Transcript Board meeting 2010

Regulating Health Practitioners:
Common Challenges across Health Systems
Martin Fletcher,
Chief Executive Officer
Australian Health Practitioner Regulation Agency
[email protected]
www.ahpra.gov.au
Overview
• Global trends
• Australian experience
• Common challenges
Health practitioner regulation
• Licensing or registration of health professionals
using a legislative base
• Enforceable requirements for entry to the
profession
• Set educational requirements and standards
• Standards of practice
• Regulates conduct, (performance and health)
– Restrictions necessary to protect the public
(protective jurisdiction rather than punitive)
Global trends in regulation
• Time of great change – no single model
• Core focus on patient and public safety
• Growing interest in effective regulatory systems
– Well designed regulation and burden
– Costs of regulation and economies of scale
• ‘Professionally led’ rather than ‘self regulation’
– Greater community involvement
Global trends in regulation
• Greater range of stakeholder involvement
• Drive for greater transparency
• Common frameworks across professions
– Multi- profession approaches
– Integration of health and social care
• Greater focus on ongoing competence to practise
• Global mobility of health workforce
Right touch regulation
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Identify the problem before the solution
Quantify the risks
Get as close to the problem as possible
Focus on the outcome
Use regulation only when necessary
Keep it simple
Check for unintended consequences
• Review and respond to change
UK Professional Standards Authority
Australia
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23 million people
Federal system of government
9.3% of GDP on health
Joint government funders
70% public – 30% private mix
Good health status overall
Major gap for indigenous health
Mal-distribution of heath workforce
Significant international workforce
www.ahpra.gov.au
Long and Proud History
Former Tasmanian
Medical Council
• 1837 – regulation of medical
practitioners in Van
Diemens Land (Tasmania)
• Predates UK by 21 years
• States have power to
register/ regulate - not
Commonwealth
• History of piecemeal
changes
• Major transformation in past
3 years
www.ahpra.gov.au
Patient safety and workforce
driving reform
A major transformation since 2010
• Eight State and Territory
based arrangements
• One national scheme
• >95 health profession
boards
• 14 health profession
boards
• 75 Acts of Parliament
• Nationally consistent
legislation (largely)
• 38 regulatory organisations • One national organisation
(AHPRA)
• 1.5 million data items from • National on line registers
94 sources
www.ahpra.gov.au
Over 600,000 Health Practitioners
July 2010
1. chiropractors
2. dental care (including dentists,
dental hygienists, dental
prosthetists & dental therapists),
3. medical practitioners
4. nurses and midwives
5. optometrists
6. osteopaths
7. pharmacists
8. physiotherapists
9. podiatrists
10. psychologists
July 2012
1. Aboriginal and Torres Strait
Islander health
practitioners
2. Chinese medicine
practitioners
3. medical radiation
practitioners
4. occupational therapists
www.ahpra.gov.au
How many registered practitioners in Australia?
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Objectives of Legislation
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Protection of the public
Workforce mobility within Australia
High quality education and training
Rigorous and responsive assessment of overseas
trained practitioners
• Facilitate access to services in accordance
with the public interest
• Enable a flexible, responsive and
sustainable health workforce and enable
innovation
www.ahpra.gov.au
What do we do?
AHPRA works with 14 National Health
Practitioner Boards to:
• Set professional standards - entry into
the profession
• Register practitioners - compliance
with standards (annual renewal)
• Maintain national register
• Manage notifications - address
concerns about ‘fitness to practice
• Accreditation - set standards for
educational pathways to registration
www.ahpra.gov.au
Registration standards
Common Domains
1. Criminal history
2. English language
requirements
3. Professional Indemnity
Insurance arrangements
4. Continuing Professional
Development
5. Recency of Practice
www.ahpra.gov.au
Criminal history checks – the first year
• 52,445 checks requested
• 2992 (6%) identified criminal
history
• 449 (0.0075%) of these with
potential to affect registration
• 40/449 action by a National
Board:
– 1 application refused
– 6 applications withdrawn
– 31 conditions/ undertakings
– 2 conditions imposed at
renewal
Cancelled Health Practitioners
Common Issues
• How do we regulate
‘honest’ error?
• Ensuring ongoing
competence
• Social media
• Transparency and trust
Shared responsibility for patient safety
Indemnity
Organisations
Community
Practitioners
Regulators
Law
Employers
Educators
INDIVIDUAL
SYSTEM
Mandatory notifications
• Practitioners and employers must report a registrant who they
believe has engaged in notifiable conduct (some exceptions)
• Belief formed through the practice of the profession
• Notifiable conduct is:
– practising while intoxicated by drugs or alcohol
– engaging in sexual misconduct in professional practice
– placing the public at risk of substantial harm through a physical
or mental impairment affecting practice
– placing the public at risk of harm through a substantial
departure from accepted professional standards
• Educators – obligated to report significant student impairment and
serious criminal matters
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Lessons?
• Continuing competence a focus of all regulatory systems
– no single model
• Much debate about methods and approaches
• Importance of local systems for identifying and
managing poor performance
• Opportunities to learn from the UK experience
– Difference in role of employers
• Embryonic evidence on links to safer outcomes
– Work is still to be done
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What does Confucius have to
say about the regulation of
health practitioners?
www. ahpra.gov.au