# Australian Health Practitioner Regulation Agency

The Australian Health Practitioner Regulation Agency (Ahpra) is a cross-jurisdictional statutory authority responsible for the regulation of 16 common health professions in Australia. While legislated responsibility for regulation sits with 15 independent, profession-specific National Boards (Medical Board of Australia, etc.), Ahpra provides day-to-day services such as managing the registration of health practitioners and notifications (complaints) against practitioners on behalf of the National Boards. Ahpra and the National Board's primary purpose is to protect the health and safety of the Australian public through the registration and regulation of health practitioners, including delegating accreditation of education programs and maintaining the National Register of Health Practitioners.
According to a 2011 publication, "Australia [is] the first country in the world to have a national registration and accreditation scheme regulating health practitioners."
At the end of June 2024, there were 920,535 Ahpra-registered health practitioners, representing approximately 3.2% of the Australian population. In the 2023-24 financial year, Ahpra responded to 11,200 notifications about health practitioners, of which 2% resulted in practitioner de-registration and 10.9% resulted in other regulatory action.

## Legislative framework

Ahpra and the National Boards operate under the Health Practitioner Regulation National Law, whereby all state and territories enact similar legislation which recognises regulatory decisions made in other jurisdictions. Queensland acts as the 'host jurisdiction' of the National Law, whereby Queensland law establishes the relevant authorities which are then recognised by all other jurisdictions. National oversight and collaboration for the scheme takes place through the Australian Health Ministers' Conference and Australian Health Workforce Ministerial Council of all state and territory health ministers.
This effectively creates a national scheme, whereby health practitioner registration is managed federally, and regulation decisions apply in all other states and territories regardless of the jurisdiction that a decision was made in. In all states and territories, other than New South Wales and Queensland which have their own state-based regulators, Ahpra manages notifications (complaints) against health practitioners. The Office of the Health Ombudsman manages complaints for Queensland-based health practitioners, and the Health Professional Councils Authority and 15 profession-specific state boards manage complaints in New South Wales.

## Regulated professions and protected titles

As of 2022, Ahpra and the National Boards regulate 16 health professions in Australia. Registered members of these professions are called "health practitioners", while other clinicians are more generally called health professionals. 'Unregulated professions' such as sonography are still required to comply with the National Code of Conduct for Health Care Workers, however complaints are managed by state and territory health complaint organisations instead of Ahpra and the National Boards.
On 1 July 2010, the National Registration and Accreditation Scheme (NRAS) began for 12 profession groups:
* Chiropractors
* Dental practitioners (including dentists, dental hygienists, dental prosthetists, and dental therapists)
* Medical practitioners
* Nurses and midwives
* Optometrists
* Osteopaths
* Pharmacists
* Physiotherapists
* Podiatrists
* Psychologists
A further 4 professions were added the National Registration and Accreditation Scheme in July 2012:
* Aboriginal and Torres Strait Islander health practitioners
* Chinese medicine practitioners (including acupuncturists, Chinese herbal medicine practitioners and Chinese herbal dispensers)
* Medical radiation practitioners (including diagnostic radiographers, radiation therapists and nuclear medicine technologists)
* Occupational therapists

### Protected titles

Under the National Law, it is unlawful for a person not registered by Ahpra for that profession to hold themselves out to be a registered health practitioner or use a "protected title". Protected titles largely reflect the profession name, such as claiming to be a medical practitioner or a registered nurse, and recognised specialities within that profession such as being neurosurgeon. Only Ahpra-registered health workers may call themselves a "health practitioner". For a person to be able to lawfully describe themselves using a protected title, they must be registered by Ahpra for that speciality and must comply with the profession's standards for practice and code of conduct.
As of June 2022, although there exists guidelines under the AHPRA for "medical practitioners who perform cosmetic medical and surgical procedures", the term "surgeon" and related terms like "cosmetic surgeon" are not "protected titles". This meant that registered medical practitioners in Australia could these titles even when having different training and qualifications. A public consultation about this began on 1 December 2021 via Engage Victoria, an online platform run by the Victoria government department of health, which closed feedback submissions on 1 April 2022.
As of June 2022, the following professions are not regulated by Ahpra or a National Board, and do not have a protected title:
* Social workers
* Speech pathologists
* Dieticians
* Audiologists
* Sonographers
* Orthotist/ prosthetists
* Perfusionists
* Exercise and sport scientists

## Registration

There are four categories of registration conducted through the Medical Board of Australia, depending on training and expertise, including "general", "specialist", "provisional", "limited" and "non-practicing", along with a student registration. Medical graduates applying from New Zealand are treated with the same registration standards as Australians, differing from the international registration process. As of 22 July 2021, there are separate fees for both registration and application. Initial registration and application fees for general, specialist and limited registrations is $835 AUD, with some categories of New South Wales registrations receiving rebates.
The registration process includes a criminal history check, where individuals must inform the national board under application jurisdiction if they have been "charged with an offence punishable by 12 months imprisonment or more, or convicted or found guilty of an offence punishable by imprisonment in Australia and/or overseas". There exists a dispute resolution process with the Australian Criminal Intelligence Commission and relevant police departments, if the result of a criminal history check prevents registration under the AHPRA.

## Complaints process

In Australia, complaints to Ahpra or to the Queensland or New South Wales health regulators are termed "notifications". The complaints process includes several stages, which may advance a stage, result in disciplinary action, a fast-track process called "immediate action", or the complaint may be dropped. The stages include a receipt of the complaint, preliminary assessment, investigation, panel hearing, and a tribunal hearing, and at any stage of the process the complaint to advance immediately to a tribunal hearing. Unlike the other stages, a tribunal hearing outcome is made to the public, and a tribunal typically consists of "a District Court judge, two medical practitioners and a lay person, specifically appointed to consider the evidence".
According to AHPRA, in 2021 there were 10,147 notifications about 7,858 health practitioners, and 1.6% of those registered were the subject of a complaint. According to Sharon Russell, "many medical practitioners will be the subject of an AHPRA complaint at some stage during their career".
Complaints can be made online via the AHPRA website, by mail, telephone or attending an office. There is also a whistleblower policy governed under the Public Interest Disclosure Act 2013 where anonymous complaints can be made for serious misconduct.

## Criticism

The AHPRA has been subject to criticism, including for medical right to privacy and informed consent of those registered, and the long amount of time taken to resolve complaints. There was an investigation in 2014 following complaints to the AHPRA about how complaints are managed, including a lack of transparency over the complaint review process, and delays in investigations, with one case taking 2,368 days to resolve. There have been senate inquiries (see Australian Senate committees) by the Parliament of Australia in 2011, 2017 and 2021 over related issues. The 2021 public submission of support from the Royal Australian College of General Practitioners identified the main issues with the AHPRA as being "communication, transparency and timeliness of the complaints mechanism, and the importance of appropriate recognition of the impacts of assessment and investigation on a practitioner’s mental health". Over a four-year period, researchers identified 16 suicides and a further four instances of attempted suicide or self-harm among health care workers subject to regulatory notifications.
Submissions for the 2021 senate inquiry were extended to March 2022, with the final senate report being released on 1 April 2022. The senate inquiry resulted in 14 recommendations, including improving the complaints process, more flexible re-registration after a period of absence, and the regulation of surgeons, social workers, aged care workers and personal care workers along with adding these professions to the list of "protected titles".