Registration– how registration works

• 744,437 registered health practitioners in Australia, across 16 professions (up 5.9% from 2017/18)
• 6,744 health practitioners identify as Aboriginal and/or Torres Strait Islander
• 41,696 (5.9%) more registrants than last year
• 93,079 new applications for registration received – 26.2% increase since last year
• 36,468 new applications were from new graduates, including nearly 20,000 applying for registration as a nurse
• 17,323 paramedics registered in a newly regulated profession
• 99.2% of all eligible practitioners renewed their registration online
• 96,124 domestic and international criminal history checks made
• 4,214 applications for registration refused because they did not meet suitability/eligibility requirements (4.5% of all new applications)
• 5,414 new audits of compliance with registration standards initiated
• Time to decide the outcome of an application: median time of 8 days (up from 7 in 2017/18), average of 24 days (up from 23 days in 2017/18)
• While the overall performance of registration was strong, at times there were significant delays in assessing applications. We have invested additional resources and changed our internal reporting so we can respond to delays earlier.

Registered practitioners

Of the registrant base, 97.9% hold some form of practising registration. There are 73,375 dental practitioners, medical practitioners and podiatrists in Australia who hold specialist registration in an approved specialty (9.9% of total registrants). In addition, 20,853 practitioners hold endorsement for particular practices (2.8% of total registrants). Each profession has different categories of registration.

Paramedics

On 1 December 2018 the Paramedicine Board of Australia registered paramedics for the first time under the National Scheme. At 30 June 2019, 17,323 paramedics are registered in Australia.

Nurses and midwives

From 1 December 2018, the National Law formally recognised nursing and midwifery as two separate professions rather than a single profession. The professions continue to be regulated by the Nursing and Midwifery Board of Australia. At 30 June 2019, 383,509 nurses and 5,727 midwives are registered in Australia, with an additional 27,707 people holding dual registration as both a nurse and a midwife.

Aboriginal and Torres Strait Islander workforce

This year, Aboriginal and/or Torres Strait Islander participation across the regulated health professions was 1%, which is consistent with data collected in previous years but well short of the 3.3% Aboriginal and Torres Strait Islander representation in the general population. Increasing participation in the registered health workforce is one of the goals of the Aboriginal and Torres Strait Islander Health Strategy.

All registrants in the Aboriginal and Torres Strait Islander Health Practice profession identified as being Aboriginal and/or Torres Strait Islander (it is a requirement for registration in that profession). The professions with the second highest percentage representation were nursing and midwifery, which had 1.2% of their workforce identifying as Aboriginal and/or Torres Strait Islander.

Student registration

Under the National Law, a National Board must decide whether students who are enrolled in an approved program of study or doing clinical training should be registered. A student does not need to apply for registration, as education providers are responsible for arranging the registration of all their students with AHPRA. The student register is not made public. All National Boards have decided to register students, except for the Psychology Board of Australia, which requires provisional registration.

The accuracy of the student registration information AHPRA receives depends on the quality of data supplied to us by education providers. We continue to work with more than 130 education institutions to improve the exchange of information and identify the status of students to ensure that information is accurate, particularly about students who may have completed, or ceased, their study.

New applications

This year, AHPRA received 93,079 applications, up 26.2% from 2017/18. The significant increase in applications received this year is due to the receipt of 18,457 applications for registration as a paramedic. Of all practitioners applying for registration, 89,543 applicants (96.2%) sought practising registration. There was a 1.5% decrease in practitioners applying for non-practising registration when compared with last year.

To improve the registration experience of applicants, where possible, the primary source of documents submitted by an applicant to prove their identity is verified using the Document Verification Service. This service confirms that the details on the document match records held by the government authority that issued the document. Previously, manual intervention was required by a staff member once assessment began on the application. The Document Verification Service also contributed to streamlining the criminal history checks for over 50% of the applications received.

Examinations

The following examinations to support registration requirements were held:

• Pharmacy Board of Australia: AHPRA administered the oral examination (practice) in October 2018, February 2019 and June 2019. Examiners assessed 1,696 candidates.
• Psychology Board of Australia: 726 candidates sat the national psychology examination. This exam is delivered at test centres in each capital city on a quarterly basis.
• Medical Radiation Practice Board of Australia: 47 candidates sat the national exam.

Criminal history checks

AHPRA received the results of 96,124 domestic and international criminal record checks of practitioners and/or applicants for registration this year, an increase of 22.6% since 2017/18).

Overall, 5.4% of the results indicated that the applicant had a disclosable court outcome. Usually an applicant is granted registration if the nature of an individual’s disclosable court outcome has little relevance to their ability to practise safely and competently.

Outcomes for applications finalised

There were 92,142 decisions made about applications for registration. Of these, 5.8% resulted in conditions being imposed on a practitioner’s registration, or a refusal of registration, in the public interest.

Renewing registration

Once on the register, health practitioners must apply to renew their registration each year and be reassessed against registration requirements. There are three annual renewal periods:

• nurses and midwives must apply by 31 May
• most medical practitioners by 30 September, and
• other health practitioners by 30 November.

AHPRA renewed registration for 665,310 practitioners across Australia. As with new applications for registration, National Boards may impose conditions on a practitioner’s registration or refuse renewal entirely.

Online renewal was once again widely accepted across professions, with 99.2% of all eligible practitioners renewing their registration online (19,958 more practitioners than last year, an increase of 0.2%). This is attributed to both renewal campaign improvements and the take-up by new graduates who engage with online registration processes when they are first registered. The high rate of online renewals enhances the practitioner experience and reduces costs associated with mailing out hard-copy reminders. Work is ongoing for both online applications and online renewals. We are working both to improve our digital 'front door' and make it easier for practitioners to use our online services.

Practitioner audits

Auditing compliance

Since we began conducting audits in 2012, most practitioners audited have been found to comply with registration standards. About 1.6% of those audited elected to surrender their registration, failed to renew their registration or changed their registration type to non-practising. Analysis of the circumstances of those practitioners demonstrates two clear groups:

• practitioners residing overseas, and
• those no longer practising but maintaining registration.

On a random schedule, AHPRA initiated 5,414 new audits for practitioners across 12 professions, excluding paramedics due to their recent inclusion in the National Scheme. Nearly all National Boards audited compliance with one or more of the registration standards. We closed 5,275 audits, while 2,029 remain open and subject to ongoing management.

Of the completed audits, nearly 93% of practitioners were found to be in full compliance with the registration standards being audited. We analysed the audit outcomes to better understand why non-compliance occurs. In some professions, practitioners were not always fully aware of specific requirements for continuing professional development. This is being addressed through increased communication about what is required to comply with professional development standards.

How our audit process works

Each time a practitioner applies to renew their registration they must make a declaration that they have met the standards for their profession. During an audit, a practitioner is required to provide evidence to support the declarations made in the previous year’s renewal of registration.

The standards that may be audited are:

• continuing professional development
• recency of
• professional indemnity insurance arrangements, and
• criminal history.

All Boards have adopted an educational approach to conducting audits. Practitioners who are found to have not quite met the registration standard, but are able to provide evidence of achieving full compliance during the audit period, are managed through education to achieve full compliance.

Audit outcomes

• 92.6% compliant: fully compliant with the registration standards
• 3.4% compliant (education): compliant through education in one or more standards
• 1.1% non-compliant: non-compliant with one or more standards
• 2.9% no audit action required by National Board: during the audit period, 1.6% of practitioners changed their registration type to non-practising, elected to surrender their registration or failed to renew their registration; and 1.3% of practitioners were referred to a co-regulatory jurisdiction to manage the matter due to suspected non-compliance in a jurisdiction where a National Board does not have power to take action outside an application for registration or renewal of registration

Non-compliant with standards

When an audit finds that a practitioner has not met the requirements of the registration standards, all Boards follow an approach that aims to work with the practitioner to ensure compliance before the next renewal period. This may include formally cautioning the practitioner about the importance of complying with registration standards.

All matters that involve issuing a caution or placing conditions on a registration are subject to a ‘show cause’ process. This process alerts the practitioner of the intended action and gives them an opportunity to respond before a decision is made.

Of the practitioners found to be non-compliant, 75.0% of cases resulted in some form of regulatory action being taken (such as cautions and imposition of conditions). For 23.0%, the result was no further action. In these matters, further information was received from the practitioner that identified that there was no risk to the public that would warrant regulatory action being taken. With the remaining 2.0%, information was being sought from the practitioner and a decision is yet to be made.