Most notifications (70.9%) are made by patients, their families and friends, and other members of the public. This was consistent with last year (71.0%).

A further 18.7% were from health practitioners and employers.

We received 2,620 confidential (we know the identity of the notifier and were asked not to disclose it) and anonymous (the notifier does not disclose any identifying information to us) notifications. This was 44.9% more than we received last year.

Improvements

Across the year we made several process improvements, including the following:

• Redesigned a webpage with clearer and more streamlined information on how to raise a concern about a health practitioner. Visits were 89% higher than in the same period last year and it has had more than 87,000 visits since launch.
• Improved engagement with notifiers through a dedicated intake team to take all new notifications. This team had more than 9,000 phone calls and more than 11,000 emails with notifiers.
• Established a team to support improved consultation with the health complaints organisations (HCOs) in each state and territory. As a result, consultations between Ahpra and the HCOs were completed an average of 7.6 days sooner than last year.
• Worked with the Medical Board of Australia and Dental Board of Australia to streamline decision making for lower-risk concerns. This has resulted in a 33-day reduction in the time taken to complete lower-risk matters.
• Certificate IV Investigator Training for staff who manage notifications to hone their investigative and case-management skills. More than 200 notifications staff have completed this program since January 2022.
• Greater support for the wellbeing of notifiers and practitioners interacting with us through promotion of profession-specific support services. An update of our support services webpage has resulted in more visits.

Experience

We seek direct feedback from notifiers and practitioners by sending them a survey when a notification is completed. This year we saw an increase in notifier and practitioner satisfaction with our processes.

• Practitioner responses reflected an increase in overall satisfaction (from 57% last year to 62% this year).
• Notifier responses reflected an increase in overall satisfaction (from 30% last year to 36% this year).

Specific to the process improvements we made in relation to lower-risk concerns, practitioners are reporting an increase in satisfaction (from 60% last year to 64% this year).

For those practitioners where we adopted a strengthening practice approach there was an increase in practitioner satisfaction (from 57% last year to 60% this year).

The work we have done to support notifiers has also had a positive impact. Notifiers whose matter resulted in no restrictions on the practitioner’s registration reported an increase in satisfaction with the process (from 25% last year to 32% this year). Where regulatory action was taken, notifiers also reported an increase in satisfaction (from 59% last year to 64% this year).

Though these rates are improving, we recognise they are low and we continue to work on several fronts to improve the experience of notifiers and practitioners.

Managing concerns

There are three types of allegations we can manage. They are that:

• a practitioner is practising their profession in an unsafe way
• a practitioner’s behaviour is placing the public at risk
• a practitioner’s ability to make safe judgements about their patients might be impaired because of their health.

The most common type of concern relates to the way a practitioner is practising their profession, including concerns about inadequate or inappropriate treatment (see Table 16).

A notification can be about more than one concern and 35.3% of notifications we received contained multiple concerns.

Not all concerns raised with us are about individuals we register or things that we can deal with. When concerns are not within our jurisdiction, we speak with the notifier about why we are not able to consider their concerns and, where appropriate, help them to seek support elsewhere.

Our case-management approach

Once we determine that a concern is within our jurisdiction to manage, we decide how it can best be managed by considering:

• the nature of the concern
• the powers or processes best suited to gathering the required information
• the likelihood that regulatory action might be needed.

Where possible, each notification is allocated to a single case manager from beginning to end.

Early determination

When a notification indicates no or low ongoing risk to patients, we consider whether it is appropriate to refer it to a health complaints organisation (HCO; also known as a health complaints entity).

There are HCOs in every state and territory. They are vital partners in ensuring that consumer complaints about health services are resolved. HCOs share the complaints they receive about registered health practitioners with Ahpra, and Ahpra shares relevant consumer complaints it receives with HCOs. Together we decide which is the most appropriate body to deal with the complaint.

A total of 2,057 notifications were retained by, or referred to, an HCO during the year. This is 18.4% of all the notifications we completed and slightly fewer than the previous year.

A further 1,841 (16.5%) did not require referral to an HCO but did not require any action from us. These were closed.

Identifying at an early point which notifications can be dealt with through early determination has significantly improved the time it takes to close notifications.

We closed:

• 50% of low-risk notifications in less than 3 months compared to 42% last year
• 88% of low-risk notifications in less than 6 months compared to 67% last year.

Strengthening practice

When a concern identifies some risk to the public, we engage with practitioners.

Our specialist teams gather information from practitioners, employers and others about a practitioner’s practice and, where required, to understand what steps have already been taken to improve it.

When this information indicates that we can rely on individual, organisational or regulatory risk controls to be confident there is no ongoing risk to the public, we can take no further action.

Around half of notifications this year were referred to the strengthening practice team and 19% of these matters were closed without any regulatory action because the practitioner demonstrated the steps they had taken to reflect on and improve their practice.

Health management

When a practitioner has a health impairment that affects their ability to practise safely, we have a role to ensure public safety. We have a specialist team that manages health-related concerns and we continue to implement changes to minimise distress for practitioners involved in our regulatory processes.

The improvements we are making have had a significant impact on timeframes. During the year, 41% of health concerns were completed within three months, compared to 39% in 2022/23 and 28% in 2021/22.

Professional standards

Behaviour by a practitioner that is substantially below the standard expected by the public or their peers, or inconsistent with the requirement to be a fit and proper person to hold registration, is investigated by the National Boards. They can refer the concerns relating to the practitioner to tribunals across the country.

This year, 235 practitioners were referred to a tribunal. This is a 1.7% increase compared with last year.

Matters referred to tribunals include allegations of sexual misconduct. Sexual misconduct notifications are included in our data on boundary violations (Table 17), which are 37.5% higher than last year. The numbers of boundary violations reported to us have been growing over recent years, and we have developed a plan of work to manage concerns specific to sexual misconduct.

Under new legislative provisions that came into effect in May 2023, the National Boards have limited discretion to decide not to refer professional misconduct matters to a tribunal. This year, Boards decided not to refer three practitioners (eight notifications) as there was no public interest in their notifications being heard by a tribunal.

Case studies

Not a ground for a notification

A patient raised concerns with us about having to wait 45 minutes to see her general practitioner. When she asked about the delay, the reception staff advised her that the doctor was delayed due to a phone consultation. The notifier cancelled her appointment and told the reception staff she would not return. She believed the doctor should have better managed their time and not made her wait in the reception area.

We acknowledged the frustrations felt by the notifier but are not able to assist with concerns about waiting times or the scheduling of appointments. We spoke with the notifier and provided her advice on seeking a resolution directly with the medical clinic. 

Referral to an HCO

A notifier advised that their regular medical practitioner had closed down their clinic. Signs on the front desk and website advised patients to contact the clinic to organise transfer of their medical records to another clinic.

The notifier had sent two emails to the clinic within a two-week period and had left at least one voice message. The notifier had received no response from the clinic and their medical records had not been transferred to their new general practitioner.

Ahpra consulted with the relevant HCO, which agreed they would help the patient to get their medical records transferred to their new clinic.

No response required

A patient raised concerns about a medical practitioner who had refused to prescribe medication for their joint pain.

The Medical Board of Australia decided that, as the practitioner had practised for over 15 years with no prior notifications, as it is best practice for medical practitioners to exercise their own professional judgement in prescribing medications, and that to refuse to prescribe is not unreasonable, a response from the practitioner was not needed. The Board decided no regulatory action was required.

Strengthening practice: Steps taken to address

The Psychology Board of Australia reviewed patient records in the course of managing a notification. It identified that the records of consultations with a patient did not appear to be adequate, contrary to parts of the code of conduct that applies to psychologists.

The practitioner agreed with the Board’s concerns and provided a copy of the professional development and supervision plan they had agreed with their employer to improve their record keeping.

The plan included completion of an education module on record keeping and regular auditing of the practitioner’s records to confirm they were compliant with the education.

The Board decided that both the practitioner and their employer had taken steps to address the concerns. They decided to close the notification without regulatory action being taken. 

Strengthening practice: Regulatory action necessary

Two notifications were received about a pharmacist. The concerns raised included failure to:

• adequately store and monitor schedule 8 medications
• follow adequate protocols for destroying schedule 8 medications
• follow documented infection control procedures while working in the pharmacy.

The practitioner had a history of notifications, which resulted in the Pharmacy Board of Australia requiring them to undertake further education in medication management.

In their response to the most recent concerns the practitioner advised they had introduced new policies and procedures within the pharmacy.

The Board noted the practitioner had taken some steps to address the concerns but felt the steps were not adequate to address the ongoing concerns about the failure to follow established protocols.

The Board imposed conditions on the practitioner’s registration requiring the practitioner to undergo mentoring with a registered pharmacist and to be subject to practice audits.

A health concern

A nurse self-notified about their recent inpatient admission following a new diagnosis of bipolar disorder. This diagnosis, if unmanaged, could affect the practitioner’s ability to practise safely.

The nurse provided a letter from their employer that demonstrated support for them to return to work and a letter from a treating mental health clinician outlining the steps the nurse had taken to ensure a safe return to practice.

The Nursing and Midwifery Board of Australia noted that the nurse had taken time off work, sought treatment and was engaging with their employer and treating practitioner to ensure they were practising safely. The Board decided no further regulatory action was required.

Serious conduct concerns

Eight notifications were received across a two-year period about a medical practitioner. The concerns included:

• engaging in a personal relationship with a patient and their children, including making personal visits to their home, providing financial assistance and, when the patient ceased contact with the practitioner, engaging in threatening and intimidating behaviour
• threatening and intimidating other health practitioners
• disclosing personal information to another patient in voicemails and texts, despite the patient not responding to or engaging in the correspondence
• billing Medicare for services not provided to patients and other inappropriate billing practices.

The Medical Board of Australia decided to take immediate action to suspend the practitioner’s registration. Several months later, the practitioner surrendered their registration.

After an investigation, the Board decided that the concerns amounted to professional misconduct and required referral to a tribunal.

Mandatory notifications

In certain circumstances, practitioners and employers must tell us if they think a practitioner’s conduct, performance or health places their patients at risk.

Mandatory notifications made up 10.4% of notifications received.

We received 1,165 mandatory notifications, 15.2% more than last year (see Table 18).

• 43.8% (510) were about nurses.
• 29.4% (343) were about medical practitioners.

Most mandatory notifications received related to the practitioner suffering from a possible impairment (41.4%), followed by departure from professional standards (39.0%), sexual misconduct (10.6%) and intoxication (9.0%).

Immediate action

When we are worried that there is a serious risk to public safety, or it is otherwise in the public interest, we can take immediate action while we make further enquiries.

Table 19 shows that immediate action was taken 413 times (Ahpra data only). This is up 23.3% from last year, largely due to the increase in notifications received.

Being the subject of an immediate action by a Board can be extremely daunting. We only use our immediate action powers when:

• there is a serious risk to the public 
• we believe a practitioner’s registration has been improperly obtained because they have provided misleading information when applying for registration
• the practitioner holds registration outside Australia and that registration has been suspended or cancelled by another regulator
• there is a clear and compelling reason to restrict or suspend the practitioner’s registration based on public interest reasons (including, for example, that a practitioner has been charged with, or convicted of, serious criminal behaviour).

Students

We look into concerns raised about students who are studying to become registered health practitioners.

There are limited grounds for making notifications about students: a notification can be made about their criminal history, an impairment, or if they have not complied with a restriction on their registration.

There is only one ground for a mandatory notification – an education provider needs to tell us when they have formed a reasonable belief that a student has an impairment that may place a patient at substantial risk of harm when the student is doing clinical training.

• 20 notifications were made to Ahpra about students; this is up from 16 last year.
• Only one notification resulted in restrictions affecting a student’s registration, compared to four last year.

Timeframes

The changes we have made to how we manage concerns are helping us to close more notifications sooner.

Nearly 80% of all closed notifications were closed within six months of receipt: 45.1% (5,029) within three months of receipt, and a further 34.5% (3,849) three to six months from receipt. There was a significant improvement in timeframes for closure: compared with last year, there were 22.7% more notifications closed within three months and 67.8% more notifications closed in three to six months.

The number of notifications open for more than 12 months fell by 20.6% compared with last year, excluding those being managed through a panel or tribunal process (see Table 20).

Many of the higher-risk notifications referred to a tribunal or panel involve complex and long-running investigations. They are often required to await the outcome of other legal or investigative processes such as police investigations or coronial inquiries. Of the notifications completed this year, 195 spent time awaiting the outcome of an external process and the average time waiting for the external processes was 344 days.

Once a matter has been referred to a panel or tribunal, we rely in part on the timeliness of external parties, such as the tribunal itself or the practitioner’s representatives. Once a matter was referred, it took on average 683 days for it to be finalised by the tribunal.

Outcomes

There are several possible outcomes for notifications (see Tables 21 and 22).

Restrictions on the practice of a health practitioner can only be imposed if they are necessary to ensure that health services are safe and of an appropriate quality. Actions taken by practitioners, workplaces and other regulators or entities can contribute to an outcome of ‘no further regulatory action’.

Of notifications closed:

• 2.0% resulted in the practitioner losing their registration or being disqualified from applying for registration
• 10.9% required regulatory action that allowed the practitioner to continue practising while ensuring they were doing so safely
• 87.1% resulted in no further regulatory action.

The Office of the Health Ombudsman (OHO) receives notifications about registered and unregistered practitioners in Queensland.

Ahpra and OHO work together to manage Queensland notifications. Together we responded to 4,080 notifications, and 42.6% were referred to Ahpra and the National Boards to manage (Table 24).

OHO closed 1,509 notifications about registered health practitioners following joint consideration, after agreeing with Ahpra that they did not require regulatory action. A further 833 notifications were retained by OHO for further action (for example, investigation or other complaints-resolution processes).

The average time to complete the joint consideration process was 7.5 days. This is consistent with the timeframes for last year. For matters that were retained by OHO to close, notifiers and practitioners were advised of the outcome significantly faster than before joint consideration was mandated in December 2021.

Our Cosmetic Surgery Enforcement Unit has experienced investigators to manage all cosmetic surgery hotline where members of the public and practitioners can make confidential or anonymous notifications. The hotline received 514 calls this year.

Ahpra received 199 notifications related to cosmetic practice from all sources. At 30 June, we were managing 299 cosmetic practice notifications related to 102 practitioners. More than half of these notifications (174) related to only 14 practitioners. These 14 practitioners are no longer practising or have restrictions on their registration while we investigate. Three practitioners have been referred to tribunals for alleged professional misconduct.

Information flow between regulators

Collaborating with other regulators improves everyone’s information as we work together to reduce risks in the healthcare system. The Cosmetic Surgery Enforcement Unit meets regularly with relevant state and territory health facility licensing units, such as the Victorian Department of Health Private Hospitals Unit, and co-regulators, such as the Office of the Health Ombudsman in Queensland.

Licensing units visit practices that offer cosmetic surgery to confirm compliance, and during those visits, they may identify concerns about individual health practitioners that they can raise with Ahpra. Similarly, Ahpra’s investigations into complaints about health practitioners may identify concerns about licensed facilities, which can be shared with licensing units. Meeting regularly helps ensure that we are sharing information effectively.

Case studies: Cosmetic surgery notifications

Regulatory action required

Following a site visit by a facilities licensing unit, we were advised of concerns about a medical practitioner. Medical records indicated that the practitioner may have been performing surgery at facilities that did not hold the appropriate licence for the procedures. Patients had also indicated that they were unhappy with their surgical outcomes.

Ahpra investigated the concerns and the Medical Board of Australia decided to impose conditions requiring the practitioner to undertake a period of mentoring by another practitioner.

No regulatory action required

We received concerns about a medical practitioner who had performed abdominoplasty surgery. The concerns related to alleged poor infection control practices when responding to a post-operative complication. Our investigation included an interview with the notifier, review of the patient records and additional information from the practitioner.

Although the patient was unhappy with the outcome, the investigation identified that the practitioner had demonstrated adequate aseptic technique and made adequate arrangements for patient care. We shared the concerns regarding infection control with the facilities licensing unit so that they could assess any additional concerns with the facility.