Revised guidelines for mandatory notifications have been released as changes are set to come into effect early next month
With amendments to the Health Practitioner Regulation National Law having been passed last year, AHPRA has released its revised guidelines for mandatory reporting ahead of their commencement in early March 2020.
The amendments, which will apply in all states and territories except Western Australia, have raised the threshold for what should lead to mandatory notification by treating practitioners for three of the four types of conduct—impairment, intoxication and practice outside of professional standards.
This threshold will now be “substantial risk of harm” which AHPRA describes as “a very high threshold for reporting risk of harm to the public”.
“In context of mandatory notifications, we want to hear from practitioners and employers only where there is a concern of substantial risk to patients,” explains CEO of AHPRA Martin Fletcher.
However any concerns about sexual misconduct—the fourth type of conduct—should continue to be the subject of a mandatory notification, with treating practitioners required to report past, present and future concerns as well.
Under the amendments, the reporting thresholds vary for different groups.
While treating practitioners must report practitioners who are practising with an impairment, practising while intoxicated by alcohol or drugs, or are significantly departing from professional standards, they must only do so if they believe the conduct to “be at a level that “place[s] the public at substantial risk of harm”.
They must report any circumstance where the practitioner “has engaged in, is engaging in or might engage in sexual misconduct connected to their practice” (emphasis added).
Meanwhile non-treating practitioners and employers must do the same except for a few differences – they must report all practitioners who are practising while intoxicated by alcohol or drugs, regardless of whether it is believed they are placing the public at risk of substantial harm.
And they must report practitioners if they engage in sexual misconduct connected to their practice.
Western Australia will continue to operate under different legislation.
Treating practitioners in Western Australia providing a health service to a practitioner-patient or student are exempt from the requirement to make a mandatory notification.
However, these practitioners still have a professional and ethical obligation to protect and promote public health and safety, so they may consider whether to make a voluntary notification, says AHPRA.
As there are only limited circumstances when a mandatory notification can be made about a student, separate guidelines for notifications about students and practitioners have been developed.
A mandatory notification about a student can only be triggered by concerns about impairment.
According to the new guidelines, the National Law defines ‘impairment’ as a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect the student’s capacity to carry out clinical training as part of the approved program of study in which the student is enrolled, or arranged by an education provider.
“A health condition and impairment are not the same thing,” explain AHPRA and the national boards in the new guidelines.
“An illness or condition that does not have a detrimental impact on a student’s capacity to undertake clinical training is not an impairment.”
Providing guidance on behalf of AHPRA, psychiatrist Dr Kym Jenkins explains that fear of mandatory reporting should not be a barrier for health professionals seeking help.
“Illness is not impairment—feeling stressed and wanting to do something about it is not a condition for mandatory reporting,” explains Dr Jenkins.
“Being on treatment for a mental illness is not a condition for mandatory reporting. Seeking treatment for it, having a mental illness in the past or taking time off work are not conditions for mandatory reporting,” she says.
Mr Fletcher says AHPRA is aware that many health practitioners have “crippling fears” about receiving a mandatory report about health impairment.
“These are the unintended consequences of mandatory reporting. And this is a challenge for all of us, because all of us want to make sure that health practitioners feel safe to get the care they need when they need it,” he says.
“Healthy practitioners are good for patient safety. We want all registered practitioners to know what the changes mean for them and to seek advice and support for their own health and wellbeing, without fear of an unnecessary mandatory notification.”
See some case studies here. Further case studies and supporting resources can be found within the revised AHPRA guidelines (see below).
If you are a registered health practitioner, employer and/or education provider who’s thinking about making a mandatory notification before March 2020 you need to refer to the current guidelines.