Compliance

We monitor five streams:

• conduct
• health
• performance
• prohibited practitioner/student
• suitability/eligibility.

When someone applies for registration but doesn’t quite meet the standards, Boards consider whether there are additional things that practitioner can do, or if there are additional checks and balances that can be put in place so that they can practise safely.

The most common example is when a practitioner returns from an extended period away from the profession. Each profession has a recency of practice standard; for example, doctors must have practised for four weeks in the past year or 12 weeks in the past three years. An experienced doctor who has not practised for more than three years will need to provide a re-entry to practice plan and have an approved supervisor. This approach allows the practitioner to get back into practice while ensuring that patients receive safe and appropriate treatment. We review information from the practitioner and their supervisor to confirm that the arrangements continue to be appropriate and we remove the restrictions when they are no longer required.

The same is true when we receive notifications about a practitioner. Only a small number of notifications are so serious that the practitioner is not permitted to practise. Where a Board needs additional assurance, it may impose restrictions on the practitioner’s registration. For example, a practitioner who has demonstrated poor record keeping may be required to attend additional education regarding record keeping and may then have their records audited to ensure that the education was successful. During the period of these restrictions, the practitioner is still permitted to practise while the education and audit ensure their practice is improving. Our role is to confirm that the practitioner nominates an appropriate education course, and to review the course completion and audit reports.

Where a Board imposes the requirements, we use the term conditions. In other cases, a practitioner is aware of what they need to do and provides an enforceable undertaking that they will meet additional requirements. We use the term restrictions to include both conditions and undertakings.

We recognise that having to comply with restrictions can be confusing and stressful for practitioners. We publish additional guidance to help practitioners understand our processes.

How we monitor

We gather information to monitor health practitioners and students with restrictions on their registration or whose registration has been suspended or cancelled. Monitoring plans guide our monitoring and compliance activities, and help practitioners understand what is required of them.

We have a National Restrictions Library and we use the same wording about restrictions for similar cases. This ensures that the restrictions are achieving the desired outcome, are understood by practitioners and that we develop consistent monitoring plans.

Where a practitioner does not do what the restrictions require, we first seek an explanation from them. The Board that placed the restrictions may choose to take additional action, such as a caution or further restrictions, to ensure the public remains protected.

Prohibited practitioners

We also monitor practitioners who are not permitted to practise because they have had their registration cancelled or suspended, have surrendered their registration or are restricted from practising.

• Tribunals have the power to cancel a practitioner’s registration – these practitioners must reapply for registration after an imposed minimum period of time.
• Tribunals and panels can suspend a practitioner’s registration – these practitioners have their registration reinstated at the completion of the period of suspension.
• Boards are able to suspend a practitioner through an immediate action while awaiting completion of an investigation or an assessment.
• Boards can impose conditions or accept undertakings that restrict the practitioner from practising until some other requirement is met.
• Some practitioners who are subject to a notification may surrender their registration or request a non-practising form of registration.

Most common restrictions

Each restriction on a practitioner’s registration is assigned a restriction category. Where a practitioner is subject to multiple restrictions they will have multiple restriction categories – this results in a greater total number of restrictions on practitioners than total cases being monitored.

The top 10 restriction categories by volume being monitored by Ahpra at 30 June contained 5,840 restrictions.

• 69.4% (4,051) of restrictions in the top 10 restriction categories were imposed following assessment of an application for registration or renewal of registration.
• 30.6% (1,789) of the restrictions in the top 10 restriction categories were imposed because of a finding made by a National Board, panel or tribunal about a practitioner’s health, performance or conduct.

Outcomes from monitoring cases

When a practitioner has completed the requirements, they can apply to the Board to remove the restrictions. The case is closed when the Board agrees that restrictions are no longer needed.

When we close the case, we retain important information to ensure that we consider the practitioner’s regulatory history for any subsequent applications.

During the year, we created 2,208 new monitoring cases and closed 2,170, leading to an increase in overall cases. Of the cases we closed:

• 1,429 cases were closed because the restrictions were removed
• 702 were closed because the practitioner was no longer registered
• 39 were closed for other reasons, such as transferring NSW practitioners to the HPCA for monitoring.

We assessed 380 complaints about advertising. Of these:

• 96 were complaints about corporate entities or unregistered persons, or assessed as serious-risk complaints
• 284 were lower-risk complaints about registered health practitioners and assessed under the Advertising compliance and enforcement strategy:
  • 187 were assessed as lower-risk potential breaches
  • 97 cases had no breach identified.

When we identify that advertising by registered health practitioners is not compliant with the Guidelines for advertising a regulated health service, we initially provide practitioners with an opportunity to correct their advertising and only take further regulatory action when this is unsuccessful.

Sometimes practitioners do not realise what they are not allowed to claim when they advertise. We provide information to help them. Where practitioners fail to correct their advertising, Boards may impose a caution or conditions on the practitioner’s registration. Ahpra may also prosecute advertisers for breaching the National Law.

Proactive advertising audit

We completed a two-year-long advertising audit of a random sample of 1,242 practitioners across 13 health professions. We reviewed all online advertising by each of these practitioners, including on social media, and assessed a sample of this content against our advertising guidelines. Of the audited practitioners, we identified 529 (42.6%) who were advertising and 213 (17.1%) who had non-compliant advertising. Two of these cases were assessed as high risk and resolved using our normal advertising complaints procedures. The most common theme across professions was inappropriate use of terminology related to specialist registration.

This audit supplements our complaints-based approach to advertising breaches and helps us understand the rates of advertising in each profession along with the frequency of issues identified and any common themes. We are using this information to improve our guidelines for practitioners and the information on our website, as well as publishing articles in each Board’s newsletter to encourage improved compliance.

Cosmetic surgery audit

We also conducted a targeted audit of advertising about cosmetic surgery. We searched for common terminology related to cosmetic surgery and identified practitioners and practices with the highest search results or the most followers on social media. This represents the advertising most likely to be viewed by consumers. We reviewed a sample of content on 69 practitioner or practice websites and social media to identify non-compliance and found 65 cases (94.2%) of non-compliant advertising. Practitioners were provided with details and an opportunity to address our concerns. The majority addressed the concerns without the need for further regulatory action. Where the concerns were not addressed, or the practitioner had been subject to prior advertising concerns, the Medical Board of Australia considered regulatory action and imposed five cautions and two conditions.

The most common concerns identified were:

• practitioners reposting patient social media imagery with no comparative ‘before’ photos
• trivialising the risk and recovery associated with cosmetic surgery procedures
• inappropriate use of terminology related to specialist registration
• use of testimonials
• content that was potentially misleading or may cause unreasonable expectations of benefits.

Case study: Cosmetic surgery advertising

We reviewed a doctor’s cosmetic surgery advertising on their website, YouTube, Instagram and Facebook. We identified issues such as:

• claims of permanent results (misleading)
• claims to improve self-confidence and self-esteem (misleading)
• videos of patients talking about their experiences (testimonial)
• engaging with patient comments on social media regarding their outcomes (testimonial)
• stock imagery rather than genuine ‘before’ and ‘after’ photos (unreasonable expectation)
• limited information about risks and recovery (unreasonable expectation).

The doctor addressed some of the concerns; however, subsequent audits identified further breaches. After several attempts to work with the practitioner to resolve remaining issues, the Medical Board of Australia imposed conditions requiring education about the advertising guidelines and restricted the practitioner’s advertising. When the practitioner provided evidence of completing the education and a reflective report identifying what they had learned, the Board removed the conditions.

In response to concerning reports of dangerous conduct by some medical practitioners in the cosmetics sector, the final report of the Independent review of the regulation of medical practitioners who perform cosmetic surgery was released on 1 September. Ahpra and the Medical Board accepted all recommendations in the report. An independent Cosmetic Surgery Oversight Group chaired by Ms Delia Rickard, former Deputy Commissioner of the Australian Competition and Consumer Commission (ACCC), was established to provide assurance to the Ahpra Board that the recommendations are being implemented.

Enforcement unit

We established a Cosmetic Surgery Enforcement Unit with experienced investigators to manage all cosmetic surgery complaints, and we established a dedicated cosmetic surgery hotline available to members of the public and practitioners. Callers can make confidential or anonymous notifications.

From 5 September to 30 June, the hotline received 315 calls. Over the same period, Ahpra received 157 notifications related to cosmetic practice from all sources. At 30 June, Ahpra was managing 268 cosmetic practice notifications related to 90 health practitioners. More than half of these notifications (177) related to only 15 practitioners. These practitioners are no longer practising or are subject to restrictions on their registration while our investigations are being completed.

We began a targeted audit of advertising and are working closely with social media experts to monitor emerging trends on platforms such as Instagram. A new cosmetic surgery hub was developed on our website. The hotline and hub were supported by proactive communications and promoted with paid advertising.

Targeted intervention

The Medical Board’s National Special Issues Committee dealt with cosmetic practice matters and worked closely with the Cosmetic Surgery Enforcement Unit. This provides a consistent group of decision makers dealing with notifications and advertising breaches related to cosmetic practice.

The Medical Board consulted and released updated guidelines for medical practitioners who perform cosmetic surgery and procedures, and guidelines for medical practitioners who advertise cosmetic surgery. These guidelines were supported by FAQs and visual examples on our website. They took effect on 1 July 2023 and will inform future advertising audits and the assessment of future cosmetic surgery notifications.

Working with others

We worked with other agencies to enhance cooperation and reduce potential gaps. We established regular meetings to examine cosmetic surgery risks and issues with state and territory health facility licensing units, the Therapeutic Goods Administration, the Office of the Health Ombudsman, the Health Care Complaints Commission and the Medical Council of NSW.

We provided input into an Australian Government public education campaign that is jointly funded by federal, state and territory governments.

The Australian Commission on Safety and Quality in Health Care drafted and consulted on safety, quality and licensing standards for cosmetic surgery. Ahpra and the Medical Board have representatives on the Project Advisory Committee and Executive Steering Committee for these projects.

Case studies: cosmetic surgery notifications

Immediate action required

We received multiple concerns about liposuction performed by a medical practitioner with general registration. The concerns were raised by patients and through a mandatory notification from another practitioner who performed revision surgery. Concerns included inadequate consent practices for interstate patients, removing amounts of fat that were inconsistent with patient expectations and potentially in breach of state licensing requirements, use of sedation that was inconsistent with the extent of the surgery, and inadequate post-operative care. While investigations were underway, the Medical Board of Australia decided to take immediate action to protect public health and safety by imposing conditions requiring the practitioner to be supervised by another practitioner for liposuction procedures.

No regulatory action required

We received concerns about a specialist plastic surgeon who performed breast reduction surgery. The patient reported that the surgery resulted in their breasts being uneven, misaligned and scarred. Ahpra’s investigation identified that the practitioner provided appropriate information to the patient regarding risks and potential outcomes of the surgery, including asymmetry and scarring. The patient’s outcomes were reviewed by another specialist plastic surgeon who concluded that they represented a reasonable outcome. The practitioner provided the patient with a partial refund in response to their dissatisfaction. The Board decided that no regulatory action was required.