The Aboriginal and Torres Strait Islander Health Practice profession is the only ethnically based profession in the world that is regulated, complete with training curriculum and registration requirements.
• Australia is the first country outside China to nationally regulate Chinese medicine, including acupuncture, Chinese herbal medicine practice and Chinese herbal dispensing.
• With 411,216 registrants, nursing is by far the largest registered health profession. In contrast, with 690 registrants, Aboriginal and Torres Strait Islander Health Practice is the smallest.
• Mostly as a result of a notification received, regulatory action was taken in relation to registered health practitioners 1,582 times to reduce the risk of harm to the public.
• For consistency across professions and jurisdictions, 99% of registration restrictions imposed by National Boards come from the National Restrictions Library.
• 69.5% of notifications ended with a decision to take no further regulatory action.
• 100% of registrants reviewed under the Advertising compliance and enforcement strategy became compliant with their advertising when the matter was raised with them, either immediately or in response to proposed regulatory action.
• AHPRA completed 15 proceedings in the courts for offences under the National Law across five jurisdictions. The individual or entity was convicted in every case.

Introduction

AHPRA works collaboratively with 15 National Boards to implement the work of the National Registration and Accreditation Scheme. At its heart, the National Scheme is about patient safety and protecting the public.

Our scheme continued to meet significant milestones this year.

We worked with our valued partners towards health equity for Aboriginal and Torres Strait Islander Peoples. Led by Aboriginal and Torres Strait Islander health experts, this work is a shared commitment with all National Boards, accreditation authorities and AHPRA to do our part to eliminate racism from the health system. Cultural safety is inextricably linked with patient safety and must be defined by Aboriginal and Torres Strait Islander people. This year, we partnered with the National Health Leadership Forum to begin developing a definition of cultural safety for the National Scheme and delivered AHPRA’s first Reconciliation Action Plan.

Australia now has over 740,000 registered health practitioners across 16 professions, with paramedicine becoming a nationally regulated profession this year. More than 17,000 paramedics joined the scheme and can now register once, renew yearly and practise anywhere. As with all professions, patients, the public and employers can now check the public register of practitioners to see if a paramedic is registered.

This year, we continued working on improving how we manage notifications. This includes connecting people who have made, or are the subject of, a notification to services to support them through the process. Despite a 14.3% increase in notifications, we completed more matters more quickly and reduced overall timeframes for dealing with notifications. We also produced specific information materials, including videos of real practitioners who have had a notification made about them, to explain the process better.

We put in place a new, national operating model for practitioner registrations that will bring considerable benefits to our work. While the implementation began this year, it took longer than expected, which resulted in some registration applications being delayed. To address this, we have invested more resources and further streamlined the model, along with improved communications with employers, professional groups and applicants. Ensuring that our registration performance meets stakeholder expectations is an important ongoing focus for our work.

National Boards and AHPRA worked with accreditation authorities to finalise new agreements and committee terms of reference which reflect greater transparency, performance and accountability in the accreditation arrangements. The Agency Management Committee has worked closely with National Boards to provide a scheme-wide view of accreditation and to work jointly on common issues such as multi-professional practice, Aboriginal and Torres Strait Islander health and links with key stakeholders.

For the first time, we asked practitioners across all regulated professions, as well as members of the community, about their trust and confidence in our work. The results showed that practitioners want us to be less focused on explaining who does what and more focused on being positive and educational in our communications. They also showed that about two-thirds of people in the general community are interested in finding out more about what we do. We have incorporated these insights into our refreshed engagement strategy with the community and with practitioners.

It has been another big year for our scheme, and we thank AHPRA employees, Board and committee members for their commitment and partnership as we regulate in the public interest. We would like to especially thank the six National Board Chairs who finished their term and welcome the new Chairs.

Mr Martin Fletcher
Chief Executive Officer, AHPRA

Mr Michael Gorton AM
Co-convenor, Forum of National Registration and Accreditation Scheme Chairs Chair, Agency Management Committee, AHPRA

Mr Ian Bluntish
Co-convenor, Forum of National Registration and Accreditation Scheme Chairs Chair, Optometry Board of Australia

Progress towards our strategic outcomes

Reduced risk of harm to the public associated with the practice of regulated health professions

Regulating in the public interest

Of the 174 notifications decided by tribunals, 96% resulted in disciplinary action. For example:

• A notification was received after a practitioner’s spouse, who had a medical condition needing high-level care, was admitted to hospital and the practitioner disclosed he was his spouse’s primary general practitioner. After an investigation, the Medical Board of Australia imposed conditions prohibiting the practitioner from treating family members and others with whom he had a close personal relationship, except in emergencies. The practitioner appealed to a tribunal seeking the removal of the conditions, but the tribunal upheld the Board’s conditions.
• AHPRA received a notification from a patient who experienced extreme discomfort after undergoing dental implant surgery. The dentist admitted that the treatment plan was deficient, the outcome of the surgery was not satisfactory and the implants were not positioned correctly. The Dental Board of Australia took immediate action and accepted an undertaking from the dentist to not provide surgical implant treatment until approved to do so. After an investigation, the Dental Board referred the matter to a tribunal, which reprimanded the dentist and required him to complete further training.
• After a pharmacist was convicted of unlawfully importing over 2,000 ice-pipes, the Pharmacy Board of Australia referred the matter to a tribunal, which found his behaviour constituted professional misconduct. He was reprimanded and disqualified from re-applying for registration for six months. The pharmacist was also ordered to pay $1,000 towards the Board’s costs of the tribunal proceedings.
• The Nursing and Midwifery Board of Australia took action against a nurse by referring her to the tribunal for allegedly providing inappropriate care and treatment, practising outside of her scope of practice, failing to properly document treatment, failing to seek medical practitioner assessment, and falsely documenting medical officer authorisation. The tribunal reprimanded the nurse and imposed conditions on her registration.
• An audit found that a psychologist had falsely declared to the Psychology Board of Australia during her registration renewal that she had professional indemnity insurance and provided a false certificate. The Board referred the psychologist to a tribunal, which found that the conduct was substantially below that expected, reprimanded the practitioner, suspended her from practising for three months and imposed conditions on her registration.

Assurance that registered health practitioners are suitably trained and qualified to practise in a competent and ethical manner

New accreditation agreements strengthen approach

Accreditation is a way the National Scheme assures that registered health practitioners are suitably trained and qualified to practise competently and ethically. This is done through setting standards, assuring the quality of education programs approved for registration and assessing overseas-qualified practitioners.

Accreditation authorities play a critical role in protecting the public by accrediting programs of study against the accreditation standards approved by the Board. The work of each accreditation authority ensures that when a National Board approves an accredited program as a qualification for registration, it is confident that graduates have the knowledge, skills and professional attributes to practise the relevant profession. This is critical to public protection.

Each National Board decides whether the accreditation functions for the profession it regulates will be carried out by an external accreditation body or a committee established by the National Board.

If the National Board decides on an external organisation, AHPRA enters into a contract with them to set out the accreditation functions to be delivered and the associated reporting and funding arrangements. If the National Board decides on a committee, these matters are covered in terms of reference.

New accreditation agreements and terms of reference are in place for the next five years from 1 July 2019. They provide a contemporary framework for addressing key accreditation issues such as cultural safety, safety and quality, reducing regulatory burden and duplication, multi-profession collaboration to achieve greater consistency and meet evolving health care needs, and strengthened governance, accountability and transparency. They also include principles for funding and fee setting and new key performance indicators to track progress on priority accreditation issues.

These agreements and terms of reference help address accreditation issues that will contribute to improving public protection as well as providing increased transparency and accountability.

Increased public confidence in the effective and efficient regulation of health practitioners

We cannot take trust for granted

Our work to help build trust continued to be a focus, as it is integral to:

• public confidence in regulated health practitioners
• professional standards being met by registered health practitioners, and
• confidence of the regulated health professions in the National Boards and AHPRA.

Part of ensuring accountability for the trust others place in AHPRA and the National Boards is understanding their experiences and perceptions of us and what we do. The views of consumers, practitioners and stakeholders were tested through commissioned social research, with the aim of measuring how these change over time. Knowing more about levels of awareness, understanding and interest in our work helps us improve how we engage.

One example of improving how people experience interacting with us, particularly during a notification, included developing the Let’s talk about it video series, featuring real stories from practitioners who have been through a notification.

Amendments to our legislation in February 2019 changed the approach to how practitioners who are treating other registered health practitioners are required to notify concerns about public safety. These changes to mandatory reporting requirements will start in 2019/20 and will apply in all states and territories except Western Australia. The laws exist to protect the public and to ensure health practitioners can seek help for their health concerns when they need it.

Penalties for a number of offences increased from 1 July 2019. They now include possible custodial sentences of up to three years’ imprisonment. AHPRA welcomed these changes as they strengthen the action we can take and are a strong deterrent to anyone tempted to claim to be a registered health practitioner when they are not.

Increased public benefit from the use of our data for practitioner regulation, health workforce planning and research

Health workforce survey

Each year at renewal, a survey is completed by registered health practitioners to collect critical demographic information about Australia’s health practitioner workforce. This year, 96.5% of practitioners responded to the survey at renewal. AHPRA has liaised with the Australian Department of Health (DoH) to facilitate the secure and timely transfer of survey data and to resolve any issues with data quality. The DoH-published workforce data analyses for all professions regulated by the National Scheme, including profession-specific fact sheets and high-level workforce summaries. You can find these workforce data on the Health Workforce Data website.

Developing our taxonomy

AHPRA is conducting a literature review to identify international best practice for regulatory taxonomies to help guide further improvements in managing and analysing National Scheme notifications data. A clearly defined taxonomy can represent often complex notifications data in a simple and logical fashion. This in turn affects: data transparency and data sharing; capacity to understand system-wide problems and regulatory effectiveness; and accuracy of the data collected.

Using predictive analytics

AHPRA has started a project to explore how data analytics can be used to predict the likelihood of notification outcomes. This will support regulatory decision-making.

Improved access to healthcare through our contribution to a more sustainable health workforce

Addressing health inequity and racism

AHPRA, the National Boards and accreditation authorities have been working with Aboriginal and Torres Strait Islander health sector leaders and organisations on how to support health equity for Aboriginal and Torres Strait Islander Peoples. This is our ongoing commitment to do our part in helping to eradicate racism from the health system.

Led by the National Scheme’s Aboriginal and Torres Strait Islander Health Strategy Group (Strategy Group), this work includes:

• partnering with the National Health Leadership Forum, comprising leaders from Australia’s Aboriginal and Torres Strait Islander health peak sector, to develop and consult on a baseline definition of cultural safety for the National Scheme, noting that it is inextricably linked to patient safety and must be defined by Aboriginal and Torres Strait Islander Peoples. A draft definition went to public consultation in April and May, and is expected to be finalised in 2019
• implementing high-quality cultural safety training for all AHPRA staff, Board and committee members with a view to helping us be more culturally safe in our work. The training will also be made available to all accreditation authorities in the National Scheme. AHPRA undertook a tender process to appoint a provider for cultural safety training, which is expected to start rolling out from late 2019
• recommending and advocating change to the National Law to ensure consistency in cultural safety for Aboriginal and Torres Strait Islander Peoples, including adding both a principle and an objective supporting increased participation by Aboriginal and Torres Strait Islander people on Boards, committees and accreditation authorities through proactive advertising and engagement campaigns and advocating for greater representation. Four National Board appointments, four National Board committee and panel appointments, and one state, territory and regional board appointment were made to people identifying as Aboriginal and/or Torres Strait Islander, and
• attracting and retaining Aboriginal and Torres Strait Islander staff members.

This work is the first phase of a planned five-year strategy which will be finalised in 2019/20. Updates and strategy group communiqués are published on the AHPRA website.

Reconciliation Action Plan

We successfully implemented most of the initiatives in our first Reconciliation Action Plan (RAP), including developing Acknowledgment of Country information for each office; encouraging that an acknowledgement be given at the start of formal meetings and raising awareness with staff about our work to support health equity. RAP working groups, set up in all of our offices, lead local engagement with staff and Aboriginal and Torres Strait Islander communities, organisations and businesses. All offices celebrated National Reconciliation Week and NAIDOC Week, including hosting film nights, attending historical walks and exhibitions, inviting Aboriginal and Torres Strait Islander health professionals and Elders to talk with staff, and procuring goods and services from local Aboriginal and Torres Strait Islander businesses.