Australian Health Practitioner Regulation Agency (AHPRA) was established on
July 01, 2010, as part of the National Registration and Accreditation Scheme
(NRAS), with the purported role of protecting the public by regulating healthcare
practitioners (HCPs) over multiple disciplines. Over the last 15 years, it has evolved
into a behemoth and it now presents an extraordinary challenge for Australia’s
healthcare providers and consumers. Trust in AHPRA is dropping at an
extraordinary rate.
Interestingly, AHPRA was not formally established by the Australian Constitution
(i.e., there is no constitutional mandate); rather, it was created through an
agreement between the governments of the Commonwealth and the states and
territories which adopted the Health Practitioner Regulation National Law (The
National Law). This law provides the legal framework for AHPRA’s functions.
There is now widespread opinion that AHPRA has increased in bureaucratic
function; and, based on multiple examples of it employing unorthodox approaches,
has a self-appointed remit beyond its intended purpose – with chilling effect to the
850,000 HCPs (of which 15 per cent are doctors and over half are nurses) being
handled with relative impunity. At the heart of this is the incompetence of investigators who, very simply, frequently misinterpret the subtleties of doctor-
patient interactions and seemingly subscribe to the upside-down tenet that a ‘HCP must be guilty until innocence is proven’. Are these investigators drunk on power or
forced to meet arbitrary targets? Probably both...
Consequently, many have even started to openly question if AHPRA is fit for
purpose, with some exploring the feasibility of an alternative registration body
where the senior staff are elected and not selected. If the political will were present
and given the demand from stakeholders; it is likely that competition to the
regulation of doctors, for whom practice is hugely more complex and nuanced than
for other disciplines, would result in superior delivery of regulation and outcomes.
In the meantime, what is clear is that the significant problems with AHPRA need
to be addressed. AHPRA’s responsibility revolves around the registration of
healthcare practitioners and managing their professional standards, which includes
complaints handling. However, innumerable practitioners who are medical and
paramedical (such nurses and dentists), along with lawyers, journalists, patients,
and other critics, have argued that AHPRA has sequentially exerted
disproportionate ‘control’ over the last decade. Indeed, the last few years in
particular, have highlighted the stymying of considered individual opinion, stifling
of dissent, and the gross undermining of professional autonomy for doctors in
particular, at the hands of AHPRA’s administrative staff who, frequently, have
neither medical nor legal backgrounds.
Overstepping of operational scope covers the following 10 domains:
1. Disciplinary actions which are excessive and where standards have been
applied heterogeneously.
2. Influence on clinical judgment, where guidelines are sometimes enforced as algorithmic requirements, with the resultant rigidity impeding nuanced, patient-
specific decision-making with blunted empathetic practice.
3. Punitive measures with the punishment being the process even for
unsubstantiated, frequently vexatious, complaints, which many believe to be
related to AHPRA hitting its key performance indicators (KPIs).
4. Erosion of critical thinking, free speech, and scientific debate; fostering a
culture of surveillance and suspicion.
5. Weaponisation of ‘experts’, who then engage in sham peer review, to restrict
innovative practices which are logical in nature, due to the fear of regulatory
repercussions.
6. Deterrence of patient advocacy if contrary to the winds of populist thought
which are propagated by mainstream media.
7. Inappropriate intervention into commercial decisions unrelated to patient care.
8. Adverse impact on practitioner wellbeing with increased psychological
morbidity and mortality (suicide), and the wider impact on the practitioner’s family members due, primarily, to financial distress.
9. A culture of fear leading to the destruction of professional collegiality.
10. Destruction of public confidence by, ironically, undermining the public’s trust in
the ethics and processes of health care in Australia.
Whilst regulation is essential for maintaining professional standards and protecting
patients, it must be balanced against the need for professional autonomy and
innovation which is ethically delivered in the absence of fear. Accordingly,
reforming AHPRA’s governance structures must include:
1. Increased representation by practitioners who, additionally, are elected.
2. Regular audits of AHPRA’s operations, along with transparent, independent
reviews of AHPRA’s activities.
3. Widely publicised, meaningful processes for complaining against AHPRA.
4. Regular publishing of data from the National Health Practitioner Ombudsman
(NHPO).
5. Personal accountability of AHPRA’s employees who fail to act in good faith.
Every reasonable HCP would agree that a regulatory body is de rigueur, but with
great power comes great responsibility. Per AHPRA’s own statistics, a double-digit
number of HCPs have committed suicide under the shadow of investigation
therefore, it is incumbent upon us all to demand an end to the institutional
arrogance which underpins the persecutory and arguably predatorial nature of
AHPRA.
The restoration of fairness and trust has unmatched implications for the wellbeing
of practitioners and the public. This is not only necessary, but urgent, in order to
ensure that Australia’s health-care system may return to being a bastion of
excellence and compassion. Lives, quite literally, depend on this.