Background
The recommendations made are as follows:
- Proposed reforms to the National Law to regulate the use of the title ‘surgeon’ should undergo broad consultation and be progressed as a priority.
- AHPRA and national boards should introduce a more flexible re-registration model across professions that would enable health practitioners to more easily re-enter the workforce after a period of absence.
- The Ministerial Council should consider whether currently unregulated professions including social workers, aged care workers and personal care workers should be included in the National Regulation and Accreditation Scheme.
- AHPRA should undertake urgent action in relation to supervisory failures and ensure that individual cases are not indicative of a systemic failure.
- All supervisors should have a direct point of contact within AHPRA and that this point of contact should be made available prior to any contractual arrangements being made, as well as throughout the entire supervisory period.
- AHPRA should review and simplify its published information about notifications and other complaint pathways.
- AHPRA and the national boards should undertake education and awareness activities, explaining notifications and other complaints pathways, with health practices and services.
- The Ministerial Council should consider reform to the National Law to enable health practices and services to be referred low risk notifications to be dealt with in the first instance, and AHPRA and the national boards should have discretion to refuse these matters on that ground.
- Notifications accepted by AHPRA should be limited to clinical issues relating to patient safety.
- AHPRA and the national boards should consider improving the notifications data it collects and publishes to better understand where protracted timeframes are experienced and the reasons for any delays.
- AHPRA and the national boards should undertake an analysis of the cause of protracted notifications timeframes and identify ways to further improve timeliness.
- AHPRA and the national boards should develop and publish a strategy for identifying systemic issues and working with stakeholders to proactively address areas of concern.
- The Ministerial Council should remove the current mandatory reporting requirements and align the approach with the Western Australian model.
- AHPRA and the national boards should develop and fund a comprehensive strategy for providing tailored support for the notifications process to practitioners in all regulated professions.
Some key issues and findings of the report are considered below.
Time frames
The timeliness of the notification process was a common issue raised during the inquiry. This was also raised in the committee’s previous inquiries. According to the Australian Medical Association (AMA), the number of notifications taking longer than 3 to 6 months to close is concerning:
As more than 80% of notifications for medical practitioners result in no further action from the [Medical Board of Australia], the AMA would expect to see this timeframe falling … Ideally the AMA would support no investigation taking longer than 2 years other than in exceptional circumstances.
It was noted that delays are particularly common in complex and serious matters, and that this was having a detrimental impact on patient care, and the wellbeing of the health practitioner subject to the notification.
Low risk or frivolous notifications
The committee heard that low-risk notifications that are closed with no further action are taking up too much of AHPRA’s limited resources. The majority of complaints about medical practitioners—71.1 per cent in 2019-20—were closed with no further action. These are the lowest-risk notifications, but they consume significant resources.
The committee heard that high numbers of ‘meritless’ or ‘frivolous’ claims made to APHRA are not being identified and closed early in the process. It was also suggested that some of the notifications that AHPRA receives and progresses do not raise issues that legitimately risk public safety.
Lack of transparency
Concerns were raised about a lack of transparency in the notifications process. For example, the Australian Psychological Society suggested the decision framework explaining how AHPRA deals with matters and the timeframes that can be expected is not clear and transparent.
The committee heard that AHPRA’s communication with notifiers and health practitioners during the notifications process is inadequate. Issues included difficulty contacting AHPRA, inconsistent information, and delays in communication throughout the process.
Procedural fairness
Many health practitioners reported feeling a presumption of guilt in the way they are notified of a complaint. One submitter referred to it as a ‘guilty until proven innocent approach’.
In addition, a number of inquiry participants said health practitioners have insufficient time to provide responses. According to the RANZCP, the time practitioners are given to respond to a concern ‘may not allow enough time for practitioners to get legal advice and to consider all the options’.
The committee heard that when immediate action is taken, the national boards need to consider the sometimes severe impact on health consumers— including suicide—if practitioners are not even given time to make alternative arrangements for their patients.
The Australian Association of Psychologists said another concern was that the process is entirely in writing and by email, which makes it difficult and time-consuming.
Supervised practice conditions
Where conditions are placed on practitioners with immediate effect, witnesses told the committee that this can have unintended negative consequences for patient outcomes and continuity of care in rural and regional areas.
The committee heard that it is sometimes hard to find supervisors that are appropriately qualified, and that this can result in a practitioner not being able to practice. Several submissions commented on the time that it took for nominated supervisors to be approved by AHPRA.
The committee heard evidence of particular instances where AHPRA has delayed approving a nominating supervisor, and not communicated clearly the supervisor’s responsibilities. The committee was told that the process engaged by AHPRA lacked natural justice and demonstrated failures within AHPRA’s internal communications, which resulted in the supervisor themselves being pursued by AHPRA for failing to provide adequate supervision.
Systemic issues
It was suggested that there needs to be improved responses to systemic factors underpinning the significant numbers of notifications. According to one witness:
… the model of professional regulation we have under our national law focuses on the individual and what they should have done. It misses the chance to look holistically at improving patient care and workplace culture. Blaming an individual is neither fair nor helpful to them. To ensure patient safety, professional wellbeing and good healthcare culture, we say there needs to be a better approach.
Impact of notifications
The committee acknowledged that there is a significant amount of stress involved in the notifications process for practitioners. This is unduly exacerbated by a range of issues with the process, including how regulators communicate with parties, a lack of understanding and transparency about the process, and of course, because of protracted timeframes and delays.
The committee was strongly of the view that AHPRA and the national boards must continue to prioritise reforms that will improve health practitioners’ and notifiers experience with the process.
To facilitate this improvement, the committee believed all registered health practitioners subject to a notification should have the right to request to meet in-person with any official undertaking a preliminary assessment or subsequent investigation.
The evidence provided to the committee on the mental health risks within the medical profession, and the need to encourage and support practitioners to seek out help when they are unwell, was particularly compelling and concerning.
Read the full report here
