30 November 2023
PDF version [568 KB]
Rebecca Storen and Leah Ferris
Social Policy and Law & Bills
Digest
Introduction
This quick guide provides an overview of health practitioner
regulation in Australia. It first discusses the establishment of the Health
Practitioner Regulation National Law (National Law) and the National
Registration and Accreditation Scheme (National Scheme), then outlines the role
of the Australian Health Practitioner Regulation Agency and the National Boards,
and key elements of the National Scheme. It then summarises other regulatory structures
that health professionals may fall under and provides links to health workforce
statistics.
Establishment of the National Law and the National Scheme
In 2006, the Productivity Commission’s Australia’s
health workforce report recommended national consolidation of health
workforce registration and accreditation functions to facilitate a consistent
approach across professions and jurisdictions. Later that year, the Council of
Australian Governments (COAG) agreed in principle to establish
a national registration scheme (to register individuals qualified
to practise in selected professions) and a national accreditation scheme (to assess
education and training courses), each supported by national profession-specific
boards and accreditation authorities (p. 6). Two years
later, the Intergovernmental
Agreement for a National Registration and Accreditation Scheme for the Health
Professions was
signed.
The National Scheme was implemented through the adoption of
the National Law in all states and territories in 2009 and 2010. The National
Law is not a Commonwealth law. Instead, it is enacted and implemented by each state
and territory parliament having
passed nationally consistent legislation. Under the Intergovernmental
Agreement, Queensland is the host jurisdiction and the National Law is set out
in a schedule to the Health
Practitioner Regulation National Law Act 2009 (Qld). Other
jurisdictions enacted either corresponding legislation or legislation applying
the Queensland legislation in their jurisdiction. In order for the National Law
to be amended, any proposed amendments must be approved by the Ministerial Council
(which meets as the Health
Ministers Meeting) and passed by the Queensland Parliament (and other state
and territory parliaments where required).
The number of professions regulated by the National Law has
grown over time, with the Intergovernmental Agreement setting out the agreed
process for adding additional health professions to the National Scheme. There
are currently 16 professions under 15 Boards in the National Scheme, up from 11
professions on commencement in 2010 (Table 1).
Table 1 Professions in the
National Scheme and corresponding National Board
Source: Australian Health
Practitioner Regulation Agency and National Boards, A unique and substantial achievement: Ten years of
national health practitioner regulation in Australia, 2020, p. 10.
Role of Ahpra and the National Boards
The National Law establishes the Australian Health
Practitioner Regulation Agency (Ahpra) as the National Agency and provides a
framework for a National Health Practitioner Board for each health profession
(the National Boards).
Both Ahpra and the National Boards are required to take direction from the
Ministerial Council in exercising their respective functions under the National
Law (Figure 1).
Figure 1 Main groups that administer the National Scheme
Source: ‘What we do’,
Ahpra.
The National Scheme is funded by practitioners’ registration
fees, with fees set by each National Board to reflect the cost of regulating
each profession under the National Law.
Ahpra
Ahpra provides administrative assistance and supports the
National Boards to perform their functions. Its role includes:
- managing
applications for registration of health practitioners
- receiving
and investigating complaints about health practitioner performance, health and
conduct
- maintaining
a public register of health practitioners.
National Boards
The National Law is administered by the National Boards
established for each health profession. Their primary function is to protect
the public, and their role includes:
The National Scheme
The National Scheme is made up of several elements and
includes registration of health practitioners, maintaining a public register of
practitioners, accreditation of education providers and complaints management.
Protected titles
The titles of regulated
health professions are protected under the National Law. For example,
registered nurse, pharmacist and paramedic are all protected titles, meaning
anyone using those titles must be registered with the relevant National Board.
In addition, medicine, dentistry and podiatry also have specialist
titles approved by the Ministerial Council. If a person is eligible to use
a title, they appear on the Register
of practitioners. The list of titles may be updated from time to time,
which requires amendment to the National Law. As an example, the Health
Practitioner Regulation National Law (Surgeons) Amendment Act 2023 passed
by the Queensland Parliament in September 2023 made ‘surgeon’
a protected title for medical practitioners.
Registration of health
practitioners
A person who is registered under the National Law to practice
in a health profession is a ‘registered health practitioner’ and must meet the
relevant National Board’s registration standards. The registration standards
have 5 core requirements, with some variation on the specifics between Boards:
Health practitioners need to renew their
registration each year, with different renewal dates for different
professions.
Students who are undertaking a National Board approved
program of study or undertaking clinical training in a health profession under
the National Scheme are also required to register with the relevant Board. Under
the National Law, the education provider is responsible for ensuring that its students
are registered. There are no fees for student registration.
Register of practitioners
Ahpra is required to maintain an online register
of practitioners. This register enables anyone to search for a health
practitioner and identifies any condition, undertaking or limitation that has
been placed on a person’s registration. Ahpra also maintains a list of people
whose registration has been
cancelled and a list of people who have agreed
not to practice. Anyone on these lists is not allowed to provide services
as a health practitioner.
Training and education accreditation
Accreditation of study programs helps ensure provision of
high quality training and education of health practitioners.
Each health profession has an accreditation
authority that works closely with the relevant National Board (nursing and
midwifery are grouped together). Accreditation
authorities and National Boards have separate, but
complementary functions under the National Law.
The accreditation authorities develop and review the
accreditation standards, and assess study and education programs. Some of the
accreditation authorities also assess overseas assessment authorities and internationally
qualified practitioners.
The Boards are responsible for approving the accreditation
standards and the education
programs and determining if an overseas-qualified practitioner qualifies
for registration.
In
2022–23, there were more than 800 accredited education programs, and 19,288
overseas-qualified practitioners gained registration in Australia (pp. 47, 56).
Australian Medical Council
The Australian Medical
Council (AMC), the accreditation authority for medicine, is responsible for
developing standards for medical education and training across all stages of
medical education. The AMC accredits Australian and Australasian primary
medical education programs provided through universities,
and specialist medical training provided through the specialist
medical colleges.
The AMC-accredited specialist medical training programs provide
qualifications to practice in a recognised medical speciality. Specialist
registration is only available to medical practitioners who have been
assessed by an AMC-accredited specialist college as being eligible for
fellowship (or recognised equivalent courses).
For information on Australian Government funding for
university medical places, please see the Parliamentary Library’s FlagPost
on this topic.
Complaints about health
practitioners
Part 8 of the National Law sets out the processes by which
notifications (complaints) may be made to Ahpra about a registered health
practitioner. As NSW and Queensland have declared that they are not
participating in these processes (NSW wished to retain its existing
processes upon the introduction of the National Law, while Queensland established
a single-entry complaints management system in 2013), different
arrangements exist for reporting complaints in those jurisdictions (known
as the co-regulatory jurisdictions). Upon receiving a notification, Ahpra must
then refer the matter to the relevant Board and in the case of Queensland and
NSW, the relevant co-regulatory agency. In some
circumstances, Ahpra may refer notifications to the police and/or other
national or state-based complaints bodies (p. 15).
The National Law also requires health practitioners to make
a notification to Ahpra about a registered health practitioner in certain
circumstances and to report certain events to the relevant Board. A Board may
also decide to investigate a practitioner on its own motion.
Upon receiving a complaint, the Board will assess
the concern and can then take a number of actions, including dismissing the
concern, taking
immediate action or referring the matter for
investigation. For the most serious matters, a National Board or panel
may refer the matter to a tribunal.
There are a number
of possible outcomes from raising a concern. Some of these are decided by a
National Board and some can only be decided by a panel or a tribunal (for
example, only a tribunal can cancel a health practitioner’s registration).
Complaints can also be made to the National Health Practitioner
Ombudsman regarding the activities of Ahpra, the Boards and the
accreditation authorities in regulating health practitioners.
Other governance and regulation for health professionals
Professions outside of the scheme
Not all professions that work in the health and care sectors
come under the National Scheme – for example, social workers and dietitians are
‘unregistered’ professions. Unregistered practitioners are regulated by a
variety of self-regulatory mechanisms and codes of conduct, and are subject to
state and territory health complaints schemes.
In 2015, the COAG
Health Council agreed to the terms of the National
Code of Conduct for health care workers, setting out practice and conduct
standards for unregistered health workers, with each jurisdiction to implement and
regulate the National Code.
Other regulations
Health service provision is a complex system with
overlapping regulator jurisdictions. Alongside the regulation of individual
health practitioners through the National Scheme, people working in the system
are likely to have obligations through other mechanisms. Depending on the
setting, this may include common law obligations, care standards, medicine or
therapeutic goods regulations, occupational health and safety obligations, and
Australian consumer law.
Australian Commission on Safety and
Quality in Health Care (ACSQHC)
The ACSQHC is the national body responsible for leading and
coordinating improvements in health care safety and quality, notably through
the development of the National
Safety and Quality Health Service (NSQHS) Standards. State and territory
health departments determine which services
must be accredited, but in general, all public and private hospitals, day
procedure services and public dental practices must have accreditation. Alongside
the NSQHS Standards, the ACSQHC also undertakes work on several other sets of
standards, such as the National
Safety and Quality Primary and Community Healthcare Standards, clinical
care standards and the clinical
care standard of the Aged Care Quality Standards.
State and territory health
departments
State and territory health departments have a range of
regulatory functions that can directly and indirectly impact health
practitioners. For example:
- public
hospital staff may be required to have specific vaccinations before they can
work in a clinical setting
- the
jurisdictions’ medicines
and poisons laws can, among other things, enable pharmacists to provide
some vaccines and determine the use of electronic scripts.
Health workforce statistics
Ahpra publishes a range
of reports including quarterly
performance reports by state and territory. These reports provide
information on the health practitioners registered in the jurisdiction and some
comparison over time. The National Boards also release statistics for each practitioner
group (for example, see the registration
data for nurses and midwives). In 2022–23 there were 877,119
registered health practitioners. Table 2
shows the totals by profession.
Table 2 Total number of registered
health practitioners by profession, 2022–23
| Profession |
Total |
| Aboriginal and Torres Strait Islander Health Practitioner |
887 |
| Chinese medicine practitioner |
4,823 |
| Chiropractor |
6,345 |
| Dental practitioner |
26,692 |
| Medical practitioner |
136,742 |
| Medical radiation practitioner |
18,976 |
| Midwife |
7,683 |
| Nurse |
453,515 |
| Nurse and midwife* |
26,555 |
| Occupational therapist |
29,742 |
| Optometrist |
6,762 |
| Osteopath |
3,325 |
| Paramedic |
24,164 |
| Pharmacist |
36,425 |
| Physiotherapist |
42,098 |
| Podiatrist |
6,038 |
| Psychologist |
46,347 |
| Total |
877,119 |
*
Registrants who hold dual registration as both a nurse and a midwife.
Source: Ahpra, Annual report 2022–23 supplementary data tables, Table R5.
Further information is available through the National
Health Workforce Dataset, which includes registration and survey data. The
Department of Health and Aged Care makes some of this data available through a dashboard and
additional information may be accessed through the health workforce data tool. The
Australian Institute of Health and Welfare also releases health
workforce information from time to time.
Information on regulated health practitioners and
professions that are outside of the National Scheme is available from the
Australian Bureau of Statistics Census
of Population and Housing and its regular labour
force survey. This data also informs the interactive Australian Jobs Market website
and reports from Jobs and Skills
Australia.
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