Notifications

Each year, we make changes to our notification process to improve its timeliness, quality and experience.

Our new risk-assessment approach was implemented across all professions

We’ve expanded the set of information that we consider when deciding how to approach a practitioner who is the subject of a notification. We evaluate a practitioner’s overall regulatory history when a notification prompts us to risk-assess the practitioner. We consider practice context and setting information. 

Our work as a regulator supports and takes account of the professionalism of individual practitioners and clinical governance protections that support safety and quality in healthcare. How an individual practitioner, or an organisation they work for, responds to poor patient experiences or safety concerns can be powerful tools in preventing future risk to the public. 

When we contact practitioners who are the subject of a notification, we are looking for safe, professional responses to incidents, events or experiences. 

When we identify patterns of concerns, or more serious isolated concerns about an individual practitioner, the responses of their employers are taken into account. 

Safe, professional responses by practitioners and their employers help us to ensure future protection of the public. Safe, professional practitioners, engaged by safe health services, benefit all patients and the broader community. 

Clinical advisors available for all professions

We have recruited practitioners from all professions to join our existing clinical advisor network, including a team of medical advisors. We recognise that a strong understanding of how health services are delivered safely is vital to our work. These registered health practitioners work alongside our regulatory staff to identify concerns or issues, understand risk, interpret clinical matters and reference profession-specific guides, standards and codes. Clinical input is accessed at various times when managing a notification. 

Adding these clinical advisors means we now employ clinicians for every profession covered by our scheme.

Three-year check-up since the chaperone review

We engaged Professor Ron Paterson to review the changes we have made over the past three years to manage sexual boundary notifications since his original review in 2017. 

Professor Paterson found that: 

• nearly all 28 recommendations of the 2017 chaperone review report have been fully implemented 
• the changes made by Ahpra and the Medical Board of Australia have been wide and deep. The impact of implementing the recommendations has been profound in terms of how notifications of alleged sexual abuse are dealt with by regulators. 

For Ahpra’s response accepting all recommendations and the report see Three years on: changes in regulatory practice since Independent review of the use of chaperones to protect patients in Australia.

Policy direction from COAG Health Council

Ahpra started implementing COAG Health Council’s Policy direction 2019-1: Paramountcy of public protection when administering the National Scheme. The policy direction provides a clear mandate to Ahpra and the National Boards to prioritise public protection; to protect the public and prevent harm, paying attention to the needs of vulnerable people.

Timeliness

We continue to aim to reduce the time to complete notifications. As a measure of the time that it takes us to manage notifications overall, we improved our timeliness:

• we reduced the average time to complete notifications by 10 days from 187 days to 177 days 
• we completed the majority (71.6%) of notifications in less than six months; this is an improvement on previous years (68.2% in 2018/19 and 64.5% in 2017/18)
• the average age of open notifications also reduced from 226 to 209 days. 

We saw a slight increase in: 

• the proportion of notifications that have been open for longer than 12 months from 13.7% to 15.4%. 

Surveying notifiers and practitioners

Since 2016, we have been asking notifiers and practitioners to tell us about their experience of the notifications process. This year, we received 1,858 responses to our post-notifications surveys, 60% of which were from practitioners. We know that some key things matter to both notifiers and practitioners: ease of finding information, knowing who to contact, receiving regular updates and having clear reasons for decisions. We use the survey data to inform improvements we need to make and to track whether changes have actually delivered improved experiences. In addition, we interviewed a small number of notifiers and practitioners to capture an end-to-end, detailed understanding about their experience of the process. 

As a result of earlier feedback from practitioners that they would have benefited greatly from hearing the voice of other practitioners who have gone through the notifications process, Ahpra launched the second first-person practitioner experience video Putting it in perspective: a practitioner’s notification experience. 

Equipping our people with improved IT 

We made significant investments in IT hardware and software through 2019/20, to enable our notification teams to be more productive. 

We developed a tool that enables us to more easily show our staff a single practitioner view of a practitioner’s total regulatory history. 

We have automated production of information to support efficient management and decision-making and reduce manual effort.

Changes to the mandatory notification laws

Treating practitioners are registered health practitioners who treat other health practitioners as patients. The mandatory requirements for treating health practitioners to make notifications under the National Law changed in all states and territories excluding Western Australia. These legislative amendments increase the threshold for when a treating practitioner must make a mandatory notification about another health practitioner. 

The threshold for a treating practitioner to report a concern about impairment, intoxication and/or a departure from professional standards has been raised. The threshold is now reached when there is a substantial risk of harm to the public. The changes were introduced to give practitioners the confidence to seek help from a treating health practitioner if they need it to manage their own health. 

To help practitioners understand the changes, we launched a public awareness campaign in advance of the changes starting on 1 March. The aim of the campaign was to provide greater clarity to treating practitioners on when they need to make a mandatory notification to ensure public safety, and to encourage practitioners to seek help for their health and wellbeing without fear they’ll be the subject of an unnecessary mandatory notification. Alongside the revised guidelines, we developed and launched new resources to explain the changes. This included three new videos, case studies, expanded FAQs, a podcast and a myth-busting guide. Media stories featured in a range of publications and we ran a social media campaign across our main channels (Facebook, Twitter, Instagram and LinkedIn) to raise awareness when the changes came into effect. 

The guidelines and resources are available on all National Boards' websites and the Ahpra website.

We established a mandatory notification information service (hotline) so that people with mandatory reporting obligations can have de-identified discussions about potential mandatory notifications with Ahpra staff with significant experience in managing them. These calls help people to determine when a practitioner’s health, conduct or performance might reach the new threshold and when it is not likely to do so.

Response to independent research on vexatious complaints

In 2018, new independent research was published finding that there is more risk from people not reporting concerns than from making dubious complaints. Ahpra commissioned the research from the School of Population and Global Health, The University of Melbourne, to find out the size of the problem of vexatious complaints and identify how they can be better prevented, identified and managed. Ahpra initiated this work in line with its commitment to the Senate Affairs Reference Committee into the medical complaints process in Australia. The report found that the number of vexatious complaints dealt with in Australia and internationally is very small, less than 1%, but they have a big effect on the practitioner involved. 

The Medical Board has toughened its Code of conduct on vexatious complaints. Other National Boards are also doing this. These clear benchmarks will enable further action against a practitioner who makes complaints purely to damage someone. Ahpra staff have received training to better recognise vexatious notifications early and work is underway on further guidance.

Review of confidentiality safeguards for notifiers

Ahpra started acting on the recommendations of the independent review by the National Health Practitioner Ombudsman and Privacy Commissioner (NHPOPC) of the confidentiality safeguards in place for individuals making notifications about registered health practitioners. 

The Review of confidentiality safeguards for people making notifications about health practitioners was conducted at our request following the conviction of a general practitioner for the attempted murder of a pharmacist who had made a notification about his prescribing practices. 

It examined our current management of confidential and anonymous notifications and whether there were ways to strengthen safeguards to ensure safety of notifiers. The review found that our practices for managing confidentiality and anonymity were reasonable and consistent with the practices of other regulators internationally. 

Ahpra has accepted all 10 recommendations for improvements and outlined a timeline to adopt the changes. 

This year, Ahpra received more notifications than we have ever received in a single year. A total of 10,236 notifications were received, 9.6% more than the number we received in 2018/19 (9,338 notifications), and 40.7% more than in 2017/18 (7,276 notifications). 

The larger pool of practitioners because of the creation of the pandemic response sub-register has reduced the percentage of the registrant base with notifications made about them to 1.6%. 

Without the practitioners on the pandemic response sub-register, the percentage of all registered health practitioners with notifications made about them was 1.7%. For comparison, this percentage was 1.7% in 2018/19 and 1.6% in 2017/18. 

We receive most notifications (51.6%) from patients, their families and friends, and other members of the public. 

We receive notifications (17.4%) from health practitioners and employers. 

The number of notifications (44) we received about students decreased. The proportion of the notifications that resulted in conditions or undertakings affecting the student’s registration decreased by 3.7% compared to last year.

Standards of clinical care continue to be the primary issue notified. The proportion of notifications that were made about this issue decreased by 2.5%.

Ahpra received 1,107 mandatory notifications. This is 4.0% less (46 notifications) than in 2018/19. 

• 29.4% of the mandatory notifications received were about medical practitioners, the same as in 2018/19 
• 48.1% of the mandatory notifications received were about nurses, down slightly from 49.1% in 2018/19 
• The number of mandatory notifications related to impairment increased from 236 in 2018/19 to 322 in 2019/20. 

Mandatory notifications made up 10.8% of notifications received. 

Immediate action was considered on 291 occasions for mandatory notifications. Immediate action was taken 230 times. 

The serious nature of mandatory notifications is reflected in the outcomes of closed matters. Regulatory action was taken more often in response to mandatory notifications compared to other notifications, with 35.8% of mandatory notifications completed resulting in a form of regulatory action being taken in relation to a practitioner’s registration (compared to 14.0% for all notification categories). Regulatory action taken in relation to mandatory notifications is down from 38.2% in 2018/19.

National Boards took immediate action on 580 occasions, which is 51.0% (196) more than in 2018/19. The proportion of notifications where immediate action was taken was 5.7% of the notifications received. 

Although the increase in immediate action taken this year looks high, it is similar in proportion to immediate action taken as a percentage of notifications received in previous years (4.1% in 2018/19 and 5.7% in 2017/18). 

Of the 464 sexual boundary notifications received by Ahpra in 2019/20, 84.1% were made about practitioners in three professions: medical practitioners (45.0%), nurses (21.6%) and psychologists (17.5%). As a proportion of all notifications received about registered health practitioners in each profession this equates to 3.6% of medical practitioner notifications, 5.3% of nurse notifications and 11.0% of psychologist notifications. 

Immediate action was considered on 158 occasions for sexual boundary notifications. Immediate action was taken 109 times, with 12 matters yet to be decided at 30 June. Of the immediate action taken about sexual boundary notifications, 52.3% of the action taken related to medical practitioners, 9.2% to nurses and 17.4% to psychologists. 

Sexual boundary notifications resulted in a higher proportion of suspensions through immediate action (37.3% of matters) compared to all notifications (27.2% of matters). As an outcome of immediate action, National Boards imposed conditions in 22.8% of sexual boundary matters, accepted an undertaking in 8.2% of matters and after initially considering it, decided not to take immediate action in relation to 23.4% of matters. 

The serious nature of sexual boundary notifications is reflected in the outcomes of closed matters. Action was taken more often in sexual boundary matters compared to other notifications with 10.9% of all sexual boundary matters resulting in a caution or reprimand (compared to 4.6% of all notifications categories), 11.5% resulting in conditions being imposed on the practitioner’s registration (compared to 7.3%) and 10.9% resulting in the practitioner’s registration being surrendered, suspended or cancelled (compared to 0.9%). 

The higher risk profile of sexual boundary matters is also reflected in the stage of closure when compared to all notifications with 14.2% of sexual boundary matters closed after referral to a tribunal (compared to 1.6% for all notification categories), 45.3% closed following an investigation (compared to 21.7%) and 38.8% closed at the assessment stage (compared to 73.6%).

Assessment

National Boards closed 70.2% of notifications following an assessment. These notifications did not require an investigation. This is up from 68.1% in 2018/19. In 92.4% of cases closed following an assessment, a National Board decided to take no further action; or decided that a complaint raised with a health complaints entity (HCE) would be retained by an HCE. In 7.4% of cases closed following an assessment, a National Board took regulatory action by: referring the notification to another body, cautioning the practitioner, imposing conditions on registration, or accepting an undertaking. In one case a practitioner surrendered their registration. 

Investigation

The proportion of notifications that progressed from assessment to investigation because a National Board required more information before it could make an informed decision was 26.2%, less than in previous years (29.6% in 2018/19 and 33.1% in 2017/18). 

In all, 2,881 notifications about 2,271 practitioners were referred for investigation. Deciding to investigate does not indicate that an allegation made in a notification is true. 

We completed 3.5% more notifications than in 2018/19. This represents the highest number of closures (9,291) since the start of the National Scheme. 

Of the notifications that were closed, 14.0% resulted in regulatory action about a practitioner and 16.5% were referred to another body; or to a health complaints entity for consideration of early resolution, conciliation or other complaint resolution outcome.

Both the increase in the number of notifications received and the initial slowing of assessments as we embedded our risk assessment framework contributed to an increase in average time to complete matters at assessment. We expect this to continue to improve as the risk assessment process is further embedded. 

In 2019/20, 41.8% of all notifications were closed in less than three months. The majority (71.6%) were completed in less than six months. This is an improvement on previous years (68.2% in 2018/19 and 64.5% in 2017/18).

Moving from office-based teams to working-from-home arrangements

The evolving COVID-19 pandemic left Ahpra, like many organisations, needing to continue to provide services where movement to and from our offices in each capital city was affected. 

Fortunately, during the year we had already made significant investments in IT hardware and software to help our notification teams do their work more efficiently. We were able to build on this new resource quickly by deploying portable IT equipment to all notifications staff to enable them to work from home rather than from an office. 

We equipped intake and assessment team members with ‘soft-phone platforms’ so they could continue to make and receive calls as if they were in the office, ensuring that members of the public could still make notifications verbally. 

Conducting interviews and health assessments remotely 

We have adapted the way we conduct interviews during investigations to take advantage of videoconferencing facilities. 

We adjusted our scheduling of face-to-face health assessments, using telehealth services to ensure that health assessments of practitioners could continue.