19,777 (2.5%) registered health practitioners have no principal place of practice (includes overseas-based registrants).
In 2020 we marked 10 years of national health practitioner regulation in Australia and the establishment of the National Registration and Accreditation Scheme, Ahpra and the National Boards. No one could have predicted that this important milestone would occur in the middle of a pandemic that has turned our lives upside down. The COVID-19 pandemic left us with no choice about the need to engage, navigate, adapt and respond quickly.
2020 has shown us all how much we rely on health practitioners at the frontline to keep us all safe. Ahpra and National Boards have worked closely with accreditation authorities, governments and our partners to ensure we play our part fully in supporting these health practitioners and the wider health system response to COVID-19.
In particular, we have worked to ensure that our health services could access the qualified and experienced health practitioners they need. We quickly established a pandemic sub-register to respond to surge workforce needs across the health system which saw more than 35,000 health practitioners return to registration. We also worked with National Boards to streamline our regulatory requirements and processes wherever possible, while still ensuring patient safety. Acknowledging that students are the registered practitioners of the future, accreditation authorities, National Boards and Ahpra moved quickly to clarify how existing accreditation standards enabled flexibility in the ways clinical education requirements could be achieved for students. We ensured national agreement to principles for clinical education during the pandemic.
Our annual report highlights the impact of COVID-19 on our regulatory work and how we have adapted. Ahpra became a virtual organisation within weeks. Board meetings were held on digital meeting platforms and all Ahpra staff started to work from home, many for the first time. Having well-established relationships with our stakeholders, we worked hard to keep registered health practitioners, governments and other stakeholders updated about our work and other developments.
In a big, busy year other achievements and activities also stand out.
There are now 801,659 registered health practitioners in Australia, across 16 professions.
We continued to improve our timelines for registering new practitioners including an extensive campaign to ensure around 39,000 new graduate applications for registration were managed smoothly.
New and modernised accreditation agreements with external accreditation authorities came into effect and National Boards established new terms of reference for accreditation committees.
The number of notifications Ahpra received increased by 9.6% on the previous year. Although we reduced the average time to complete notifications, there was an increase in the number of open notifications. The timeliness of our notifications process is an ongoing focus.
We implemented changes to the National Law for reporting of mandatory notifications by treating practitioners and carried out an extensive education campaign.
We initiated an independent review of reforms to our management of sexual boundary notifications, and this year, for the first time, we also report on this important area of our work.
Our work towards eliminating racism from the health system continued, in particular through partnerships with Aboriginal and Torres Strait Islander health experts and representatives. It’s an ambitious and important goal that requires commitment and hard work from multiple agencies and individuals across the National Scheme. We deeply appreciate the commitment and work of our Aboriginal and Torres Strait Islander Health Strategy Group.
In its 10th year the value of the National Registration and Accreditation Scheme has been demonstrated, particularly as we have been able to respond to the uncertainties and new challenges of COVID-19. In a year where we had to quickly make unprecedented changes, National Board and committee members, accreditation authorities and Ahpra staff have worked exceptionally well in an environment of great uncertainty. For this we are deeply grateful, and we sincerely thank everyone for their efforts. We will continue to keep learning and adapting.
Ultimately, our purpose is to ensure safe and professional registered health practitioners for all Australians. At the end of an extraordinary year, we acknowledge and thank all health practitioners who have responded with such professionalism and commitment to keep us all safe and recognise the students who are our health practitioners of the future.
Mr Martin Fletcher
Chief Executive Officer, Ahpra
Ms Gill Callister PSM
Co-convenor, Forum of National Registration and Accreditation Chairs
Agency Management Committee, Ahpra
Mr Brett Simmonds
Pharmacy Board of Australia
Examples of our work are provided for each outcome.
Ahpra has worked with National Boards to embed our risk-based approach to notifications to progressively improve regulatory effectiveness and notifier and practitioner experience. We have continued to develop and implement our risk framework with a focus on patient and public safety. The information we receive in a notification is our starting point and tells us about the notifier’s concerns. As part of how we assess a notification we also consider information about the types of activities the practitioner does, the practice setting and patients and consumers the practitioner works with, and what we know about the practitioner’s registration history.
Our risk approach is also focused on reducing the chances of similar events or concerns occurring again. So, we ask practitioners about the things they have done to manage the risks and we want to understand what health services or practices have done to respond to the concerns raised. When the concerns are serious, or more needs to be done to protect the public, Boards take regulatory action including imposing conditions or restrictions to manage risk. A number of national notification assessment committees have been established during this year, to support early assessment and response to risk.
Trust is fundamental to our work as a regulator. We received over 1,858 responses to our post-notifications surveys, 60% of which were from practitioners. This feedback from notifiers and practitioners helps us improve our notifications processes. We also received over 8,000 responses to our community surveys of health practitioners and members of the community about their awareness and understanding of our work, and their levels of trust and confidence in us.
The Pharmacy Board of Australia’s registration examination (written and oral) provides assurance that pharmacy graduates during internship (interns), and pharmacists who are returning to practice after an absence, are competent to practise. The Board and the Australian Pharmacy Council jointly developed the Intern Year Blueprint (IYB) as part of the Board’s long-standing work program on intern assessment quality improvement. The IYB provides a direct link between learning objectives and assessment methods. The Board is working on a revised assessment process to implement the most appropriate and effective assessment for each competency that pharmacists must meet to practise.
Following a review of the current arrangements, the Chinese Medicine Board of Australia is developing new written and clinical regulatory examinations that are consistent, reliable and valid to assess internationally qualified Chinese medicine applicants. The Board has partnered with education providers and individual subject matter experts to develop and implement the regulatory examinations.
The Nursing and Midwifery Board of Australia (NMBA) and Ahpra have reformed the process for internationally qualified nurses and midwives (IQNMs) wanting to apply for registration in Australia. The new process is evidence-based and ensures that all nurses and midwives are required to meet the same standards, no matter where they gained their qualifications.
IQNMs can now use an online self-check tool for their qualifications and in most cases to receive immediate advice on how it compares to an NMBA-approved program of study, as well as what steps they’ll need to take to be eligible to apply for registration.
All IQNMs who continue towards registration in Australia now complete an interactive orientation program to support their transition to our healthcare context. IQNMs who hold relevant, but not substantially equivalent, qualifications (and who meet the mandatory registration standards) are assessed according to an outcomes-based model, which consists of a multiple-choice question exam and objective structured clinical exam.
We all have a part to play in ensuring culturally safe healthcare and addressing the gap in health outcomes for Aboriginal and Torres Strait Islander Peoples.
Implementing cultural safety is as much about individual practice as it is about changing systemic and institutional responses, whether that be practice standards, policy or legislation.
Our work on doing our part to eliminate racism from the health system continues through the Aboriginal and Torres Strait Islander health and cultural safety strategy 2020–2025. Focusing on embedding cultural safety and increasing participation of, and access by, Aboriginal and Torres Strait Islander Peoples in the National Scheme, the strategy was launched in February. It was developed in partnership with Aboriginal and Torres Strait Islander health experts and representatives from the National Scheme through our Aboriginal and Torres Strait Islander Health Strategy Group.
The National Boards set the national standards that all registered health practitioners must meet to become and remain registered. The Boards are progressively integrating cultural safety requirements into these standards, meaning that the community can be clear about what they can expect from their practitioner. It also means that if a practitioner fails to provide culturally safe care, a Board may take regulatory action.
Ahpra collects unique national data about the registered health professions. These data can be de-identified and used for a range of approved purposes that can benefit the public.
Examples include contributing to the evidence base for the regulatory standards, codes and guidelines set by National Boards; building an evidence base for regulatory approaches, such as audits of advertising compliance to establish a baseline level of compliance and help to target interventions; and highlighting issues for professions/cohorts of practitioners to reinforce Boards’ expectations of professional practice. We also supply public information to health services about their registered practitioner employees through our Practitioner Information Exchange (PIE) and data extract subscription services. This helps employers to stay current with public information from the national register.
Our data can also be used to inform workforce policy, planning and initiatives. For example, we have provided data securely for use in public benefit activities, such as SafeScript and National Real Time Prescription Monitoring. We are supporting health workforce planning by providing national health workforce surveys to practitioners when they renew their registration. We use data to inform health workforce initiatives most recently about the numbers of registrants who could potentially support a surge workforce during the COVID-19 pandemic.
Our data are also used for approved research purposes. When our data are used for research purposes these are often published as research outcomes in academic journals. Our data also support innovation and learning. We are exploring how to give feedback to accreditation authorities and education providers about any issues emerging in notifications about practitioners in the early years post-graduation. And we are part of an international collaboration exploring how new data analytic approaches and technologies can support regulatory decision-making and enhance the effectiveness of our regulatory work.
Practitioner health is vitally important not only for the individual's wellbeing but also for quality patient care.
The Medical Board of Australia funds a national network of doctors’ health services that provide health advisory and referral services for doctors and medical students. Doctors’ Health Services Pty Ltd (DrHS) (known as DRS4DRS) was established in 2016 as a subsidiary of the Australian Medical Association and is run independently from the Board to enable doctors across Australia to access confidential advice and support 24/7.
Nurse and Midwife Support funded by the Nursing and Midwifery Board of Australia also started in 2016. This initiative ensures that nurses, midwives and nursing and midwifery students anywhere in Australia can access confidential advice and referral on issues about their health. The service provides education, advice and referral and raises awareness about health issues for nurses, midwives, students, education providers, employers and concerned others. It is independently run and operated by Turning Point (part of Eastern Health in Victoria) allowing practitioners to access free and confidential advice 24/7.
Following the success of these services, the Dental Board of Australia started developing a national 24/7 telephone and online service to support all dental practitioners and students. The development of Dental Practitioner Support was fast-tracked during the COVID-19 pandemic to give support, advice and assistance at a time of uncertainty and change surrounding providing dental care. The project team was able to complete the first phase of the service (telehealth and website) within 12 weeks, allowing the service to be launched on 6 July 2020.
Ahpra launched its podcast series this year, with new episodes released regularly. Focused on topics that are relevant to both patients and practitioners, each episode features a conversation with one or more health practitioners. The goal of this series is to share knowledge and interesting facts and observations in a way that is easier to access for busy people.