Is AHPRA a “partly failed” experiment?

Questions raised over the success of our national healthcare professional registration scheme

Australia’s five-year-old national registration scheme for healthcare practitioners is flawed, an academic has claimed.

Writing in the Australian Health Review, Kerry Breen from the Department of Forensic Medicine at Monash University says “the available evidence indicates that the scheme’s design and its implementation were rushed and that the legislation has serious flaws”.

The most obvious drawback was the sudden marked increase in the annual fee for renewal of registration when it was introduced in 2010. Subsequent condemnation led to political pressure being brought to bear on AHPRA and the boards to keep future increases within the consumer price index (CPI).

“This restriction may make it more difficult to fund desirable new initiatives,” said Breen, a past president of the Australian Medical Council and of the Medical Practitioners Board of Victoria.

Other drawbacks include the size of the new bureaucracy (creating problems of accountability and efficient access to information and advice), its remoteness from those it regulates and forcing of a single framework on all health professions.

“The single framework for some policy documents means that important guidelines are delayed by the need for every health professional board to be consulted and for agreement to be reached on wording,” he said.

Breen says communication at a state, and particularly local, level has been lost with the introduction of the national board scheme, and that the complaint notification process is confused.

In addition, Breen said the most controversial flaw in the legislation lies in Section 141, which covers mandatory reporting of several forms of alleged misconduct, along with alleged impairment of practitioners due to ill health where that impairment has placed the public at risk of substantial harm.

“There are two distinct problems,” he said. “First, it is stigmatising to group the reporting of ill health with the reporting of allegations of sexual misconduct; ill health should have its own section in the national law.”

Second, constituent AHPRA boards are able to issue a caution without the health professional in question being interviewed by a Board member or even by an AHPRA staff member.

“The national scheme should be regarded as an expensive experiment that has partly failed,” Breen concludes.

“In hindsight, I recognise the wisdom of the reluctance of NSW to join. For those jurisdictions with a long experience of fully local and well-integrated health complaints commissioners, registration boards and independent disciplinary and appeal tribunals, the NSW model of co-regulation must now seem very attractive.

“To move in this direction would bring the benefits of more accountability of the core aspects of the scheme to the state health minister, a less remote bureaucracy and restoration of trust”.

Breen says the one aspect of the national scheme that is regarded as a success – a central database for national portable registration – should be maintained by a much pared-down AHPRA.

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