AHPRA – Working to bring the national scheme to life

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There are now more than 600,000 health practitioners registered to practise in Australia – or more than one in 20 working Australians. That’s a huge number of direct relationships with individual practitioners, as well as the stakeholders Australian Health Practitioner Registration Agency (AHPRA) works with every day to bring the National Registration and Accreditation Scheme (National Scheme) to life. AHPRA CEO Martin Fletcher provides an update on the progress of the National Scheme.

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By law, the core purpose of the National Scheme is to protect the public and facilitate access to safe, flexible and sustainable health service. While we have many different roles and responsibilities, most of what we do boils down to patient safety.
Our core roles include registering practitioners who are suitably trained and qualified to provide safe healthcare, investigating concerns (or complaints) about practitioners’ performance, conduct or health (these are known as notifications) and managing the implications for registration of health practitioners as necessary as a result. The National Boards set the standards and policies for each profession that all registered health practitioners must meet. Other important roles relate to the accreditation of training and education for health practitioners.
How do we compare internationally?
Introducing the National Scheme was one of the most ambitious reforms of health practitioner regulation implemented anywhere in the world. Only in the UK is there a serious comparison with multi-professional regulation – and there are significant differences between the National Scheme and the UK Health Care Professions Council (HCPC).
The National Scheme is governed by a nationally consistent law passed by each state and territory parliament. There is oversight by a Ministerial Council made up of all Australia’s health ministers.
By early 2014, National Scheme regulated 602,000 health practitioners across 14 National Boards. In 2010 the scheme regulated: chiropractors, dental practitioners, medical practitioners, nurses and midwives, optometrists, osteopaths, pharmacists, physiotherapists, podiatrists, psychologists. Four more health professions joined the National Scheme in July 2012: Aboriginal and Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners and occupational therapists. This brought more than 40,000 additional practitioners into national regulation, many of whom were registered for the first time.
In comparison, the HCPC regulates 16 professions with a total of about 304,000 registrants in the UK. There are only five professions common to both the HCPC and the National Scheme in Australia.
Many international regulators and governments have their eyes firmly fixed on Australia’s National Scheme, and our ability to set consistent standards for professions nationally and in some cases across professions, is the envy of many.
What do the Boards expect of health practitioners?
National Boards set the standards and policies for each profession that all registered health practitioners must meet. These include a mix of registration standards, as well as codes and guidelines that set out the Boards expectations of practitioners and against which the Boards hold practitioners to account. Boards also issue policies on specific issues to guide practitioners.
The Australian Health Practitioner Regulation Agency (AHPRA) is responsible for implementing the National Scheme in partnership with the National Boards. Each National Board has a separate website, accessible through the AHPRA website, which publishes important information for the community and practitioners.
What’s new in regulation?
March 2014 marks a very important milestone in the National Scheme, when revised codes and guidelines take effect. From this month, revised advertising guidelines and mandatory reporting guidelines that are common across boards come into force. The Boards have revised and reissued their codes of conduct – which set out the Boards’ expectations of practitioners – and there is also a new social media policy that details what practitioners can and cannot do when using social media.
The National Boards consulted widely with the community and the professions in revising the codes and guidelines and developing the new social media policy. The codes and guidelines replace the versions that have been in place for the last three years. The revisions focus on making it easier for practitioners to understand their obligations and for the community to understand what is expected of health practitioners.
The Social media policy is new. It does not change the basic obligations that practitioners must meet under existing codes and guidelines, but extends these obligations into social media. The basic principle is that the same expectations apply to practitioner’s behaviour wherever it occurs – online or in person. If you’re a social media user and a health practitioner, it’s important to be aware of what your board expects.
Part of Australia’s safety and quality framework
AHPRA supports the National Boards in their work with independent accreditation councils and committees to develop standards to ensure graduating students are suitably qualified and skilled to apply to register as health practitioners.
More widely, the National Scheme is an essential part of ensuring the safety and quality of healthcare across Australia. The public is protected by clear national standards which ensure that only suitably trained and qualified practitioners are registered to practise.
National registration means a practitioner can use a protected title that consumers identify and understand. This protected title assures the public that health services are being delivered by a qualified person who has met and maintains a national standard regardless of where they practice. This includes the rigorous assessment of overseas-trained practitioners.
An important milestone in our work occurred in January this year when a person in Western Australia was ordered to pay $20,000 in fines for offences under the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law). This marked the first successful prosecution of a person for ‘holding out’ – or using a protected title and claiming to be a registered health practitioner when they were not. In this case, a woman pleaded guilty using the title ‘psychologist’ and claiming to be a registered psychologist when she had not been registered for a number of years, in breach of the National Law.
Transparency and accountability
One of the most important features of the National Scheme is the National Register – an online, searchable database that shows the current registration status of every health practitioner registered to practise in Australia. The register is published on the AHPRA website. If a person does not appear on the register, they are not registered to practise in a regulated health profession in Australia.
Health practitioners must renew their registration to practise annually. Each time they renew, they must make declarations that they comply with a range of registration standards that have been developed by the National Board that registers them.
Practitioner audits are another important way that the National Boards and AHPRA protect the public, by regularly checking these declarations for a random sample of practitioners. Audits help to make sure that practitioners are meeting the standards and provide important assurance to the community and the National Boards. In 2014, audits are becoming routine business in the National Scheme.
On the horizon
It’s been a busy three years bringing the National Scheme to life, and 2014 is showing no signs of changing pace. During the next 12 months, there will be a scheduled three year review of the National Scheme, as governments look at what is working well and seek opportunities to make it work even better. The Victorian Parliament is expected to this month release its report after an inquiry into our work, and a new model of health complaints management will start in Queensland in July.

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“Many international regulators and governments have their eyes firmly fixed on Australia’s National Scheme, and our ability to set consistent standards for professions nationally and in some cases across professions, is the envy of many.”

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As ever, we have a long list of improvements detailed in our business plan, all designed to improve the service, consistency and capability our work in delivering the National Scheme.
More than anything, we look forward to working with the community, the professions and our other stakeholders in government, and the education and health sectors more widely, to keep improving what we do and making sure all our work is focused on our core roles of protecting the public and facilitating access to health services.
Martin Fletcher
Martin Fletcher is the inaugural Chief Executive Officer of the Australian Health Practitioner Regulation Agency which implements the National Registration and Accreditation Scheme in partnership with 14 National Health Practitioner Boards.