Compliance

Many practitioners find restrictions difficult, but they are a way of allowing practitioners to provide healthcare while keeping the public safe. 

Restrictions can be put in place during the initial application or renewal process; for example, when a practitioner is: 

• returning to practice after an absence 
• changing their scope of practice 
• not fully meeting the eligibility requirements or other registration standards. 

A National Board may decide that a practitioner can be registered and provide healthcare while the shortfall is addressed through supervision, additional education, mentoring or limiting scope of practice. 

Restrictions can also be used in response to a notification where a Board believes that: 

• a practitioner has demonstrated performance or conduct that is unsatisfactory 
• a practitioner has or may have a health impairment that may affect public safety 
• it is in the public interest. 

For example, a practitioner alleged to have entered into an inappropriate sexual relationship with a patient may be prohibited from seeing patients of that gender while the investigation is underway, under the process of immediate action. A practitioner with an alcohol-use disorder may be required to conduct supervised breath tests before each shift. 

Where a Board imposes the requirements, we use the term conditions. Sometimes a practitioner is aware of what they need to do and provides an enforceable undertaking that they will meet additional requirements. We use the term restrictions to include both conditions and undertakings.

We gather information to monitor health practitioners and students with restrictions on their registration or whose registration has been suspended or cancelled, and to assess compliance with restrictions. The types of information we gather are listed in the restrictions. Monitoring plans are used to guide our monitoring and compliance activities, and to help practitioners understand what is required of them and how to comply with the restrictions. 

For example, a practitioner subject to supervision restrictions is required to find a potential supervisor and nominate them for Board approval. The monitoring plan shows the practitioner when the supervision plan and forms are due, how to access them from our website, and where to submit the information. After we receive the supervision plan and the Board approves the supervisor, we receive routine reports from the supervisor to confirm that the practitioner is progressing as expected. Once the practitioner has achieved the required hours of supervision or the required standard of competence, they can apply to have the restrictions reviewed. We seek a final report from the supervisor, and the Board considers removal of the restrictions. 

We have a National Restrictions Library and we use the same wording about restrictions for similar cases. This ensures that the restrictions are achieving the desired outcome, are understood by practitioners and that we can develop consistent monitoring plans. 

Where a practitioner does not do what the restrictions require, we first seek an explanation from them. The Board may choose to take additional regulatory action, such as a caution or additional restrictions, to ensure the public remains protected.

We also monitor a group of practitioners who are not permitted to practise because they have had their registration cancelled or suspended, have surrendered their registration or are restricted from practising. 

• Tribunals have the power to cancel a practitioner's registration – these practitioners must reapply for registration after an imposed minimum period of time. 
• Tribunals and panels can suspend a practitioner's registration – these practitioners have their registration reinstated at the completion of the period of suspension. 
• Boards are able to suspend a practitioner through an immediate action while awaiting completion of an investigation or an assessment. 
• Boards can impose conditions or accept undertakings that restrict the practitioner from practising until some other requirement is met. 
• Some practitioners who are subject to a notification may surrender their registration or request a non-practising form of registration. 

We monitor these practitioners to confirm they are not practising. We do this by communicating with former employers, conducting site visits, checking advertising and ensuring that the original issues are reviewed if the practitioner subsequently applies for practising registration.

We recognise that having to comply with restrictions can be confusing and stressful for practitioners. We published additional guidance to help practitioners understand our processes, including information on how to ask the Board to change or remove restrictions, and on the evidence that a Board is likely to need to help in making the right decision. 

Supervision is our most common restriction category, so we have provided extra advice on the expectations of supervisors and supervisees. For most professions we have a common Supervised practice framework with extensive guidance and templates. 

We have also published a frequently asked questions page on our website and continue to improve the language in our correspondence to make it clear to practitioners what they need to do next.

Each restriction on a practitioner’s registration is assigned a restriction category. Where a practitioner is subject to multiple restrictions they will have multiple restriction categories – this results in a greater number of total restrictions on practitioners than total cases being monitored. 

The top 10 restriction categories by volume being monitored by Ahpra at 30 June contained 6,314 restrictions. 

• 65.9% (4,162) of restrictions in the top 10 restriction categories were imposed following assessment of an application for registration or renewal of registration. 
• 34.1% (2,152) of the restrictions in the top 10 restriction categories were imposed because of a finding made by a National Board, panel or tribunal about a practitioner’s health, performance or conduct. 

We close a monitoring case when the restrictions are no longer required. 

When a practitioner has completed the requirements of the restrictions they can apply to the Board to remove the restrictions. The case is then closed. 

When a practitioner's registration is not renewed we close the case but retain important information to ensure that we consider the practitioner’s regulatory history for any subsequent applications. 

During the year we created 2,129 new monitoring cases and closed 2,037, leading to an increase in overall cases. Of the cases we closed: 

• 1,325 cases were closed because the restrictions were removed 
• 651 were closed because the practitioner was no longer registered 
• 61 were closed for other reasons. 

Assessment of complaints 

We assessed 499 advertising complaints. Of these: 

• 70 were complaints about corporate entities or unregistered persons, or assessed as serious-risk complaints 
• 429 were lower risk complaints about registered health practitioners and assessed under the Advertising compliance and enforcement strategy: 
  • 299 were assessed as lower risk potential breaches (157 in 2020/21, 412 in 2019/20); this represents a return towards pre-COVID numbers 
  • 130 cases had no breach identified. 
• A further 15 enquiries were awaiting initial assessment. 

When we identify that advertising by registered health practitioners is not compliant with the Guidelines for advertising a regulated health service, we initially provide practitioners with an opportunity to correct their advertising and only take further regulatory action when this is unsuccessful. 

Sometimes practitioners do not realise what they are not allowed to claim when they advertise. We provide information to help them. An example would be where a chiropractor claims that treatment can boost immune functions but there is no acceptable evidence to validate this claim. Removal of the claim would result in closure of the complaint. 

Where practitioners fail to correct their advertising, we propose to take regulatory action by imposing conditions on the practitioner’s registration. There were 97 instances of practitioners correcting their advertising following a formal proposal to take regulatory action, and no instances where we needed to impose conditions. 

See page 85 for action taken about advertising that is unlawful. 

Proactive advertising strategy 

Work continued our two-year-long advertising audit of a random sample of 1,231 practitioners across 13 health professions. 

We search for any advertising by each practitioner across the internet, including social media, and assess a sample of the content we find against our guidelines for advertising a regulated health service. This audit supplements our complaints-based approach to advertising breaches and helps us understand the rates of advertising in each profession along with the frequency of issues identified and any common themes. We use the information to improve our guidelines and website, and our engagement with practitioners.