Chiropractic Board of Australia

2015/16 Annual Report Summary

At a glance: Regulating chiropractors in 2015/16

This annual report summary provides a snapshot of our work regulating more than 5,100 registered chiropractors in the financial year to 30 June 2016.

A more detailed profile, encompassing data relating to all 14 National Boards in Australia, is published in AHPRA and the National Boards’ 2015/16 annual report

About this report

This report provides a profession-specific view of the Chiropractic Board of Australia’s work to manage risk to the public and regulate the profession in the public interest in 2015/16.

The Board has worked in close partnership with the Australian Health Practitioner Regulation Agency (AHPRA) to provide all Australians with a safe, qualified and competent workforce under the National Registration and Accreditation Scheme (the National Scheme).

Information included in this report is drawn from the data published in the 2015/16 annual report by AHPRA and the National Boards, and was correct as at 30 June 2016.

Whenever possible, historical data are provided to show trends over time, as well as comparisons between states and territories.

For a wider context, and to compare the profession against national data from all 14 professions regulated by National Boards under the National Scheme, this report should be read in conjunction with the 2015/16 annual report. You can download the report.

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Message from the Chair, Chiropractic Board of Australia

Ensuring the public receives safe, competent and ethical care from chiropractors is the guiding principle embedded in all aspects of the work of the Chiropractic Board of Australia.

In addition to setting the ethical and professional standards for the profession, the facilitation of practitioner understanding and compliance with these standards is a critical element of the Board’s work. The Board welcomes engagement with, and feedback from, all stakeholders in relation to its activities.

The Board is fortunate to have excellent support from its regulatory partners in carrying out its important work, particularly AHPRA, the Council on Chiropractic Education Australasia and coregulators (such as the Health Professional Councils Authority in New South Wales [NSW], the Chiropractic Council of NSW and the Office of the Health Ombudsman in Queensland).

The Board is committed to furthering the objectives of the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law), in the public interest.

Members of the Board in 2015/16

• Dr Wayne Minter AM (Chair)
• Dr Michael Badham
• Ms Anne Burgess
• Dr Phillip Donato OAM
• Mr Frank Ederle (from 31 August 2015)
• Dr Graham Goodreid
• Ms Barbara Kent
• Dr Amanda-Jane Kimpton (until 30 August 2015)
• Dr Mark McEwan (until 30 August 2015)
• Dr Anna Ryan (from 31 August 2015)
• Ms Margaret Wolf (until 30 August 2015)
• Mrs Ailsa Wood (from 31 August 2015)

During 2015/16, the Board was supported by Executive Officer Paul Fisher.

More information about the work of the Board, including codes, guidelines and information on registration standards, can be found on the Board website.

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Message from the AHPRA CEO and the Agency Management Committee Chair

Since the National Scheme began six years ago, AHPRA has worked in partnership with the National Boards to ensure that the community has access to a safe and competent health workforce across 14 registered health professions Australia-wide.

We rely on the expertise and insights of the National Boards to make decisions about the 657,621 health practitioners currently registered in Australia in the interests of the Australian public. It’s a role that Board members commit to with dedication and passion, and the community can be assured that its safety is always their number-one priority.

As at 30 June 2016, there were 5,167 registered chiropractors. Overseeing the registration and regulation of the profession is the Chiropractic Board of Australia, with valuable input from professional and community groups.

The Board upholds the values of the National Scheme by taking a risk-based approach to regulatory decision-making and policy implementation, with a continued focus on finding ways to improve effectiveness, efficiencies and timeliness.

In 2015/16, the Board worked tirelessly to ensure chiropractors understand their requirements around professional standards, particularly in regards to advertising their services. This included direct engagement with practitioners via surveys to ensure their unique challenges were taken into account when providing regulatory guidance.

We’d like to thank Board members for their continued commitment to ensuring a competent and flexible health workforce that meets the current and future health needs of the community.

We look forward to continuing to work in partnership with the Board.

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Year in review: Chiropractic Board of Australia

A recurring theme to the Board’s work this year has been our commitment to ensuring the public has access to safe and competent health services from registered chiropractors.

Following Ministerial approval, AHPRA and the Board successfully published and implemented revised registration standards for professional indemnity insurance arrangements, recency of practice and continuing professional development. The Board started scheduled reviews of its registration standards for limited registration in the public interest, and limited registration for teaching and research.

An important Board initiative throughout 2015/16 was the development of protocols to analyse notifications data. This is to help the Board gain a better understanding of the trends and areas of risk in notifications brought to the Board’s attention.

The Board issued strong, clear messages to the profession outlining its expectations around professional standards, and it continues to work with practitioners and stakeholder groups to enhance their understanding of the requirements and expectations of the Board and the National Law, particularly in the areas of continuing professional development and advertising.

We worked closely with AHPRA to develop and refine the processes for managing offences under the National Law, particularly in relation to advertising, to ensure matters that pose the highest risk to the health and safety of the public are dealt with as quickly as possible.

In 2015/16, the Board conducted a voluntary, anonymous email survey of chiropractors. The high response rate has provided the Board with a better understanding of chiropractors’ knowledge of their obligations under the National Law, and the areas in which it may need to provide more regulatory guidance.

The Board has continued to develop strong links with other international chiropractic regulators, including by participating in meetings of the International Chiropractic Regulatory Collaboration and the New Zealand Chiropractic Board.

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Data snapshot: Regulation at work in 2015/16

The profession in brief

• The chiropractic registrant base grew by 3.4% year on year, to 5,167 in 2015/16.
• NSW was the principal place of practice for most of these practitioners (1,736); the Northern Territory (NT) was home to the least (23).
• The age bracket with the most practitioners was 25–29 (857 registrants).
• 135 registered chiropractors were under 25 years of age; 13 were aged 80 or over.
• Women comprised 38.5% of the profession.

About our data

2015/16 annual report, published by AHPRA and the National Boards. Data relating to chiropractors have been extracted from national source data that include all 14 health professions currently regulated under the National Law.

In the following pages, you’ll find registration data, including registrant numbers by age and principal place of practice, and data about notifications (complaints or concerns) received about chiropractors in the year to 30 June 2016. Data about statutory offence complaints are also included.

For a further breakdown of data from the 2015/16 annual report by AHPRA and the National Boards, including summary reports by state and territory, go to the annual report website.

Notifications data

Notifications are complaints or concerns that are lodged with AHPRA about registered health practitioners or students practising in Australia.

Our data generally excludes complaints handled by co-regulatory jurisdictions, such as in:

• NSW, where complaints about health practitioners with this state as their principal place of practice (PPP) are not managed by the Board and AHPRA, unless the conduct occurred outside NSW. Complaints about health practitioners where the conduct occurred in NSW are handled by the Health Professional Councils Authority (HPCA) and the NSW Health Care Complaints Commission (HCCC), and
• Queensland, where complaints are received and managed by the Office of the Health Ombudsman (OHO) and may be referred to AHPRA and the relevant National Board. We are not able to report on all complaints about health practitioners in Queensland because we only have access to data relating to matters referred to us by OHO.

Note that some NSW regulatory data published in this report may vary from data published in the HPCA’s annual report. This is due to subsequent data review by the HPCA after submission of initial data to AHPRA. For more information on how complaints about health practitioners are managed in NSW, and for data about complaints made in the state, please refer to the HPCA website.

For data relating to complaints in Queensland that have not been referred to AHPRA, please refer to the OHO website.

Registration of chiropractors

At 30 June 2016, there were 5,167 chiropractors registered across Australia. This represents a national increase of 3.4% from 2014/15.

Chiropractors made up 0.8% of all registered health practitioners across the National Scheme. Of all registered chiropractors:

• 94.3% held general registration to practise as a chiropractor, with this cohort of registrants increasing by 3.5% from last year, and
• 5.7% held non-practising registration and could not practise as a chiropractor. This cohort of registrants grew by 1.0% this year.

The total number of registered chiropractic students decreased by 34.5% compared to last year; to 1,240.

The Board received 394 new applications for registration, an increase of 6.2%. Of these, 86.3% were for general registration and 12.9% were applications to move to the non-practising register.

See Tables 1–3 for segmentation of registration data about chiropractors.

As a standard part of the registration process, applicants for initial registration as a health practitioner in Australia must undergo a criminal record check. AHPRA requested 66,698 domestic and international criminal history checks for practitioners across all professions in 2015/16. Of these, 787 checks were carried out for practitioners wanting to register as chiropractors. The checks resulted in 66 disclosable court outcomes. No conditions or undertakings were imposed on any practitioner’s registration as a consequence.

For source data on domestic and international criminal history checks, and registration information across all 14 regulated health professions, refer to the 2015/16 annual report.

Regulation of chiropractors

In 2015/16, 146 notifications were received nationally about chiropractors (including HPCA data). Noting that there was a significant reduction in new notifications received in 2014/15 (only 75 new matters nationally), this year’s total is a year-onyear increase of 94.7%.

Nationally, the percentage of registered health practitioners with notifications received during the year was 1.5%. The percentage of all registered chiropractors with notifications received was 2.8%.

A total of 49 notifications relating to a registered chiropractor (excluding HPCA) were closed. This represents 0.9% of all matters closed across all professions. Outcomes of the closed notifications included:

• 16.3% resulted in conditions being imposed or an undertaking accepted by the Board
• 16.3% resulted in the practitioner receiving a caution or reprimand by the Board
• none resulted in suspension or cancellation of registration, and
• 67.3% resulted in no further action being taken by the Board (no further action is taken when, based on the available information, the Board determines there is no risk to the public that requires regulatory action).

Immediate action was taken by the Board on eight matters relating to chiropractors in 2015/16 (compared with five instances in 2014/15), excluding matters managed by the HPCA in NSW.

A National Board has the power to take immediate action in relation to a health practitioner’s registration at any time, if it believes this is necessary to protect the public. Immediate action limits a practitioner’s registration by suspending or imposing conditions on it, or accepting an undertaking or surrender of the registration from the practitioner or student. This is an interim step that Boards can take while more information is gathered or while other processes are put in place. To take immediate action, the Board must reasonably believe that:

• because of their conduct, performance or health, the practitioner poses a ‘serious risk to persons’ and that it is necessary to take immediate action to protect public health or safety, or
• the practitioner’s registration was improperly obtained, or
• the practitioner or student’s registration was cancelled or suspended in another jurisdiction.

At the end of the year, there were 92 open notifications about registered chiropractors (excluding HPCA).

There were 54 active monitoring cases about registered chiropractors (including HPCA). The majority of these (21 cases) related to suitability/ eligibility for registration. For example, they did not hold an approved or equivalent qualification; lacked English language skills; did not meet requirements for recency of practice; or did not meet approved registration standards.

AHPRA received 601 new complaints about possible statutory offences by chiropractors this year. These complaints constitute 44.6% of all statutory offence matters received nationally in 2015/16. Almost all the new matters (96.5%) related to advertising concerns. There were 68 statutory offence matters considered and closed in this financial year.

Statutory offences are breaches of the National Law, committed by registered health practitioners and unregistered individuals. There are a number of offences created under the National Law, including the following:

• unlawful use of a protected title
• performing a restricted act
• holding out (claims by individuals or organisations as to registration), and
• unlawful advertising.

See Tables 4–11 for segmentation of notifications and statutory offence data relating to chiropractors.

Want to know more?

For more information, please refer to the full 2015/16 annual report and supplementary data tables published by AHPRA and the National Boards on the annual report website.

For an overview of the National Law as it applies to each state and territory, please see AHPRA's legisltaion.

Table 1: Registrant numbers at 30 June 2016¹

Chiropractors	ACT	NSW	NT	QLD	SA	TAS	VIC	WA	No PPP2	Total
2015/16	67	1,736	23	818	373	57	1,328	602	163	5,167
2014/15	65	1,681	25	771	362	51	1,290	594	159	4,998
% change from 2014/15	3.10%	3.30%	-8.00%	6.10%	3.00%	11.80%	2.90%	1.30%	2.50%	3.40%

Table 2: Registrants by age

Chiropractors	U-25	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65-69	70-74	75-79	80+	Not available	Total
2015/16	135	857	816	739	762	559	418	352	235	163	79	39	13		5,167
2014/15	142	827	801	725	746	490	425	335	229	149	77	41	10	1	4,998

Table 3: Registrants by gender

Chiropractors	ACT	NSW	NT	QLD	SA	TAS	VIC	WA	No PPP1	Total
Total 2015/16	67	1,736	23	818	373	57	1,328	602	163	5,167
Female	33	634	7	288	141	17	550	258	61	1,989
Male	34	1,102	16	530	232	40	778	344	102	3,178
Total 2014/15	65	1,681	25	771	362	51	1,290	594	159	4,998
Female	32	608	6	263	127	14	520	251	56	1,877
Male	33	1,073	19	508	235	37	770	343	103	3,121

Table 4: Notifications received by state or territory¹

Chiropractors	ACT	NSW2	NT	QLD3	SA	TAS	VIC	WA	No PPP4	Subtotal	HPCA5	Total
2015/16 (PPP)6	1		1	24	9		31	12	4	82	64	146
2014/15 (PPP)	3			5	5		15	13		41	34	75
2014/15 (Responsible Office)7	3			5	5		16	12		41	34	75

Table 5: Percentage of registrant base with notifications received, by state or territory

Chiropractors	ACT	NSW (including HPCA complaints)1	NT	QLD	SA	TAS	VIC	WA	No PPP2	Total
2015/16 (PPP)3	1.50%	3.70%	4.30%	2.90%	2.40%		2.30%	2.00%	2.50%	2.80%
2014/15 (PPP)	4.60%	2.00%		0.60%	1.40%		1.20%	2.20%		1.50%
2014/15 (Responsible Office)4	4.60%	2.00%		0.60%	1.40%		1.20%	2.00%		1.50%

Table 6: Immediate action cases by state or territory (excluding HPCA)

Division	ACT	NSW	NT	QLD	SA	TAS	VIC	WA	No PPP1	Total 2014/15
Total 2015/16 (PPP)2				1	3		1	3		8
Total 2014/15 (PPP)	1			1			1	2		5
Total 2014/15 (Responsible Office)3	1			1			1	2		5

Table 7: Notifications closed by state or territory

Chiropractors	ACT	NSW1	NT	QLD	SA	TAS	VIC	WA	No PPP2	Subtotal	HPCA3	Total
2015/16 (PPP)4				13	4		20	10	2	49	52	101
2014/15 (PPP)	3		1	14	10	1	24	13	2	68	30	98
2014/15 (Responsible Office)5	3		1	14	10	1	26	13		68	30	98

Table 8: Notifications closed, by stage at closure (excluding HPCA)¹

Stage at closure	Total 2015/16	Total 2014/15
Assessment2	24	11
Health or performance assessment3	2	1
Investigation	20	48
Panel hearing	3	5
Tribunal hearing	0	3
Total	49	68

Table 9: Notifications closed, by outcome at closure (excluding HPCA)¹

Outcome at closure	Total 2015/16	Total 2014/15
No further action2	33	24
Accept undertaking	1	16
Impose conditions	7	14
Caution	7	10
Reprimand	1	0
Health complaints entity to retain	0	3
Suspend registration	0	1
Total	49	68

Table 10: Active monitoring cases at 30 June 2016, by stream (including HPCA)¹

Chiropractors	Total 2015/16	Total 2014/15
Conduct	19	28
Health	1	0
Performance	10	22
Prohibited practitioner/student	3	0
Suitability/eligibility2	21	18
Total	54	68

Table 11: Statutory offence complaints received and closed, by type of offence and jurisdiction¹

Offence	ACT	NSW	NT	QLD	SA	TAS	VIC	WA	No PPP2	Total 2015/16	Total 2014/15
Title protections (s.113-120): Received		3		2				1	3	9	6
Title protections (s.113-120): Closed	1	2		3			1		2	9	13
Practice protections (s.121-123): Received								1	1	2	1
Practice protections (s.121-123): Closed						1			3	4	1
Advertising breach (s.133): Received	9	176	3	113	26	4	174	63	12	580	54
Advertising breach (s.133): Closed		38		8		1	3	2	2	54	96
Directing or inciting unprofessional conduct/professional misconduct (s.136): Received	1	4			1		2		1	9	1
Directing or inciting unprofessional conduct/professional misconduct (s.136): Closed									1	1	0
Other offence: Received									1	1	1
Other offence: Closed										0	2
Total 2015/16 (PPP)3: Received	10	183	3	115	27	4	176	65	18	601
Total 2015/16 (PPP)3: Closed	1	40	0	11	0	2	4	2	8	68
Total 2014/15 (PPP)3: Received	1	8	0	34	2	0	10	1	7		63
Total 2014/15 (PPP)3: Closed	1	40	0	33	4	0	18	9	7		112