Annual Report 2017/18 Notifications and monitoring

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Notifications Legal services Compliance

Notifications

Performance snapshot

• 7,276 total notifications received by AHPRA in 2017/18 (up 5.5% from 2016/17) – see Figure 5
• 51.5% of notifications made to AHPRA during the year were about medical practitioners (down from 52.4% in 2016/17)
• 1.6% of all registered practitioners were the subject of a notification
• 7.2% increase in mandatory notifications made to AHPRA from 2016/17
• 68% of finalised 'immediate actions' – for matters that posed serious risk to the public – led to suspension, surrender of registration or restrictions on registration
• AHPRA closed 7,105 matters in 2017/18

What is a notification?

In the National Scheme, a complaint or concern about a registered health practitioner or student is called a notification.

They are called notifications because we are notified about a concern or complaint, which AHPRA manages in partnership with the National Boards (refer to Figure 6). Most of the complaints and concerns we receive about individual practitioners are managed through Part 8 of the National Law. Decisions made in response to a notification can affect a practitioner's registration.

Some complaints are treated differently under the National Law, as they are considered statutory offences. AHPRA can prosecute individuals who commit these offences. For information about statutory offences in 2017/18, see below.

Keeping the public safe is our primary focus when AHPRA and the National Boards make decisions about notifications.

Anyone can notify us about a registered practitioner's health, performance or conduct. While registered health practitioners and employers have mandatory reporting obligations under the National Law, many of the complaints or concerns we receive are made voluntarily by patients or their families. See Figure 7.

Standards of clinical care continue to be the primary issue notified to National Boards, but significant increases in volume were also recorded for behaviour and medication issues. Refer to Figure 8.

We also receive some notifications about students who are enrolled in courses that lead to eligibility for registration as a practitioner. Usually, these complaints and concerns are made by education providers or places at which students undertake clinical training. Refer to Table 12.

How we manage complaints

We are committed to ensuring that the complaints process is completed in a timely manner, taking into account the complexities of individual notifications. Every complaint or concern we receive is assessed for potential risk to the public by both AHPRA and an appropriate committee appointed by the National Boards. When our assessment concludes that we need more information, we can investigate further. When we identify that a practitioner poses a serious risk, there are interim actions that the National Boards take. Refer to Figure 9 for an outline of the notification process.

Improving the notifier and practitioner experience

Since 2016, we have been asking notifiers and practitioners to tell us about their experience of the notifications process. We have received more than 3,500 survey responses and conducted 75 in-depth interviews, aimed at understanding what is working and where we can improve. Over half of those who responded requested more information, greater transparency and regular updates. 'Fairness' emerged as a strong theme, with more than 70% of notifiers advising that they were unhappy with the outcome.

We understand that having a notification made about them can be stressful for practitioners, and this was confirmed in our survey responses with more than 90% of practitioners rating the experience as 'very stressful'. We also received significant feedback that both groups would appreciate a more personal approach, including greater telephone contact.

The information we receive from the survey is shared with staff so that they also understand the impact of our processes on the notifiers and practitioners we engage with on a daily basis. Setting a standard of what a good experience looks like is important for AHPRA and, in response to notifier and practitioner feedback, we are developing a set of experience principles based on our commitment to improving the notification experience. These include listening, informing, working in a timely way, apologising when necessary, gathering feedback and learning from it, and just and fair treatment of all notifiers and practitioners.

We will continue to focus on this work in the next year with an expectation that these experience principles will have broader application across the National Scheme.

Notifications received

This year, AHPRA received the highest number of notifications we've received in a single financial year (refer to Table 8). This equates to 7,276 notifications received, 5.5% more than the number we received in 2016/17 (6,898 notifications) and 20.1% more than in 2015/16 (6,056 notifications).

Victoria received 2,414 new notifications and Queensland received 2,079. Together, these states accounted for 61.8% of all notifications received by AHPRA in 2017/18.

In Tables 9 and 10, you will find data about practitioners with notifications made about them in 2017/18, which are segmented by the percentage of the registrant base with notifications made about them, and the number of practitioners in each profession who have had notifications made about them. These two tables not only contain AHPRA data, but data supplied to us by HPCA for NSW and OHO for Queensland.

During the year 42 students had notifications made about them to AHPRA, refer to Tables 11 and 12.

Table 8: Notifications received in 2017/18, by profession and state or territory

Profession	AHPRA1 ACT	AHPRA1 NSW2	AHPRA1 NT	AHPRA1 QLD3	AHPRA1 SA	AHPRA1 TAS	AHPRA1 VIC	AHPRA1 WA	AHPRA1 No PPP4	AHPRA Subtotal 2017/18	HPCA5	Total 2017/18	Total 2016/176
Aboriginal and Torres Strait Islander Health Practitioner			2		1			1		4		4	7
Chinese medicine practitioner			1	16	2		18	6		43	31	74	61
Chiropractor		2	1	28	6	2	35	16	1	91	45	136	171
Dental practitioner	16	12	3	199	54	18	171	65	1	539	425	964	929
Medical practitioner	121	63	69	1,094	501	124	1,203	544	30	3,749	2,599	6,348	5,913
Medical radiation practitioner	2			4	2	1	9	5	1	24	12	36	52
Midwife	3	1	2	31	6	2	13	11	3	72	34	106	113
Nurse	40	9	48	442	307	67	473	185	41	1,612	707	2,319	2,210
Occupational therapist			1	11	5	1	13	3		34	25	59	53
Optometrist	2	2		12	2	1	10	4	2	35	28	63	60
Osteopath	1			2			13	1		17	15	32	25
Pharmacist	2	5	3	127	33	17	204	46	14	451	312	763	645
Physiotherapist	5	2	4	24	17	1	32	13		98	54	152	121
Podiatrist	1	3		17	3	2	24	9	2	61	27	88	61
Psychologist	16	12	13	69	53	15	195	63	1	437	296	733	584
Not identified7				3			1		5	9		9	4
Total 2017/18	209	111	147	2,079	992	251	2,414	972	101	7,276	4,610	11,886
Total 2016/17	242	96	169	2,046	800	329	2,230	900	86	6,898	4,111		11,009

Table 9: Percentage of all registered health practitioners with notifications made about them in 2017/18, by profession and state or territory

Profession1	ACT	NSW2	NT	QLD3	SA	TAS	VIC	WA	No PPP4	Total 2017/18	Total 2016/17
Aboriginal and Torres Strait Islander Health Practitioner			0.9%		2.2%			0.9%		0.6%	1.2%
Chinese medicine practitioner		1.4%	7.7%	2.0%	0.5%		1.3%	2.3%		1.5%	1.2%
Chiropractor	1.4%	2.3%	3.7%	3.8%	1.6%	2.0%	2.1%	2.2%	0.6%	2.4%	3.1%
Dental practitioner	4.3%	4.5%	1.8%	5.6%	2.3%	3.6%	2.7%	2.2%	0.2%	3.7%	3.8%
Medical practitioner	5.4%	5.7%	4.3%	7.2%	5.4%	4.4%	3.6%	4.0%	0.7%	5.1%	5.1%
Medical radiation practitioner	0.4%	0.1%		0.3%	0.2%	0.3%	0.2%	0.2%		0.2%	0.3%
Midwife5	0.4%	0.2%	0.5%	0.6%	0.2%	0.3%	0.2%	0.3%	0.0%	0.3%	0.3%
Nurse6	0.5%	0.5%	0.9%	0.7%	0.8%	0.7%	0.4%	0.4%	0.1%	0.5%	0.6%
Occupational therapist		0.4%	0.5%	0.5%	0.3%	0.3%	0.2%	0.1%		0.3%	0.3%
Optometrist	2.3%	1.4%		1.6%	0.6%	1.1%	0.6%	0.9%	1.9%	1.2%	1.1%
Osteopath	2.6%	2.2%		2.8%			1.0%	1.6%		1.4%	1.1%
Pharmacist	0.3%	1.9%	1.6%	2.4%	1.5%	2.0%	2.0%	1.4%	0.7%	1.9%	1.8%
Physiotherapist	0.6%	0.5%	2.2%	0.6%	0.6%	0.2%	0.4%	0.3%	0.1%	0.5%	0.4%
Podiatrist	1.5%	1.7%		2.2%	0.7%	1.9%	1.3%	1.7%	5.1%	1.6%	1.3%
Psychologist	1.5%	2.0%	4.3%	2.1%	2.5%	2.1%	1.7%	1.5%	0.2%	1.9%	1.6%
Total 2017/18	1.6%	1.8%	1.8%	2.1%	1.6%	1.5%	1.1%	1.2%	0.3%	1.6%
Total 2016/17	1.9%	1.7%	2.2%	2.2%	1.3%	1.9%	1.1%	1.2%	0.5%		1.6%

Table 10: Number of practitioners with notifications made about them in 2017/18, by profession and state or territory

Profession1	ACT	NSW2	NT	QLD3	SA	TAS	VIC	WA	No PPP4	Total 2017/18	Total 2016/17
Aboriginal and Torres Strait Islander Health Practitioner			2		1			1		4	7
Chinese medicine practitioner		28	1	18	1		17	6		71	60
Chiropractor	1	41	1	33	6	1	30	14	1	128	164
Dental practitioner	18	311	3	256	43	14	147	58	1	851	853
Medical practitioner	117	2,029	58	1,664	442	106	1,027	463	21	5,927	5,711
Medical radiation practitioner	1	7		10	2	1	8	3		32	48
Midwife5	3	18	3	44	6	2	14	10		100	95
Nurse6	33	577	43	536	278	65	425	172	14	2,143	2,151
Occupational therapist		21	1	19	5	1	11	3		61	58
Optometrist	2	26		18	2	1	9	4	3	65	57
Osteopath	1	13		6			13	1		34	25
Pharmacist	2	181	4	147	33	15	161	45	4	592	545
Physiotherapist	4	51	4	39	16	1	29	12	1	157	133
Podiatrist	1	24		19	3	2	22	8	3	82	62
Psychologist	14	241	10	138	44	13	168	58	1	687	571
Total 2017/18	197	3,568	130	2,947	882	222	2,081	858	49	10,934
Total 2016/17	222	3,332	155	2,958	726	282	1,961	819	85		10,540

Table 11: Student notifications received in 2017/18 (mandatory and voluntary)

Profession	AHPRA1 ACT	AHPRA1 NSW	AHPRA1 NT	AHPRA1 QLD	AHPRA1 SA	AHPRA1 TAS	AHPRA1 VIC	AHPRA1 WA	AHPRA1 No PPP2	AHPRA Subtotal 2017/18	HPCA3	Total 2017/18	Total 2016/17
Aboriginal and Torres Strait Islander Health Practitioner										0		0	0
Chinese medicine practitioner										0		0	1
Chiropractor										0	1	1	1
Dental practitioner				1						1	2	3	1
Medical practitioner				3	1				6	10	9	19	9
Medical radiation practitioner										0	1	1	2
Midwife					1			1	4	6	1	7	0
Nurse				1					20	21	14	35	43
Occupational therapist										0	1	1	2
Optometrist										0		0	0
Osteopath										0	3	3	1
Pharmacist									2	2	3	5	1
Physiotherapist										0		0	0
Podiatrist									2	2	1	3	1
Psychologist										0		0	0
Total 2017/18	0	0	0	5	2	0	0	1	34	42	36	78
Total 2016/17	0	1	0	4	3	1	1	0	20	30	32		62

Table 12: Outcomes of notifications (mandatory/voluntary) about students by stage at closure

Stage at closure	Assessment	Health or performance assessment	Investigation	Panel hearing	Tribunal hearing	Total 2017/18	Total 2016/17
No further action – AHPRA	17	4	7			28	21
No further action – HPCA1	3	3				6	16
Impose conditions – AHPRA	1	2				3	6
Impose conditions – HPCA				2		2	13
Accept undertaking – AHPRA	1		1			2	1
Accept undertaking – HPCA						0	0
Caution – AHPRA						0	4
Caution – HPCA						0	0
Cancel registration – AHPRA						0	1
Cancel registration – HPCA						0	0
No jurisdiction – AHPRA						0	0
No jurisdiction – HPCA	3			2		5	5
Refer to other entity – AHPRA						0	0
Refer to other entity – HPCA	2					2	1
Discontinue – AHPRA						0	0
Discontinue – HPCA	7					7	3
Counselling – AHPRA						0	0
Counselling – HPCA						0	0
Surrender – AHPRA						0	0
Surrender – HPCA						0	1
Withdrawn – AHPRA						0	0
Withdrawn – HPCA						0	1
Total 2017/18	34	9	8	4	0	55
Total 2016/17	32	11	11	18	1		73

Mandatory notifications

All health practitioners, their employers and education providers have mandatory reporting responsibilities under
the National Law.

This means that they must tell AHPRA if they have formed a reasonable belief that a registered practitioner or student has behaved in a way that constitutes notifiable conduct.

Notifiable conduct by registered practitioners is defined as:

• practising while intoxicated by alcohol or drugs
• engaging in sexual misconduct in the practice of the profession
• placing the public at risk of substantial harm because of an impairment (health issue), or
• placing the public at risk because of a significant departure from accepted professional standards.

AHPRA received 908 mandatory notifications in 2017/18, up by 7.2% (61 notifications) compared with 2016/17. More than 79.5% of the mandatory notifications received were about medical practitioners or nurses, which is consistent with long-term trends. Almost 45% of mandatory notifications completed during 2017/18 resulted in some form of regulatory action being taken against a practitioner. This is consistent with trends from previous years and suggests a continued understanding of the mandatory notification requirements under the National Law. Notifiers are making appropriate mandatory notifications, having reasonably assessed that the risk to the public warrants the notification being made. Refer to Tables 13, 14 and 15.

Table 13: Mandatory notifications received, by profession and state or territory (including HPCA)

Profession	AHPRA1 ACT	AHPRA1 NSW2	AHPRA1 NT	AHPRA1 QLD3	AHPRA1 SA	AHPRA1 TAS	AHPRA1 VIC	AHPRA1 WA	AHPRA1 No PPP4	AHPRA Subtotal 2017/18	HPCA5	Total 2017/18	Total 2016/17
Aboriginal and Torres Strait Islander Health Practitioner			1		1					2		2	2
Chinese medicine practitioner					1		2			3		3	1
Chiropractor						1	3	2		6	2	8	15
Dental practitioner		2			12		15	2		31		31	29
Medical practitioner	13	7	12	4	50	10	116	38	5	255	88	343	294
Medical radiation practitioner					1	1	3	3		8		8	8
Midwife			1		2		1	4		8	14	22	21
Nurse	8	4	12	2	165	22	172	68	14	467	234	701	639
Occupational therapist					2		3	2		7	3	10	6
Optometrist		1				1				2	2	4	1
Osteopath							1			1	1	2	1
Pharmacist	1	1	1		9	4	24	2	2	44	4	48	65
Physiotherapist					4		8	5		17	4	21	12
Podiatrist				2			2		1	5	2	7	5
Psychologist	6	2			13	3	22	6		52	8	60	43
Total 2017/18	28	17	27	8	260	42	372	132	22	908	362	1,270
Total 2016/17	32	7	15	13	255	73	335	111	6	847	295		1,142

Table 14: Grounds for mandatory notification by profession (including HPCA)

Profession	Standards – AHPRA	Standards – HPCA1	Impairment – AHPRA	Impairment – HPCA	Alcohol or drugs –AHPRA	Alcohol or drugs – HPCA	Sexual misconduct –AHPRA	Sexual misconduct – HPCA	Total 2017/18 – AHPRA	Total 2017/18 – HPCA	Total 2016/17 – AHPRA	Total 2016/17 – HPCA
Aboriginal and Torres Strait Islander Health Practitioner			2						2	0	2	0
Chinese medicine practitioner	3								3	0	0	1
Chiropractor	6			2					6	2	11	4
Dental practitioner	27		3				1		31	0	21	8
Medical practitioner	188	53	43	20	5	4	19	11	255	88	224	70
Medical radiation practitioner	5		2				1		8	0	6	2
Midwife	6	12		2	2				8	14	17	4
Nurse	330	156	93	76	31		13	2	467	234	471	168
Occupational therapist	4		1		2			3	7	3	4	2
Optometrist	2	1		1					2	2	1	0
Osteopath			1					1	1	1	0	1
Pharmacist	36	4	7				1		44	4	51	14
Physiotherapist	12	1	2		1	1	2	2	17	4	8	4
Podiatrist	2	1	2	1	1				5	2	4	1
Psychologist	35	5	11	3			6		52	8	27	16
Total 2017/18	656	233	167	105	42	5	43	19	908	362
Total 2016/17	619	173	148	72	34	29	46	21			847	295

Table 15: Outcomes of mandatory notifications closed, by profession (including HPCA)

Profession	Aboriginal and Torres Strait Islander Health Practitioner	Chinese medicine practitioner	Chiropractor	Dental practitioner	Medical practitioner	Medical radiation practitioner	Midwife	Nurse	Occupational therapist	Optometrist	Osteopath	Pharmacist	Physiotherapist	Podiatrist	Psychologist	Total 2017/18	Total 2016/17
Discontinued/proceedings withdrawn – AHPRA																0	0
Discontinued/proceedings withdrawn – HPCA					20			16			1		1	1	1	40	30
Changed to non-practising – AHPRA																0	0
Changed to non-practising – HPCA																0	3
Other/no jurisdiction – AHPRA																0	0
Other/no jurisdiction – HPCA1					1		2	28								31	19
Counselling – AHPRA																0	0
Counselling – HPCA							1	30					2			33	23
No further action – AHPRA	1		5	21	147	1	8	238	3	2		18	4	2	27	477	408
No further action – HPCA					18		2	64						1	3	88	127
Refer all or part of the notification to another body – AHPRA					6			2	1			1				10	4
Refer all or part of the notification to another body – HPCA					4			1								5	10
Fine registrant – AHPRA					3											3	4
Fine registrant – HPCA																0	0
Orders – no conditions – AHPRA																0	0
Orders – no conditions – HPCA					1											1	2
Caution or reprimand – AHPRA			2	2	27	1	1	64	2			18	1		2	120	142
Caution or reprimand – HPCA					3			4							3	10	3
Accept undertaking – AHPRA				1	16			38				3				58	52
Accept undertaking – HPCA																0	0
Impose conditions – AHPRA	1			7	28	2	6	98	1			14	5	1	13	176	152
Impose conditions – HPCA2			2	2	15			36				3	1		3	62	65
Accept surrender of registration – AHPRA																0	2
Accept surrender of registration – HPCA					2											2	9
Suspend registration – AHPRA					5			6								11	10
Suspend registration – HPCA					1			3								4	1
Cancel registration/disqualify – AHPRA					4			2								6	18
Cancel registration/disqualify – HPCA					3			6				1			1	11	10
Not permitted to reapply for registration for 12 months or more – AHPRA																0	0
Not permitted to reapply for registration for 12 months or more – HPCA																0	0
Total 2017/18 – AHPRA	2	0	7	31	236	4	15	448	7	2	0	54	10	3	42	861
Total 2017/18 – HPCA	0	0	2	2	68	0	5	188	0	0	1	4	4	2	11	287
Total 2016/17 – AHPRA	1	2	12	25	221	6	19	426	2	0	0	42	5	4	27		792
Total 2016/17 – HPCA	0	2	1	4	66	4	0	177	2	0	2	12	4	1	27		302

Immediate action

Immediate action is a serious step that a National Board can take when it believes it is necessary to limit a practitioner's registration in some way to keep the public safe.

It is an interim measure that a Board takes only in cases where the Board believes there is a serious risk to the public or it is otherwise in the public interest to limit a practitioner's registration while it seeks further information.

In 2017/18, National Boards took immediate action on 413 occasions, which is 29.4% (320) more than in 2016/17. The proportion of notifications where immediate action was taken was 5.7% of the notifications received. This is relatively consistent with previous years (4.6% in 2016/17 and 6.2% in 2015/16). Refer to Table 16 for the breakdown of immediate action taken over the last three years and Table 17 for the breakdown by profession in 2017/18.

Timeliness in managing risk is crucial when dealing with a matter where immediate action may be required. The median time to take immediate action was seven days in 2017/18, which is the same as it was in 2016/17. In 2015/16 it was eight days. The median time continues to compare favourably to health practitioner regulators in the United Kingdom.

The multi-profession immediate action approach of nine National Boards continued this year. A new, single immediate action committee for the Psychology Board of Australia was also introduced (previously, each regional board of the Psychology Board of Australia managed immediate actions).

See the appendices in this report for information about meetings of these committees. For more information about our work on cross-profession collaboration, see Multi-profession policy.

Table 16: Immediate action taken to protect the public

Type of immediate action taken	2015/16	2016/17	2017/18
Registration surrendered	1.6%	0.3%	0.2%
Accept undertaking	17.8%	21.6%	27.3%
Impose conditions	60.9%	45.9%	42.0%
Suspended	19.7%	32.2%	30.4%

Table 17: Immediate action cases (including HPCA)

Profession	No action taken AHPRA	No action taken HPCA3,4	Action taken1 Suspend registration AHPRA	Action taken1 Suspend registration HPCA	Action taken1 Accept surrender of registration AHPRA	Action taken1 Accept surrender of registration HPCA	Action taken1 Impose conditions AHPRA	Action taken1 Impose conditions HPCA	Action taken1 Accept undertaking AHPRA	Action taken1 Accept undertaking HPCA	Decision pending2 AHPRA	Decision pending2 HPCA	Total 2017/18 AHPRA	Total 2017/18 HPCA	Total 2016/17 AHPRA	Total 2016/17 HPCA
Aboriginal and Torres Strait Islander Health Practitioner	1		1										2	0	0	0
Chinese medicine practitioner	1		2	1			3						6	1	1	1
Chiropractor	4	1	2	3			2	1	2				10	5	15	5
Dental practitioner	6	1	4	6			2	11	4		1		17	18	15	17
Medical practitioner	76	19	32	20		5	65	70	51		8	4	232	118	160	91
Medical radiation practitioner	1		1				1						3	0	2	2
Midwife	2	3	1				2	2	5				10	5	4	1
Nurse	67	43	64	11	1		85	94	42		10		269	148	182	92
Occupational therapist	1			1			2	1	1				4	2	0	0
Optometrist				1				1					0	2	2	0
Osteopath	2		1										3	0	1	2
Pharmacist	1	8	4	4			7	27	4		1		17	39	22	49
Physiotherapist	8	3	3				1	2	1				13	5	1	2
Podiatrist								1			1		1	1	1	1
Psychologist	3	2	11	3			4	7	3		1		22	12	13	9
Total 2017/18	173	80	126	50	1	5	174	217	113	0	22	4	609	356
Total 2016/17	76	63	103	42	1	0	147	167	69	0	23	0			419	272

Investigations

Sometimes, the information available to a National Board when assessing a complaint or concern is not sufficient to enable a risk-informed decision. In these cases, a National Board can conduct an investigation to gather more information that is relevant to the case. A decision to investigate is not an indication that a National Board has accepted an allegation made in a notification as true.

During an investigation, information can be gathered from sources such as:

• the person who raised their concern with the Board (the notifier)
• the practitioner being investigated
• contents of patient records
• other practitioners who may have been involved in the care of a patient
• witnesses (for example, family members, other patients or staff members)
• experts (who provide independent opinions) or information from professional bodies
• police reports, and/or
• information from other sources such as pharmacy records, health insurers or Medicare Australia.

In 2017/18, National Boards began 2,598 investigations; 5.1% more than in the previous year. Despite the increased volume of notifications, the proportion that progressed to investigation was largely consistent with previous years at 33.0%, compared to 33.2% in 2016/17 and 36.4% in 2015/16.

In addition to regular updates on the progress of individual investigations, AHPRA routinely audits older investigations as a quality-assurance mechanism to identify ways we can reduce the time it takes for AHPRA and the Boards to investigate matters. This year, AHPRA began an investigation case conferencing project that:

• aims to review and reduce aged investigations
• identifies what issues or incidents during the lifecycle of an investigation are contributing to the time taken to complete the investigation
• considers whether clinical input can be better utilised during investigation, and
• will inform our ongoing work on assessing risk by identifying common types of information that can indicate that an investigation is likely to result in a decision to take no regulatory action.

The findings of the project will be assessed and applied to determine what activities may be introduced (or removed) to reduce the likelihood of investigations becoming aged. This work will continue into the next financial year.

We continue to refine processes to ensure timely outcomes for notifiers and practitioners, and have reduced the average number of days to complete an investigation from 398 in 2015/16, to 392 in 2016/17 and 379 days in 2017/18.

Outcomes and timeliness of notifications closed

We assessed and completed 6.5% more notifications in 2017/18 than in 2016/17. This represents the highest number of closures (7,105) since the start of the National Scheme. Of notifications that were closed, 27.8% resulted in some form of regulatory action being taken by a National Board (refer to Table 18).

The average time taken to complete an assessment and to close matters in assessment is shown in Table 19.

Table 20 shows notifications closed by profession and stage at closure and Table 21 by profession and outcome, while Table 22 contains data provided to us by HPCA about notifications closed in NSW.

Tables 23 and 24 contain data about 4,187 notifications that are currently being managed by AHPRA and remained open as at 30 June 2018.

The average time taken to close a notification in 2017/18 is shown in Figure 10. The majority (64.5%) closed in six months, which is consistent with previous years (64.9% in 2016/17 and 64.0% in 2015/16).

Table 18: Closed notification outcomes

Closed notification outcomes	2015/16	2016/17	2017/18
No further action	66.5%	68.6%	72.0%
Caution or reprimand	13.8%	14.2%	11.5%
Impose conditions	11.1%	10.6%	9.7%
Accept undertaking	3.5%	2.2%	2.2%
Refer to a HCE or other entity	3.3%	3.2%	3.4%
Registration surrendered, suspended or cancelled	1.9%	1.2%	1.0%

Table 19: Timeframes for matters in assessment

Average time (in days) to:	2015/16	2016/17	2017/18	% change 2016/17–2017/18
Close matters in assessment	82	84	82	-2.4%
Complete assessments and move to another stage	48	51	42	-17.6%

Changes to the process for assessing notifications about medical practitioners and medical students through 2017/18 led to a 26.1% reduction in the time taken to assess notifications. Medical assessments are completed in 51 days on average; 23.9% better than the national 'all boards' result of 67 days.

The final step in implementing the new process approach for medical notifications is to incorporate Tasmanian and ACT medical notifications and this will be completed in 2018.

Table 20: Notifications closed in 2017/18 by profession, by stage at closure (including HPCA)

Profession	Assessment – AHPRA	Assessment – HPCA1	Investigation – AHPRA	Investigation – HPCA	Health or performance assessment – AHPRA	Health or performance assessment – HPCA	Panel hearing – AHPRA	Panel hearing – HPCA	Tribunal hearing – AHPRA	Tribunal hearing – HPCA2	Subtotal 2017/18 – AHPRA	Subtotal 2017/18 – HPCA	Total 2017/18	Total 2016/17
Aboriginal and Torres Strait Islander Health Practitioner	2		1		1						4	0	4	6
Chinese medicine practitioner	25	40	3		1				1	1	30	41	71	65
Chiropractor	46	58	44		3	2	1	2	26	2	120	64	184	152
Dental practitioner	379	358	144	1	22	27	3	54	6	3	554	443	997	871
Medical practitioner	2,435	1,713	1,055	93	119	376	16	96	78	35	3,703	2,313	6,016	5,654
Medical radiation practitioner	13	16	5	1	5		1	2		1	24	20	44	49
Midwife	45	9	27		6	12	1	1	1		80	22	102	135
Nurse	803	476	497	17	230	30	13	87	37	17	1,580	627	2,207	2,050
Occupational therapist	25	17	6		2			3	1		34	20	54	55
Optometrist	22	24	9		1	5					32	29	61	50
Osteopath	11	16	6			3		1			17	20	37	18
Pharmacist	272	246	109		15	12	6	40	9	5	411	303	714	572
Physiotherapist	50	54	28		3			3	1	1	82	58	140	116
Podiatrist	28	20	12		1						41	20	61	70
Psychologist	264	235	93		9	13	6	8	9	4	381	260	641	547
Not identified3	11				1						12	0	12	3
Total 2017/18	4,431	3,282	2,039	112	419	480	47	297	169	69	7,105	4,240	11,345
Total 2016/17	4,141	3,145	1,919	62	362	188	72	293	175	56	6,669	3,744		10,413

Table 21: Notifications closed in 2017/18, by outcome (AHPRA)

Profession	No further action	Refer all or part of the notification to another body	HCE to retain1	Accept undertaking	Caution or reprimand	Fine registrant	Impose conditions	Accept surrender of registration	Suspend registration	Cancel registration	Not permitted to reapply for registration for 12 months or more	Total 2017/182	Total 2016/17
Aboriginal and Torres Strait Islander Health Practitioner	3						1					4	6
Chinese medicine practitioner	25				1		3			1		30	34
Chiropractor	53	25		1	26		13			2		120	88
Dental practitioner	368	6	15	13	79		72		1			554	485
Medical practitioner	2,970	23	128	64	249	8	225		16	20		3,703	3,557
Medical radiation practitioner	14				4		6					24	29
Midwife	47			2	16		15					80	86
Nurse	984	11	23	58	245	2	231	5	15	6		1,580	1,473
Occupational therapist	19	2	1		9	1	2					34	39
Optometrist	21			2	4		5					32	27
Osteopath	13			2	1		1					17	13
Pharmacist	225	3	1	10	122	1	48		1			411	355
Physiotherapist	46		2	3	14		17					82	83
Podiatrist	27		1		7		6					41	47
Psychologist	291	1	1	3	39		41		4	1		381	344
Not identified	10		2									12	3
Total 2017/18	5,116	71	174	158	816	12	686	5	37	30	0	7,105
Total 2016/17	4,572	54	159	149	946	11	706	5	30	34	3		6,669

Table 22: Notifications closed in 2017/18, by outcome (HPCA)

Profession	Aboriginal and Torres Strait Islander Health Practitioner	Chinese medicine practitioner	Chiropractor	Dental practitioner	Medical practitioner	Medical radiation practitioner	Midwife	Nurse	Occupational therapist	Optometrist	Osteopath	Pharmacist	Physiotherapist	Podiatrist	Psychologist	Total 2017/18	Total 2016/17
No further action1		17	24	93	386	5	10	194	7	12	2	120	6	10	67	953	1,108
No jurisdiction2		5		4	29	1	2	63		1	4	4			16	129	77
Discontinued		8	16	201	1,604	9	6	189	12	16	6	118	31	9	133	2,358	1,906
Withdrawn			1	7	42			2				4	2		8	66	78
Make a new complaint																0	0
Refer all or part of the notification to another body		6	14	27	85	2	1	11	1		5	4	10	1	16	181	119
Caution				29	1							7				37	18
Reprimand			1	1	12			6				3			4	27	30
Orders – no conditions				6	2											8	13
Finding – no orders				1	1							3				5	2
Counselling/interview		4	4	50	16		3	91			2	16	5		6	197	114
Resolution/conciliation by HCCC			1		31											32	18
Fine																0	0
Refund/payment/withhold fee/retreat																0	0
Conditions by consent					25			43				3				71	66
Order – impose conditions; would be conditions if registered		1	3	36	40	2		22			1	23	3		10	141	151
Accept surrender				3	16											19	32
Accept registration type change to non-practising					1										1	2	7
Suspend					3			3								6	5
Cancelled registration/disqualified from registering			1	11	28	1		11				4	1		3	60	53
Total 2017/18	0	41	65	469	2,322	20	22	633	20	29	20	309	58	20	264	4,292
Total 2016/17	0	32	65	406	2,111	20	49	586	16	23	5	225	33	23	203		3,797

Table 23: Open notifications managed by AHPRA as at 30 June 2018, by length of time at each stage

Current stage of open notification	Less than 3 months	3–6 months	6–9 months	9–12 months	12–24 months	More than 24 months	Total 2017/18	Total 2016/17
Assessment	881	153	52	11	8	5	1,110	1,079
Health or performance assessment	79	86	48	29	27	3	272	310
Investigation	564	493	334	331	555	178	2,455	2,304
Panel hearing	8	5	5	1	6	4	29	57
Subtotal 2017/18	1,532	737	439	372	596	190	3,866
Subtotal 2016/17	1,592	716	472	325	555	90		3,750
Tribunal hearing1	59	55	69	18	92	28	321	266
Total 2017/18	1,591	792	508	390	688	218	4,187
Total 2016/17	1,641	734	516	364	603	158		4,016

Table 24: Open notifications at 30 June 2018, by profession and state and territory (including HPCA)

Profession	AHPRA1 ACT	AHPRA1 NSW	AHPRA1 NT	AHPRA1 QLD	AHPRA1 SA	AHPRA1 TAS	AHPRA1 VIC	AHPRA1 WA	AHPRA1 No PPP2	AHPRA Subtotal 2017/18	HPCA3	Total 2017/18	Total 2016/17
Aboriginal and Torres Strait Islander Health Practitioner			1		1					2		2	2
Chinese medicine practitioner				17	2		8	2		29	4	33	29
Chiropractor			1	21	7	2	24	22		77	12	89	139
Dental practitioner	7	11	1	175	18	2	87	49		350	283	633	668
Medical practitioner	54	37	35	705	171	58	620	254	14	1,948	1,355	3,303	3,080
Medical radiation practitioner	1			2	3	1	8	2		17	6	23	31
Midwife	5	1		26	6	1	8	7	1	55	21	76	77
Nurse	16	11	22	308	166	37	325	120	18	1,023	453	1,476	1,367
Occupational therapist				8			8	1		17	9	26	21
Optometrist		2		8	2		6	2		20	7	27	25
Osteopath	1			2			5			8	4	12	17
Pharmacist	5	4	1	74	20	10	98	29	2	243	210	453	399
Physiotherapist	2	3	1	21	10	1	18	7		63	19	82	69
Podiatrist		3		13			13	6	2	37	9	46	19
Psychologist	11	5	5	68	29	9	117	53		297	149	446	354
Not identified4									1	1		1	1
Total 2017/18	102	77	67	1,448	435	121	1,345	554	38	4,187	2,541	6,728
Total 2016/17	107	60	90	1,431	492	141	1,125	537	33	4,016	2,282		6,298

Expanding clinical input

The outcomes of the 2017 Notifications think tank, which looked strategically at how we can improve the notifications process, also included a shared commitment to ensuring robust clinical input is readily available in the management of notifications. In February 2018 a national clinical input service was established to:

• contribute to the reform of our notification process by identifying when and how clinical advice could support better notification management
• develop models for obtaining clinical input from appropriately qualified clinical advisers within the National Scheme specifically suited to different professions based on notification volume
• implement a national process for facilitating health assessments and performance assessments for Part 7 and Part 8 matters across all professions, and
• establish and implement a national process for obtaining independent expert opinions from external providers during investigations.

The aim of this model is to deliver a single clinical input service, accessible to all regulatory staff, with clinical expertise across all professions regulated by the National Scheme. The clinical input service comprises two national teams. The national health and performance assessments team undertakes the administrative processes associated with health and performance assessment coordination. Medical clinical input is provided by a team of clinical advisers: medical practitioners with a diverse range of skills and experience across the medical profession.

The clinical input service will continue to grow in 2018/19 with the extension of clinical input to other professions. While the service will maintain certain profession-specific arrangements, it will ensure a consistent approach to clinical input – particularly in relation to notifications.

Fast-tracking investigations

A direct response to the think tank outcome was to stream lower-risk/lower-complexity matters to be managed by dedicated resources. This outcome was in response to concerns that the lower-risk/lower-complexity matters were often not prioritised because of the demands of other, higher priority investigations.

Fast-track investigation teams were established during January to June 2018 in both Hobart and Darwin to provide services across AHPRA.

Over April to June 2018, the fast-track teams completed a total of 57 investigations, or 7.7% of all investigations completed. The average time these dedicated teams take to complete investigations is less than half the time that more complex investigations take.

The fast-track teams are so far managing matters that are referred to investigation from a triage committee relating to medical and nursing matters. As more professions migrate to new, national intake and assessment processes, there is scope to increase the range of professions whose matters are suitable for management by a fast-track team.

Legal services

AHPRA's regulatory legal services team supports risk-based decision-making and gives advice on policy and procedure across our regulatory functions. The team's primary role is to manage complex or high-risk notifications that progress to a panel or tribunal. It manages appeals and has specialist units handling complaints about alleged statutory offences, release of information and the provision of strategic legal advice.

Tribunals

A National Board can refer a matter to a tribunal for hearing. Usually, this happens with the most serious allegations, such as where the National Board believes a practitioner has behaved in a way that constitutes professional misconduct.

Tribunal proceedings are conducted in accordance with timetables set by the responsible tribunal in each jurisdiction.

The tribunals in each state and territory are:

• New South Wales Civil and Administrative Tribunal
• Australian Capital Territory Civil and Administrative Tribunal
• Northern Territory Civil and Administrative Tribunal
• Queensland Civil and Administrative Tribunal
• South AustralianCivil and Administrative Tribunal
• Tasmania Health Practitioners Tribunal
• Victorian Civil and Administrative Tribunal, and
• Western Australia State Administrative Tribunal.

There were 321 notifications open in the tribunal stage as at 30 June 2018, compared with 266 at the same time last year. This increase was anticipated due to multiple years of high rates of notifications. Of the 169 notifications closed by tribunals in the year, 97% of matters resulted in some form of regulatory action or the surrender of registration, while there was a 66.7% reduction in matters resulting in no further action, down to just five individual matters. See Figure 11. This demonstrates that the National Boards' decisions are better identifying the thresholds for referring a matter to a tribunal in order to protect the public.

97.0% resulted in disciplinary action

3.0% resulted in no further action

Since 2010, all practitioners who have had their registration cancelled by a court or tribunal, been disqualified from applying for registration, or prohibited from using a specified title or providing a specified health service appear on the cancelled health practitioners register.

We also publish summaries of tribunal outcomes on the Tribunal decisions page on the AHPRA website.

During the year, the Medical Board of Australia started to publish links to disciplinary decisions by courts and tribunals on the public Register of practitioners when there has been an adverse finding about a doctor. The Board decided to introduce links to public tribunal decisions, in the interests of transparency and on the recommendation of the Independent review of the use of chaperones to protect patients in Australia Over the coming year, this approach will also be adopted by other National Boards.

Panels

A National Board has the power to establish two types of panels depending on the type of notification:

• health panels, for issues relating to a practitioner's health and performance, or
• professional standard panels, for conduct and performance issues.

Under the National Law, panels must include members from the relevant health profession as well as community members. All health panels must include a medical practitioner. Each National Board has a list of approved people who may be called upon to sit on a panel.

Of the 49 National Board matters decided by panels during the year, more than 75% resulted in some form of regulatory action being taken. See Figure 12.

32.7% resulted in conditions being imposed or an undertaking being accepted

42.9% resulted in a caution or reprimand

24.5% resulted in no further action

Appeals

All regulatory decisions are evidence-based and guided by the regulatory principles for the National Scheme. The National Law provides a mechanism of appeal against a decision by a National Board in certain circumstances, including decisions to:

• refuse an application for registration or endorsement of registration, or to refuse renewal of registration or renewal of an endorsement of registration
• impose or change a condition placed on registration, or to refuse to change or remove a condition imposed on registration or an undertaking given by a registrant, or
• suspend registration or to reprimand a practitioner.

Decisions may also be judicially reviewed if there is a perceived flaw in the administrative decision-making process, as opposed to a concern about the merits of the individual decision itself.

There were just 28 appeals lodged nationally about decisions made by National Boards under the National Law in 2017/18 (refer to Table 25 and Figure 13). This represents a national reduction of 65.9% when compared with the previous year.

28.6% related to a decision to impose or change a condition on a person's registration or endorsement

28.6% related to a decision to refuse registration, refuse renewal of registration or refuse an endorsement on registration

3.6% related to a decision to refuse to change or remove a condition imposed on a person's registration or the endorsement of a person's registration

10.7% related to a decision to suspend a person's registration

28.6% related to appeals against other decisions

The majority of these appeals related to the professions with higher regulatory decision volumes, such as medical practitioners (13), and nurses (9). There were 71 appeals finalised in 2017/18. Refer to Table 26 and Figure 14.

18.3% had the original decision confirmed

50.7% were withdrawn by the appellant and did not proceed, meaning the original decision remained in place

18.3% resulted in the original decision being substituted with a new decision
(7 matters) or the original decision being amended (6 matters)

12.7% were dismissed on administrative grounds

There were 53 appeals still pending as at 30 June 2018.

The National Scheme's regulatory principles apply to all regulatory decision-making. The principles are designed to encourage a responsive, risk-based approach to regulation across all professions to ensure the public is safe. The low proportion of successful appeals that resulted in an amended/substituted decision demonstrates that the regulatory principles continue to have a positive impact on regulatory decision-making.

More information about appeals in 2017/18 is available in the supplementary tables.

Table 25: Appeals lodged in 2017/18 by profession and jurisdiction

Profession	AHPRA1 ACT	AHPRA1 NSW	AHPRA1 NT	AHPRA1 QLD	AHPRA1 SA	AHPRA1 TAS	AHPRA1 VIC	AHPRA1 WA	AHPRA1 No PPP2	AHPRA Subtotal 2017/18	HPCA3	Total 2017/18	Total 2016/17
Aboriginal and Torres Strait Islander Health Practitioner										0		0	0
Chinese medicine practitioner										0	1	1	3
Chiropractor					1					1		1	1
Dental practitioner		1			2					3	3	6	6
Medical practitioner		5	1	3	1	1	2			13	13	26	37
Medical radiation practitioner				1						1		1	1
Midwife										0		0	0
Nurse		1	1		2		5			9	6	15	26
Nurse and midwife										0		0	1
Occupational therapist										0		0	0
Optometrist										0		0	0
Osteopath										0		0	1
Pharmacist										0		0	6
Physiotherapist										0		0	1
Podiatrist										0		0	1
Psychologist	1									1	1	2	6
Total 2017/18	1	7	2	4	6	1	7	0	0	28	24	52
Total 2016/17	1	9	3	19	10	2	23	14	1	82	8		90

Table 26: Nature of decision appealed where the appeal was finalised through consent order or a contested hearing or where the appeal was withdrawn

Profession	Original decision confirmed – AHPRA1	Original decision confirmed – HPCA2	Original decision amended – AHPRA	Original decision amended – HPCA	Original decision substituted for a new decision – AHPRA	Original decision substituted for a new decision – HPCA	Withdrawn – AHPRA	Withdrawn – HPCA	Dismissed – Administrative – AHPRA	Dismissed – Administrative – HPCA	Total 2017/18 – AHPRA	Total 2017/18 – HPCA	Total 2016/17 – AHPRA	Total 2016/17 – HPCA
Appeal against a tribunal decision	1	2				1			1	1	2	4	2	0
Decision to impose conditions on a person's registration under section 178	3		4		2		16		3		28	0	0	0
Decision to impose or change a condition on a person's registration or the endorsement of the person's registration		2	2	1	1	1	7	4	2	1	12	9	31	4
Decision to refuse to change or remove a condition imposed on the person's registration or the endorsement of the person's registration	1						1		1		3	0	5	2
Decision to refuse to endorse a person's registration											0	0	1	0
Decision to refuse to register a person	5				1		9			1	15	1	13	0
Decision to refuse to renew a person's registration											0	0	3	0
Decision to reprimand a person											0	0	1	1
Decision to suspend a person's registration	2	3			3	1		1			5	5	8	6
Other											0	0	0	1
Not an appellable decision							1		1		2	0	1	0
Judicial review	1						2		1		4	0	3	0
Total 2017/18	13	7	6	1	7	3	36	5	9	3	71	19
Total 2016/17	11	10	3	0	6	2	44	2	4	0			68	14

Statutory offences

Performance snapshot

• 581 statutory offence complaints were received this year
• 667 statutory offence complaints were considered and closed
• 189 open statutory offence complaints were still under review as at 30 June 2018, a 48% decrease compared with the previous year
• Over 71% of all new statutory offence complaints related to alleged unlawful use of title and unlawful claims to registration
• 132 new serious-risk advertising complaints were received; 143 were closed
• 13 prosecutions were completed in the Magistrates' or Local Court for statutory offences under the National Law

What are statutory offences?

The National Law includes a number of criminal (summary) offences which relate to conduct that can put individuals and the community at risk. Offences under the National Law may be committed by a person (including registered health practitioners and unregistered individuals) and/or corporate entities. Visit the What is an offence? page on the AHPRA website.

Types of statutory offence

Offences under the National Law predominantly relate to title protection, unlawful claims as to registration, restricted acts, and advertising of regulated health services.

Unlawful use of protected titles

The National Law restricts the use of protected titles (sections 113, 114 and 115). It is unlawful for someone to knowingly or recklessly use a title to make someone believe they are registered in one of the 15 regulated health professions, or other practices including using a specialist title when the person does not have specialist registration or endorsement.

A breach of this type carries a maximum fine of $60,000 for a corporate entity, or $30,000 for an individual, per offence.

Unlawful claims to registrations by individuals or corporate entities

It is unlawful to knowingly or recklessly claim to be a registered health practitioner under the National Law when you do not hold registration (sections 115, 116 and 118). This can include using a title, name, initial, symbol, word or description that could be reasonably understood to indicate that an individual is a health practitioner or is qualified to practise in a health profession. The National Law also states that a person must not claim that another individual is a registered health practitioner.

A breach of this 'holding out' provision is an offence and carries a maximum fine of $60,000 for a corporate entity, or $30,000 for an individual, per offence.

A registered health practitioner must not claim to be a specialist health practitioner if they do not hold registration in the specialist category (sections 117 and 119). A breach of section 117 or 119 by a registered health practitioner does not constitute an offence but may constitute behaviour for which health, conduct or performance action may be taken.

Performing a restricted act

The National Law (sections 121, 122 and 123) restricts certain practices:

• restricted dental acts
• restricted prescription of optical appliances, and
• restricted spinal manipulation.

A breach of restricted act provisions in the National Law carries a maximum fine of $60,000 for a corporate entity, or $30,000 for an individual, per offence.

Unlawful advertising

Under the National Law (section 133), you may not advertise a regulated health service or a business providing a regulated health service in a way that:

• is false, misleading or deceptive or is likely to be misleading or deceptive
• offers a gift, discount or other inducement to attract a person to use the service or the business, unless the advertisement also states the terms and conditions of the offer
• uses a testimonial or purported testimonial about the service or business
• creates an unreasonable expectation of beneficial treatment, or
• directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services.

A breach of the advertising provisions of the National Law is an offence and carries a maximum fine of $10,000 for a corporate entity, or $5,000 for an individual, per offence.

Concerns about unlawful advertising are managed in two ways:

• serious-risk advertising complaints, advertising complaints by corporate entities and unregistered persons are managed as statutory offences, and
• low- to moderate-risk advertising offences by registrants are managed under the Advertising compliance and enforcement strategy.

Statutory offences received and closed in 2017/18

AHPRA recorded 581 new offence complaints during 2017/18.

Most jurisdictions experienced a decrease in offence complaints received when compared with the previous year. Victoria and NSW continue to account for the majority of offence complaints and this year accounted for more than 68% of all new offence complaints.

More than 71% of offence complaints received nationally related to concerns about alleged unlawful use of title and unlawful claims as to registration. See Figure 15.

This year 667 offence complaints have been closed. Refer to Table 27.

As at 30 June 2018, there were 189 statutory offence complaints under review, down from 355 at 30 June 2017, which is a 48% decrease in open offence complaints. See Figure 16.

See Compliance for offence complaints managed under the Advertising compliance and enforcement strategy.

22.7% related to advertising offences by corporate entities or unregistered persons

71.6% related to title protection offences

2.4% related to practice protection offences

0.9% related to directing or inciting unprofessional conduct/professional misconduct

2.4% related to other offences

26.1% related to advertising offences by corporate entities or unregistered persons

69.7% related to title protection offences

3.2% related to practice protection offences

1.0% related to other offences

Table 27: Statutory offence complaints received and closed, by type of offence and profession¹

Profession	Title protections (s.113–120) – Received	Title protections (s.113–120) – Closed	Practice protections (s.121–123) – Received	Practice protections (s.121–123) – Closed	Advertising breach (s.133) – Received	Advertising breach (s.133) – Closed	Directing or inciting unprofessional conduct/professional misconduct (s.136) – Received	Directing or inciting unprofessional conduct/professional misconduct (s.136) – Closed	Other offence – Received	Other offence – Closed	Total 2017/18 – Received	Total 2017/18 – Closed	Total 2016/17 – Received	Total 2016/17 – Closed
Aboriginal and Torres Strait Islander Health Practitioner		1									0	1	3	2
Chinese medicine practitioner	19	25	1	2	11	5					31	32	72	38
Chiropractor	17	18	2	2	13	10			1	1	33	31	162	192
Dental practitioner	33	34	8	8	14	14					55	56	239	295
Medical practitioner	114	114	1	1	49	64	5	5	7	7	176	191	273	283
Medical radiation practitioner	6	7			1	1					7	8	4	9
Midwife	1	5									1	5	8	35
Nurse	62	77	2	2	8	9			2	2	74	90	76	80
Occupational therapist	14	16									14	16	9	13
Optometrist	3	2			3	5					6	7	23	24
Osteopath	2	3			2	3			1	1	5	7	252	24
Pharmacist	10	14			8	8			1		19	22	53	48
Physiotherapist	28	33		2	8	11			1	1	37	47	940	657
Podiatrist	2	6			2	2			1	1	5	9	20	19
Psychologist	105	130		1	12	11				3	117	145	116	110
Unknown2					1						1	0	47	56
Total 2017/18	416	485	14	18	1323	1433	5	5	14	16	581	667
Total 2016/17	368	422	14	18	1,895	1,416	6	10	14	19			2,297	1,885

Managing offence complaints

Statutory offences are managed with a risk-based approach, focusing on protecting the public and ensuring the timely resolution of all complaints. All new offence complaints are risk assessed, and this dictates the course of action required to ensure public safety. Offences under the National Law are 'summary offences' and are prosecuted in the Magistrates' or Local Court of the relevant state or territory. All offences under the National Law carry penalties of fines that may be imposed by a Court on a finding of guilt.

As required, serious risk offence complaints are investigated by an inspector. This may include applying to the Magistrates' or Local Court for a warrant to search premises and seize evidence.

AHPRA, in consultation with the relevant National Board, will prosecute offences against individual(s) and/or corporate entities where there is a legitimate public-interest concern to do so.

Advertising requirements

Guidelines for advertising regulated health services have been published to help anyone advertising regulated health services to do so appropriately. In turn, AHPRA and the National Boards have published and implemented an Advertising compliance and enforcement strategy that outlines the risk-based management of offence complaints, particularly advertising complaints.

For more information about the management of low- to moderate-risk advertising complaints, see the compliance section of this report.

Prosecutions under the National Law

There have been a number of significant prosecutions this year that demonstrate the importance of the statutory offence function for the protection of the public.

AHPRA completed 13 proceedings in the Magistrates' and Local Courts for offences under the National Law across three jurisdictions. All prosecutions resulted in findings of guilt; eight with a conviction and five with no conviction recorded; and in all cases the individual or entity was fined. These outcomes demonstrate that AHPRA continues to identify appropriate thresholds for referring offence complaints for prosecution to protect the public.

Further information about these matters is outlined in Table 28 and Figure 17. Some prosecutions that started in 2017/18 and were concluded after the financial year have been reported here for completeness. Information about AHPRA's prosecutions is available on the News page on the AHPRA website.

A further six prosecutions are ongoing before the courts as at 30 June 2018.

61.5% resulted in a conviction recorded against the individual, and an order to pay a fine and/or complete a period of community service or good behaviour

38.5% resulted in a finding of guilt with 'no conviction recorded', but the individuals were still ordered to pay a fine and/or complete a period of community service or good behaviour

Table 28: Completed prosecutions as at 30 June 2018

Defendant	Date of decision	Jurisdiction	Relevant Board	Relevant section of National Law1	Type of offence	Outcome	Sentence
De-identified2	29 August 2017	Vic	NMBA	s. 113(1)(a), s. 116(1)(b)(i), s. 116(1)(c)	Use of protected title Holding out as a registered health practitioner	Found guilty but no conviction recorded	The accused was fined $6,000 and ordered to pay costs of $8,217.
Jangodaz, Reza	11 September 2017	NSW	DBA	s. 116(1)(c)	Holding out as a registered health practitioner	Convicted	The accused was fined $4,750 and ordered to pay costs of $4,000.
De-identified	27 September 2017	Vic	MBA and PsyBA	s. 113(1)(a), s. 116(1)(c), s. 118(1)(b)(ii), s. 118(1)(c)	Use of protected title Holding out as a registered health practitioner Unlawful claim to specialist registrations	Found guilty, but no conviction recorded	The accused was fined $20,000 and ordered to pay costs of $10,000.
Wellness Enterprises Pty Ltd t/a Australian Male Hormone Clinic	3 October 2017	Vic	MBA	s. 133(1)(d)	Breach of advertising provisions	Convicted	The accused was fined $127,500 ($7,500 per offence) and ordered to pay costs of $6,000.
Morris, Chantelle	17 November 2017	Qld	NMBA	s. 113(1), s. 116(1)(c)	Use of protected title Holding out as a registered health practitioner	Convicted	The accused was fined $12,000 and ordered to pay costs of $3,916.
De-identified	25 January 2018	Vic	PsyBA	s. 113(1)(a), s. 116(1)(b)(i), s. 116(1)(c)	Use of protected title Holding out as a registered health practitioner	Found guilty, but no conviction recorded	The accused was fined $4,500 and ordered to pay costs of $7,500.
Zaphir, George	30 January 2018	Qld	ChiroBA	s. 113(1)(a), s. 116(1)(b), s.116(1)(c)	Use of protected title Holding out as a registered health practitioner	Convicted	The accused was fined $12,000 and ordered to pay costs of $3,537.
Mohamad Anwar, Mohamad Faizal	1 February 2018	Vic	MBA	s. 116(1)(c)	Holding out as a registered health practitioner	Convicted	The accused was fined $100,000 ($25,000 per offence) and ordered to pay costs of $14,885.
De-identified	5 February 2018	Vic	PsyBA	s. 113(1)(a), s. 116(1)(c)	Use of protected title Holding out as a registered health practitioner	Found guilty, but no conviction recorded	The accused was fined $10,000 and ordered to pay costs of $14,325.
De-identified	6 February 2018	Vic	MBA	s. 116(1)(c)	Holding out as a registered health practitioner	Found guilty, but no conviction recorded	The accused was fined $7,500 and ordered to pay costs of $20,000.
Be, Karren	28 February 2018	NSW	PharmBA	s. 113(1)(a) (withdrawn), s. 116(1)(c)	Use of protected title Holding out as a registered health practitioner	Conviction	The accused was fined $11,250 and ordered to pay costs of $6,920.
Citer, David	9 May 2018	NSW	PsyBA	s. 116(1)(b)(ii)	Holding out as a registered health practitioner	Conviction	The accused was fined $9,500 and ordered to pay costs of $5,000.
Lipohar, Edward	7 June 2018	Vic	DBA	s. 118(1)(c), s. 121(1)	Holding out as a registered health practitioner Unlawful use of specialist title Carrying out restricted dental acts	Conviction	The accused was fined $65,000 and ordered to pay costs of $25,000. The fine and cost order stayed for six months on application of the accused.

Compliance

Performance snapshot

• 5,065 cases were being actively monitored by AHPRA at 30 June 18 – these cases related to 5,005 registered practitioners
• 27.6% were about conduct, health or performance
• 66.1% were about suitability/eligibility for registration
• 6.2% related to prohibited practitioners/students
• As at 30 June 2018, there were 70 restrictions (conditions or undertakings) in the National restrictions library
• 911 new low- to moderate-risk advertising complaints about registrants were managed under the Advertising compliance and enforcement strategy

How AHPRA monitors compliance

On behalf of the National Boards, AHPRA monitors health practitioners and students with restrictions (conditions or undertakings) placed on their registration, as well as those with suspended or cancelled registration. By identifying any non-compliance with restrictions and acting swiftly and appropriately, AHPRA supports Boards to manage risk to public safety.

To find out about active monitoring cases in 2017/18, please refer to Tables 29 and 30. Table 29 reports on active monitoring cases by state and territory. Table 30 reports on these cases by each profession. Restrictions are placed on a practitioner's registration through a number of mechanisms, including as an outcome of a notification, or when a practitioner applies for registration or renewal of registration.

Each monitoring case is assigned to one of five streams.

This year, the number of active monitoring cases nationally decreased by 0.4%. The cases monitored by AHPRA relate to 5,005 individual practitioners and the majority were in relation to monitoring of eligibility/suitability requirements. There was also a 23.0% (59 cases) increase in the number of cases relating to a prohibited practitioner/student when compared with last year.

Expanding our reporting capability

Since the introduction of compliance performance reporting in 2015/16, we have continued our focus on managing risks associated with monitoring cases and identifying opportunities to improve the quality, timeliness and accuracy of our compliance work, including in reporting. Improvements have been made to our ability to report at the level of restriction categories for each compliance case. Reporting at restriction level has many advantages for understanding risks associated with the monitoring of each individual practitioner and the overall monitoring caseload. These improvements will:

• provide a simple and efficient tool to extract information about how many registrants are subject to monitoring for particular types of restrictions, such as for boundary violations, drug and alcohol testing, education and up-skilling, practice limitations and supervised practice
• provide a simple and efficient tool to extract reports about how many practitioners are subject to monitoring for 1, 2, 3, 4, 5 or more concurrent restriction categories, and
• enable the development of more effective mechanisms for identifying the complexity of monitoring cases, for establishing the resources required to monitor particular cases and for the management of individual and team caseloads.

Performance has remained strong across all key performance indicators in all quarters.

Advertising compliance and enforcement

AHPRA's compliance and legal divisions manage the enforcement aspects of the Advertising compliance and enforcement strategy. We have established an advertising compliance team, which is responsible for the triaging of all offence complaints, the assessment of all advertising offence complaints and the ongoing management of low- and moderate-risk advertising complaints under this strategy.

The strategy was developed to ensure advertising about regulated health services is done responsibly to keep the public safe from false or misleading claims and to help them make informed choices about their healthcare. It explains how:

• our risk-based approach is applied to advertising compliance and enforcement
• we encourage voluntary compliance and deal with non-compliant advertising, and
• we plan to evaluate and refine this strategy.

Responsible advertising is a professional and legal obligation. We recognise that most health practitioners want to comply with the law and their professional obligations, and we aim to make compliance as easy as possible.

The data in 2017/18 confirm that nearly 50% of registrants become compliant in response to the initial letter about the advertising breach, with the remainder becoming compliant when the imposition of advertising restrictions is being considered and the practitioner is issued with the show cause notice where each breach and its location is specified. This demonstrates the effectiveness of the strategy in educating practitioners on their professional obligations and ensuring timely remediation of inappropriate advertising for the benefit of the public. There were no instances of continued non-compliant advertising that required regulatory action through the imposition of advertising restrictions.

You can read the Advertising compliance and enforcement strategy on the AHPRA website.

Counselling restrictions pilot

This year, National Boards endorsed the introduction of counselling as a notifications outcome by placing a restriction on a practitioner's registration requiring the practitioner to attend Board-led counselling. This is only done in conjunction with a formal caution and to reinforce the issues and reasons for the caution with the practitioner and explore what is required of the practitioner to improve their conduct to prevent recurrence of the issues.

National Boards also endorsed the concept of a pilot with the Psychology Board of Australia to review and confirm the decision-making considerations for imposing a counselling restriction, Board member training, the monitoring process and the overall impact on the practitioner's insights into past conduct and prevention strategies.

The implementation of the pilot was supported by the compliance function, primarily through:

• drafting of policy and guidelines to support the use of a counselling restriction
• development of a standard counselling restriction for use in the pilot
• revising template notices to include an information sheet on the counselling process
• developing and implementing processes to support the policy position and the actual counselling requirement, and
• developing and implementing Board member training on decision-making considerations for imposing a counselling restriction, appointment of counsellors, conducting the counselling and record-keeping associated with the counselling requirement.

The pilot outcomes will inform the wider use of counselling restrictions across all professions.

Table 29: Active monitoring cases at 30 June 2018, by state or territory (including HPCA)

	AHPRA ACT	AHPRA NSW1	AHPRA NT	AHPRA QLD	AHPRA SA	AHPRA TAS	AHPRA VIC	AHPRA WA	AHPRA No PPP2	AHPRA Subtotal 2017/183	HPCA4	Total 2017/18	Total 2016/17
Conduct	7	3	5	52	45	10	107	44	2	275	365	640	687
Health	14	11	12	251	58	20	114	71	13	564	320	884	896
Performance	14	6	14	143	75	23	198	85	3	561	166	727	684
Prohibited practitioner/student	3	3	10	55	58	9	131	42	4	315		315	256
Suitability/eligibility5	52	1,292	40	544	224	41	628	415	114	3,350		3,350	3,343
Total 2017/18	90	1,315	81	1,045	460	103	1,178	657	136	5,065	851	5,916
Total 2016/17	113	1,353	53	1,069	450	107	1,138	666	135	5,084	782		5,866

Table 30: Active monitoring cases at 30 June 2018, by profession and stream

Profession	Conduct – AHPRA	Conduct – HPCA	Health – AHPRA	Health – HPCA	Performance – AHPRA	Performance – HPCA	Prohibited practitioner/student – AHPRA	Suitability/eligibility1 – AHPRA	Total 2017/18 – AHPRA2	Total 2017/18 – HPCA	Total 2016/17 – AHPRA2	Total 2016/17 – HPCA
Aboriginal and Torres Strait Islander Health Practitioner			4		2		1	55	62	0	72	0
Chinese medicine practitioner	5	1			4	1	2	876	887	2	945	2
Chiropractor	6	4	4	3	8		6	16	40	7	49	9
Dental practitioner	12	23	17	13	66	50	6	22	123	86	134	60
Medical practitioner	100	192	205	125	230	29	85	1,072	1,692	346	1,620	340
Medical radiation practitioner	1		6	2	4		2	95	108	2	88	3
Midwife	3	1	4	1	9		2	137	155	2	155	2
Nurse	85	66	281	146	161	63	178	818	1,523	275	1,553	251
Occupational therapist		1	4			1	1	52	57	2	51	4
Optometrist	2		1	2	6		1	12	22	2	15	1
Osteopath		1	1	1	3		1	4	9	2	6	4
Pharmacist	17	61	19	14	32	12	11	93	172	87	175	76
Physiotherapist	9	3	3	3	10	2	3	33	58	8	64	3
Podiatrist			3		3	1	1	10	17	1	14	0
Psychologist	35	12	12	10	23	7	15	55	140	29	143	27
Total 2017/18	275	365	564	320	561	166	315	3,350	5,065	851
Total 2016/17	356	331	577	319	552	132	256	3,343			5,084	782