Monitoring restrictions on practitioners

The delivery of our compliance functions moved to a full national operating model that aims to bring a range of benefits to practitioners, staff and Boards, through more consistent management of compliance matters. Clear visibility of national demand will allow us to better manage workloads, making the most of the skills and experience we have nationally to ensure timely management of compliance matters for practitioners. National Boards will gain from consistent, expert advice to underpin consistency in regulatory decision-making. 

To reduce the length of restrictions in the National Restrictions Library (NRL) and make them less complex and more accessible, the review has recommended that the future structure of restrictions be amended by: 

• maintaining the core restriction for publication 
• including all operating and administrative requirements in standard monitoring plans rather than as ‘operating restrictions’, and
• then applying the requirements detailed in the standard monitoring plan as enforceable requirements through the core restriction. 

This amended approach will be implemented during 2020/21.

During 2019/20 three performance and quality assurance reviews were carried out: 

• Use of monitoring plans – we evaluated the use of monitoring plans and concluded in all but two cases that monitoring by staff was consistent with restrictions. 
• Use of prescribing data – we evaluated use of prescribing data to identify any practitioners who were prescribing to a prohibited or restricted patient group such as female patients. We concluded it was appropriate to continue to use prescribing data to monitor practitioners subject to restrictions relating to sexual misconduct as 21% of the data reviewed did identify actual breaches. 
• Aged restrictions on registration – we reviewed cases with restrictions on registration aged more than two years. We concluded from the review that the aged restrictions on each practitioner’s registration were appropriate and current as they commonly related to: restricting scope of practice; monitoring long-term health issues; or the restrictions were imposed in circumstances required by the registration standard. 

In the top 10 restriction categories there were 4,743 restrictions monitored by Ahpra at 30 June. Although 4,215 cases were being actively monitored by Ahpra, each case may have more than one restriction category requiring compliance by the practitioner.

• 60.7% of restrictions imposed (2,879) in the top 10 restriction categories by volume were as a result of the routine process of a health practitioner obtaining or renewing registration with a National Board.
• 39.3% (1,864) of the restrictions in the top 10 restriction categories by volume were imposed as a result of a finding made by a National Board, panel or tribunal about a practitioner’s health, performance or conduct.

The top 10 restriction categories by volume at 30 June were:

• Restriction on practice and employment
• Requirement for supervision
• Undertake education
• Undertake assessment
• Restriction on scope of practice
• Attend treating practitioner
• Prohibition on practice
• Restriction on workplace location
• Requirement to practise under indirect and remote supervision
• Restriction on work type.

In 2019/20, 412 low-to-moderate-risk advertising complaints about registrants were received under the strategy. In 2018/19, 515 low-to-moderate-risk advertising complaints were received. The reduction of 20.0% in these types of advertising complaints received this year is the result of an increase in referral of: 

• advertising complaints about those who are not registered health practitioners to the National Legal Practice for action.
• complaints to be actioned as notifications as the matters raised related to the health, performance or conduct of a registered health practitioner. 

The data confirm that nearly 50% of registrants become compliant in response to an initial letter from Ahpra about the advertising breach. The remainder become 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 about 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.