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The 15 National Boards regulating registered health practitioners in Australia are responsible for registering practitioners and students (except for in psychology, which has provisional psychologists), setting the standards that practitioners must meet, and managing complaints and concerns (notifications) about the health, conduct or performance of practitioners.
The Australian Health Practitioner Regulation Agency (AHPRA) works in partnership with the National Boards to implement the National Registration and Accreditation Scheme, under the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law).
The core role of the National Boards and AHPRA is to protect the public.
Guidelines: Mandatory notifications about registered health practitioners (250KB,PDF*)
Guidelines: Mandatory notifications about registered students (150KB,PDF**)
These guidelines have been developed jointly by the National Boards under section 39 of the National Law. The guidelines are developed to provide direction to registered health practitioners, employers of practitioners and education providers about the requirements for mandatory notifications under the National Law.
The inclusion of mandatory notification requirements in the National Law is an important policy initiative for public protection.
The relevant sections of the National Law are attached to the guidelines.
Separate guidelines have been developed for mandatory notifications about registered health practitioners and registered students. This is because of the limited circumstances when a mandatory notification must be made about a registered student.
The requirement to make a mandatory notification about a practitioner is different for different notifier groups. For that reason, the guidelines about practitioners have been structed according to notifier type (that is treating practitioner, non-treating practitioner, employer) so that the relevant information for that notifier group is easier to find.
For more resources to help you understand when to make a mandatory notification and when not to see Mandatory notifications.
These guidelines are relevant for:
Students who are registered in a health profession under the National Law should be familiar with these guidelines. Although the National Law does not require a student to make a mandatory notification (complaint or concern), a complaint or a concern can be raised about an impaired student.
*The Guidelines: Mandatory notifications about registered health practitioners have been updated on 29 June 2020 to include minor formatting and word changes and changes to the flowcharts on pages 20, 22 and 26 of the guidelines.
**The Guidelines: Mandatory notifications about registered students have been updated on 29 June 2020 to include minor formatting and word changes and sections 39 and 40 of the National Law in Appendix A.
The Australian Health Practitioner Regulation Agency (Ahpra) works in partnership with the National Boards to implement the National Registration and Accreditation Scheme (the National Scheme) and administer the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law)1.
Ahpra supports the Boards to set standards and policies for registered practitioners. We manage notifications and register practitioners and students. Under the National Law, certain groups must make mandatory notifications about practitioners when their health, conduct or performance poses a risk to the public.
The National Law establishes requirements for mandatory reporting. This guideline has been developed to explain those requirements.
To protect the public from the risk of harm, registered health practitioners and their employers must make mandatory notifications in some limited circumstances. This is a legal requirement under the National Law. This document sets out:
It explains the circumstances that do and do not trigger a mandatory notification and the different levels of risk to be considered by notifiers.
The guidelines recognise that deciding whether to make a mandatory notification can be a difficult decision and requires a balanced judgement which should holistically consider relevant risk factors. The guidelines provide information about who may assist in making this decision (see section 1.4 How do I make a notification?).
Notifiable concerns have a specific meaning under the National Law. There are four concerns that may trigger a mandatory notification, depending on the risk of harm to the public:
A treating practitioner is a practitioner who becomes aware of the concern while providing treatment to another practitioner.
Treating practitioners in Western Australia providing a health service to a practitioner-patient are exempt from the requirement to make a mandatory notification but may still be obliged to make a notification as a nontreating practitioner (see section 1.6 Who is exempt from notifying? and section 4 Notifications by non-treating practitioners).
The circumstances for making a mandatory notification about impairment, intoxication and a departure from professional standards are more limited for treating practitioners than other groups of notifiers. The threshold for reporting risk of harm to the public is higher to give practitioners confidence to seek help if they need it (see section 3 Notifications by treating practitioners, alongside section 1 Mandatory notification requirements and section 2 Concerns to report, for more information).
A non-treating practitioner is a practitioner who has a concern about another practitioner (for example, a colleague) but did not identify it while (if) treating that practitioner. The concern cannot have come from being in a treating relationship with the other practitioner.
While non-treating practitioners have to report the same types of concern as treating practitioners, the requirement to notify us is based on a different level of risk (see section 4 Notifications by non-treating practitioners, alongside section 1 Mandatory notification requirements and section 2 Concerns to report, for more information).
An employer is a person or organisation that employs a practitioner under an employment or service contract or as a volunteer.
While employers have to report the same types of concern as practitioners, the requirement to notify us is based on a specific level of risk (see section 5 Notifications by employers of practitioners, alongside section 1 Mandatory notification requirements and section 2 Concerns to report, for more information).
These guidelines explain the requirements for making a mandatory notification about a practitioner under the National Law. Making a mandatory notification is a serious step to prevent the public from being placed at risk of harm. A mandatory notification should only be made on sufficient grounds. The guidelines explain when these grounds are likely to arise.
Read this section to understand the reporting requirements, who has to notify us and how to do this.
Under the National Law, certain groups must make mandatory notifications about registered practitioners under some limited circumstances. These guidelines cover:
If we receive a mandatory notification, the Board will consider all relevant information before deciding if action is needed to protect the public. It will not automatically take regulatory action (such as, for example, a caution).
These guidelines do not provide detailed information about the notifications process. There are a number of possible stages in the notifications process and not every notification goes through all these stages. For more information about the notification process please see the Ahpra website.
These guidelines do not affect other legal mandatory reporting requirements – for example, about child abuse.
They do not cover when treating practitioners, non-treating practitioners or education providers must report students. For more details on how mandatory notifications relate to students, please read our Guidelines: Mandatory notifications about registered students.
Under section 130 of the National Law registered health practitioners and students must notify Ahpra of certain relevant events within seven days of those events occurring. These guidelines do not cover those obligations. Information on giving notice of certain relevant events is available on the Ahpra website.
The groups who must make mandatory notifications about practitioners are:
Other people or organisations do not have to make a mandatory notification, but they can consider whether to make a voluntary notification. See section 1.7 What about voluntary notifications?
All groups should understand the mandatory notification process and when the four types of concerns must be reported. To understand this, please continue reading this section and section 2 Concerns to report.
There are different reporting limits for the different groups who must report a concern. To understand what you should consider before making a mandatory notification, please refer to:
The following table shows the types of concerns that need to be reported, and the different reporting thresholds for different groups.
Impairment
Intoxication
Departure from standards
Sexual misconduct
Treating practitioners must report practitioners who:
Non-treating practitioners must report practitioners who:
Employers of practitioners must report practitioners who:
You can make a mandatory notification to Ahpra. The simplest way is to use the portal on our website, see: Ahpra Notifications page. You can also call us on 1300 419 495 and tell us that you want to make a notification.
Our website also has information about how we handle both mandatory and voluntary notifications. It also explains how to raise a concern if you are in Queensland or New South Wales.
If you are making a mandatory notification and want your identity to be confidential, please let us know. We will endeavour to keep your details confidential. Please see the Ahpra website for more information about how we manage notifications.
A notification to Ahpra should be made as soon as practicable. In this context, the word ‘practicable’ has its ordinary meaning of ‘feasible’ or ’possible’.
We can provide general information to help you decide whether to make a mandatory notification, but we can’t tell you whether or not to notify in a specific case. If you are unsure about whether to make a mandatory notification, you may wish to seek advice from your insurer, legal advisor, or professional association on specific circumstances. You can also find more information by:
The National Law protects anyone who makes notifications in good faith. ‘Good faith’ has its ordinary meaning of being well-intentioned or without malice.
Section 237 of the National Law provides protection from civil, criminal and administrative liability, including defamation, for people making notifications in good faith. However, if you make a notification that is vexatious or not in good faith, you may be subject to regulatory action (such as, for example, a caution).
The National Law clarifies that making a notification is not a breach of professional etiquette or ethics, or a departure from accepted standards of professional conduct. It is consistent with professional conduct and a practitioner’s ethical responsibilities.
Privacy obligations do not prevent you from making a mandatory or voluntary notification.
There are exemptions to mandatory notifications for treating and non-treating practitioners where they:
Treating practitioners in Western Australia providing a health service to a practitioner-patient or student are exempt from the requirement to make a mandatory notification. However, these practitioners still have a professional and ethical obligation to protect and promote public health and safety, so they may consider whether to make a voluntary notification.
Please refer to Appendix A: National Law extracts to see if these exemptions apply to you.
You do not need to make a mandatory notification if a practitioner or employer has made a mandatory notification, and safeguards to reduce the risk to the public are being put in place.
An employer may have their own process for mandatory notification obligations. However a practitioner who is an employee might still have to make a mandatory notification about another practitioner. To assess whether the process or circumstances reduce the risk of harm to the public, an employee who is a practitioner may find it helpful to talk to their employer or professional association about the concern.
The National Law allows anyone to make voluntary notifications about a practitioner. Anyone (including practitioners, employers and education providers) can make a voluntary notification about a practitioner if they believe:
For more information about making a voluntary notification, please go to our website, see: Ahpra Notifications page, or call 1300 419 495.
This section defines the four types of concerns that may trigger a mandatory notification about a registered health practitioner: impairment, intoxication, significant departure from accepted professional standards and sexual misconduct. It also explains the concept of ‘reasonable belief’.
When you need to make a notification differs depending on whether you are a treating practitioner, non-treating practitioner or employer. Read this section, alongside section 3 Notifications by treating practitioners, section 4 Notifications by non-treating practitioners or section 5 Notifications by employers of practitioners, to understand how to assess whether you must make a mandatory notification.
A mandatory notification about a practitioner can be triggered by concerns about:
Depending on the type of concern, you must assess the risk of harm to the public when deciding whether to make a notification. In this context, ‘the public’ means:
The circumstances that would trigger a notification are different for different groups. To understand what you should consider, please refer to the right section for you:
If you are deciding whether to make a mandatory notification about a student, please read our separate guideline for practitioners and education providers, Guidelines: Mandatory notifications about registered students.
Before making a mandatory notification, you must form a ‘reasonable belief’. To do so, you generally need direct knowledge (not just a suspicion) of the incident or behaviour that led to a concern. As a practitioner or employer, you are most likely to do this when you directly observe the incident or behaviour. Speculation, rumours, gossip or innuendo are not enough to form a reasonable belief.
You may have a report from a reliable source or sources about conduct they directly experienced or observed. In that case, you should encourage the person with the most direct knowledge of the incident or behaviour to consider whether to make a notification themselves.
Your professional background, level of insight, experience and expertise will help you form a reasonable belief. Mandatory notifications should be based on personal knowledge of reasonably trustworthy facts or circumstances that would justify a person of reasonable caution, acting in good faith, to believe that the concern and a risk to the public exists.
These principles about forming a ‘reasonable belief’ come from legal cases. In short, a reasonable belief is a state of mind based on reasonable grounds. It is formed when all known considerations, including matters of opinion, are objectively assessed and taken into account.
The National Law defines ‘impairment’ as ‘a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect the person’s capacity to practise the profession’.
A health condition and impairment are not the same thing. An illness or condition that does not or is not likely to have a detrimental impact on a practitioner’s capacity to practise is not an impairment.
You do not need to notify if there are effective controls to manage the impairment and reduce the risk and severity of harm to the public, such as:
If you are a treating practitioner, the circumstances for making a mandatory notification about impairment are more limited for you than other groups. Please read section 3.2 When must I report impairment? to help you assess whether to report.
Impairment is the only type of mandatory notification that applies to students. You would make a mandatory notification about a student with an impairment only if, while they undertake clinical training, the public is placed at substantial risk of harm. For more information, please read our Guidelines: Mandatory notifications about registered students.
The word ‘intoxicated’ is not defined in the National Law, so it has the ordinary meaning of ‘under the influence of alcohol or drugs’. ‘Drugs’ include illicit drugs and prescribed and over-the-counter medicines.
If a practitioner is practising their health profession while intoxicated, this can trigger a mandatory notification. A practitioner is considered to be intoxicated when their reasonable care and skill in the practice of the profession is impaired or adversely affected by drugs or alcohol.
The key issue is that the practitioner is practising while intoxicated, regardless of when they consumed the drugs or alcohol.
You do not need to report if the practitioner is intoxicated in their private life (when not practising their profession), unless the intoxication triggers another concern for a mandatory notification.
If you are a treating practitioner, the circumstances for making a mandatory notification about intoxication while practising are more limited for you than other groups. Please read section 3.3 When must I report intoxication while practising? to help you assess whether to report.
‘Accepted professional standards’ includes reference to documents like the code of conduct and guidelines. It covers both practice and professional behaviour. You must understand the standards for that profession to judge whether there has been a significant departure from them.
If a practitioner’s practice shows a significant departure from accepted professional standards that places the public at risk of harm, it can trigger a mandatory notification. A significant departure is serious (not slight or moderate) and would be obvious to any reasonable practitioner.
You do not need to make a mandatory notification if a practitioner meets accepted standards while engaged in innovative practice. Different clinical decision-making or treatment approaches also do not trigger mandatory notification if a practitioner meets accepted professional standards.
Mandatory notifications about another practitioner from a different health profession are more likely to be triggered in a team environment, such as a surgical or mental health team. This is because different health professions work closely together and understand each other well.
If you are a treating practitioner, the circumstances for making a mandatory notification about a departure from accepted standards are more limited for you than other groups. Please read section 3.4 When must I report a significant departure form professional standards? to help you assess whether to report.
For mandatory notifications, sexual misconduct is:
It includes:
Because of the power imbalance between practitioners and their patients or clients, any sexual activity with a patient or client is sexual misconduct, even with their consent. Engaging in sexual activity with a person closely related to a patient or client under the practitioner’s care may also be sexual misconduct. In some cases, that person (such as the parent of a child patient or client) may also be considered a patient or client.
Engaging in sexual activity with a person formerly under a practitioner’s care after the professional relationship has ended may also be sexual misconduct. This depends on:
If you are a treating practitioner, the conditions for making a mandatory notification about sexual misconduct are different to other groups. Please read section 3.5 When must I report sexual misconduct? to help you assess when to report.
The circumstances for treating practitioners to make mandatory notifications are more limited than they are for other groups.
Read this section to understand how to assess whether to make a mandatory notification.
Treating practitioners in Western Australia providing a health service to a practitioner-patient are exempt from the requirement to make a mandatory notification. See section 1.6 Who is exempt from notifying? for more information.
You must make a mandatory notification as a treating practitioner if, while treating another practitioner as your patient (a practitioner-patient), you form a reasonable belief that they:
If you did not become aware of the concern while treating the other practitioner as your patient, see section 4: Notifications by non-treating practitioners.
If you are concerned about a practitioner practising with an impairment, practising while intoxicated, or significantly departing from accepted professional standards, you must also consider whether this is placing the public at substantial risk of harm.
However, a lower threshold for making a mandatory notification applies for sexual misconduct. If you have the reasonable belief that your practitioner-patient has engaged, is engaging or is at risk of engaging in sexual misconduct in connection with their practice, you must report that.
With the exception of concerns about sexual misconduct, you should make a notification only if you believe there is a substantial risk of harm. A substantial risk of harm is a very high threshold for reporting risk of harm to the public. This allows practitioner-patients to seek and have treatment for conditions without fearing a mandatory notification.
Use the charts in the following sections to help assess whether to make a mandatory notification. Consider if the risk to the public is controlled by contextual circumstances or being managed through effective treatment or other strategies. If so, this can decrease the risk of harm – and the need to report.
You may also need to make a mandatory notification about a student only if the student, doing clinical training with an impairment, is placing the public at substantial risk of harm. For more information, please read our Guidelines: Mandatory notifications about registered students.
There are consequences if you fail to make a mandatory notification when you have to. Although this is not a criminal offence under the National Law, your National Board may take regulatory action against you (such as, for example, a caution). It will consider all the circumstances before it decides whether to do so.
You must make a mandatory notification if you form a reasonable belief that your practitioner-patient is placing the public at substantial risk of harm (a very high threshold for reporting risk of harm to the public) by practising with an impairment.
To decide if a practitioner-patient’s impairment puts the public at substantial risk of harm, consider:
You only need to make a mandatory notification if your practitioner-patient is placing the public at substantial risk of harm by practising with an impairment.
Not all impairments need to be reported. A practitioner-patient may have an impairment that causes a detrimental impact on their capacity to practise but, unless it poses a substantial risk of harm to patients, it does not trigger a mandatory notification.
Example 1: A practitioner-patient has a small tremor, which is being treated. They have restricted their practice to consultations, and they no longer perform procedural work. Because the tremor would affect procedural work, not consultations, it causes little risk of harm to the public. This would not trigger a mandatory notification.
Example 2: A practitioner-patient has a mental health condition, which is stable. Because the practitioner-patient is engaged in and complying with treatment, there is no substantial risk of harm to the public. This would not trigger a mandatory notification.
Example 3: A practitioner is diagnosed with early stage dementia. The practitioner works as a sole practitioner in private practice. As the treating practitioner, you advise that the practitioner will soon need to cease practice as the condition is likely to have a detrimental effect on patients, with the memory loss putting patients at substantial risk of harm. You suggest that in the short term the practitioner could move to a group practice and work under supervision or to non-practising registration, but the practitioner-patient refuses and insists their memory loss is not affecting their practice. As this meets the very high threshold for reporting risk of harm to the public, you decide to make a mandatory notification.
If an impairment is related to or is a major cause of intoxication or departure from professional standards, consider how effective the practitioner-patient’s treatment is when you are deciding if it meets the very high threshold for reporting.
Factors including circumstance, practice context, controls such as oversight and incident reporting, and other arrangements can affect the level of risk –– and the need to report. The risk assessment for a very high risk of harm should holistically consider all relevant factors, with some factors weighted more heavily than others, depending on the circumstance.
Use the following chart to help assess the level of risk. The list of factors is designed to identify issues that may be relevant when deciding if a mandatory notification is necessary. The list is not exhaustive. It is not possible to list all the factors that may be relevant to a case and there may be other factors that you need to consider on a case by case basis. This list highlights some common factors relevant to assessing the risk of harm.
Use the flowchart to help you assess whether to make a mandatory notification.
For more on what impairment means under the National Law, see section 2.3 What is impairment?
You must make a mandatory notification if you form a reasonable belief that your practitioner-patient is placing the public at substantial risk of harm (a very high threshold for reporting risk of harm) to the public by practising while intoxicated by drugs or alcohol.
Example 1: A practitioner-patient discloses to you that they once practised while intoxicated. Because the practitioner-patient does not have issues with drug or alcohol misuse, the incident occurred several years ago, no harm occurred, and it was an isolated incident unlikely to occur again, there is no substantial risk of harm to the public. You do not need to make a mandatory notification.
Example 2: A practitioner-patient discloses that their employer has discovered that they used ice recreationally and is concerned they will be terminated. The practitioner-patient admits using the drug recreationally but does not believe this has an impact on their practice and even though use is becoming more frequent, they are convinced they can manage it. They have gone to work at least once while still intoxicated from recreational use. You determine that the increasing use is having an adverse effect on practice and would lead to a substantial risk to the public, especially as the practitioner-patient is not demonstrating any insight or willingness to seek treatment. The risk is heightened, because if they are terminated, they might seek work elsewhere and the new employer would not be aware of the potential risk. You decide to make a mandatory notification.
If the intoxication is connected to an impairment see section 2.3 What is impairment? This will help you assess whether:
Factors including circumstance, practice context, the frequency of the event, and controls such as, oversight, incident reporting, and other arrangements can affect the level of risk –– and the need to report. The risk assessment for a very high reporting threshold should holistically consider all relevant factors, with some factors weighted more heavily than others, depending on the circumstance.
For more on what intoxication while practising means under the National Law, see section 2.4 What is intoxication while practising?
You must make a mandatory notification if you form a reasonable belief that your practitioner-patient is placing the public at substantial risk of harm (a very high threshold for reporting risk of harm to the public) by practising in a way that significantly departs from accepted professional standards.
It may be more difficult for you to assess this without directly observing your practitioner-patient’s practice, especially if you are in a different profession. Other practitioners who work directly with your practitioner-patient can observe their practice directly and better assess the risk to the public. They are more likely to make mandatory notifications.
If the departure from professional standards relates to an impairment the practitioner-patient has, see section 3.2 When must I report impairment? to work out if you need to report.
A practitioner-patient may practise in a way that constitutes a significant departure from accepted professional standards, but that is not enough to trigger a mandatory notification. You need to make a mandatory notification only if the significant departure also places the public at substantial risk of harm.
Example 1: Your practitioner-patient tells you that they once failed to follow protocol and made a substantial error with medicines. The practitioner-patient explains that the error was because of personal stress but is unlikely to happen again, as their employer is now aware of the issues, and the practitioner or employer has taken steps to address this. Although the practice may have briefly departed significantly from accepted standards, it does not trigger a mandatory notification because it does not put the public at substantial risk of harm.
Example 2: Your practitioner-patient tells you they have used an unconventional treatment to ‘cure’ a skin cancer, advising their patients to abandon other conventional and accepted treatments. You know that the treatment is unsafe and dangerous, but when you raised this, the practitioner-patient shut down the discussion and changed the topic. The practitioner-patient works as a sole practitioner in a private practice. As you believe the practitioner-patient’s practice is a significant departure from accepted standards that puts the public at substantial risk of harm, you decide to make a mandatory notification.
Factors including circumstance, practice context, extent of self-reflection, controls such as oversight, incident reporting, and other arrangements can affect the level of risk –– and the need to report. The risk assessment for a very high reporting threshold should holistically consider all relevant factors, with some factors weighted more heavily than others, depending on the circumstance.
For more on what a significant departure from standards means under the National Law, see section 2.5 What is a significant departure from accepted professional standards?
You must make a mandatory notification if you form a reasonable belief that your practitioner-patient has engaged, is engaging in, or is at risk of engaging in sexual misconduct in connection with their practice.
You must report past, current and future risk of sexual misconduct that is connected to the practitionerpatient’s practice.
Example: Your practitioner-patient discloses a detailed plan to engage in sexual misconduct or discloses conduct that amounts to ‘grooming’. You must make a mandatory notification.
For more on what sexual misconduct means under the National Law, see section 2.6 What is sexual misconduct?
This section explains your obligations as a non-treating practitioner.
A non-treating practitioner is a practitioner who has a concern about another practitioner (for example, a colleague) but did not identify it while (if) treating that practitioner. The concern cannot have come from being in a treating relationship with that other practitioner.
This section tells you your obligations and when you must make a mandatory notification about impairment, intoxication, departure from professional standards and sexual misconduct.
Read this section to understand how to assess whether you must make a mandatory notification.
You must make a mandatory notification as a non-treating practitioner (most likely a manager, colleague or co worker) if, in practising your profession, you form a reasonable belief that another registered health practitioner is:
If you are concerned about a practitioner practising with an impairment or significantly departing from accepted professional standards, you must also consider whether their conduct is placing the public at risk of harm and the level of potential harm to the public. However, practising while intoxicated or engaging in sexual misconduct might need to be reported regardless of the risk to the public. For more information on these risk limits, see the following sections.
If you became aware of the concern while treating the practitioner as your patient, see section 3 Notifications by treating practitioners.
You may need to make a mandatory notification about a student only if the student, undertaking clinical training with an impairment, is placing the public at substantial risk of harm which is a very high threshold for reporting risk of harm. For more information, please read our Guidelines: Mandatory notifications about registered students.
You must make a mandatory notification if you form a reasonable belief that another practitioner in any registered health profession is placing the public at risk of substantial harm (a high threshold for reporting risk of harm) by practising with an impairment.
You should make a mandatory notification only if you believe there is a risk of substantial harm. A risk of substantial harm is a high threshold for reporting risk of harm to the public.
Use the chart and flowchart in the following section to help assess whether to make a mandatory notification. Consider if the risk to the public is controlled by contextual circumstances or being managed through effective treatment or other strategies. If so, this can decrease the risk of harm – and the need to report.
Not all impairments need to be reported. A practitioner may practise with a mental illness, physical health condition or physical illness, but that is not enough to trigger a mandatory notification. A practitioner may have an impairment that causes a detrimental impact on their capacity to practise but, if it does not pose a risk of substantial harm to the public, it does not trigger a mandatory notification.
Example: Your colleague has a small tremor, which is being treated. This practitioner has restricted their practice to consultations, and they no longer perform procedural work. Because the tremor would affect procedural work, not consultations, it causes little risk of harm to the public. This is unlikely to trigger a mandatory notification.
Factors including circumstance, practice context, controls such as engagement with treatment, and other arrangements can affect the level of risk –– and the need to report. The risk assessment for a high risk of harm should holistically consider all relevant factors, with some factors weighted more heavily than others, depending on the circumstance. As a non-treating practitioner, you may not have access to detailed information about all the factors listed below.
You must make a mandatory notification if you form a reasonable belief that another practitioner is practising while intoxicated by drugs or alcohol.
Example 1: While at a party over the weekend, you see a colleague with a group of people smoking marijuana. You wonder if this is also going on at work. As you have not formed a reasonable belief that your colleague is intoxicated at work, there is no need to make a mandatory notification.
Example 2: You see your colleague coming back from a long lunch. They smell of alcohol and are a bit unsteady on their feet. Their speech is slurred. Because you have directly observed signs of intoxication and you have formed the reasonable belief that they are intoxicated while at work, you make a mandatory notification.
Use the flowchart to help you assess whether to make a mandatory notification
You must make a mandatory notification if you form a reasonable belief that another practitioner is placing the public at risk of harm by practising in a way that departs significantly from accepted professional standards.
Non-treating practitioners in the same profession or specialty or workplace team, may more easily identify this practice, because they are in a better position to see it. They are more likely to make mandatory notifications compared with a practitioner in a different specialty or profession.
A practitioner may practise in a way that departs significantly from professional standards, but this does not trigger a mandatory notification. You need to make a mandatory notification only if the practitioner is placing the public at risk of harm.
Example 1: You know that a colleague once made an error with medicines. They took remedial steps as part of a performance management plan, and their practice is now closely monitored. Although their practice may have departed significantly from professional standards, the risk of harm to the public is rare because there are adequate controls and strategies. You do not need to make a mandatory notification.
You may need to make a mandatory notification if, after you report concerns to your employer about a colleague’s standards of practice, you still do not believe that the risk to the public is adequately managed. It may be useful to talk to your employer about your concerns before you decide if you need to make a mandatory notification.
A difference of opinion does not trigger a mandatory notification.
Example 2: Another practitioner refers a patient to you, and you disagree with their treatment plan. The plan is significantly different from what you believe is best practice, but not necessarily from accepted professional standards. The patient is not at risk of harm. You do not need to notify.
You must make a mandatory notification if you form a reasonable belief that another practitioner has or is engaging in sexual misconduct in connection with their practice.
It tells you your obligations and when you must make a mandatory notification about impairment, intoxication, departure from professional standards and sexual misconduct.
You must make a mandatory notification as an employer if you form a reasonable belief that a registered health practitioner is:
If you are concerned about a practitioner practising with an impairment or significantly departing from accepted professional standards, you must also consider whether their conduct is placing the public at risk of harm and the level of potential harm to the public. However, practising while intoxicated or engaging in sexual misconduct might need to be reported regardless of risk to the public. For more information on these risk limits, see the following sections.
If you decide to make a mandatory notification, it is still your responsibility to manage the employee practitioner’s performance and protect the public from risk of harm. An employer is expected to have processes and protocols in place to assess when and how it would make a mandatory notification. Mandatory notification obligations only extend to an employer’s (organisation’s) staff if the staff member is also a registered practitioner.
There are consequences if you fail to make a mandatory notification when you have to. We must report this failure to notify to the responsible minister in the relevant state or territory. The minister must then report it to a health complaints entity, the employer’s licensing authority or another appropriate entity as soon as possible.
You must make a mandatory notification if you form a reasonable belief that the practitioner is placing the public at risk of substantial harm (a high threshold for reporting harm) by practising with an impairment.
Example 1: An employee practitioner has a small tremor, which is being treated. They take advice from their treating practitioner about the future scope of their practice and ask you to change their duties to exclude procedural work. Because the tremor would affect only procedural work, not consultations, it causes little risk of harm to the public. This impairment is unlikely to trigger a mandatory notification.
Example 2: A employee practitioner applies for sick leave so they can be treated for a mental health condition. They tell you they cannot return to work until their treating practitioner advises them to do so. Because the employee practitioner is engaged in and complying with treatment, the public is not at risk of substantial harm, so you are not required to make a mandatory notification.
Example 3: You have been monitoring an employee’s performance because of recent and growing reports of significant errors and sentinel events. You implemented a direct supervision arrangement. The supervisor reported concerns with the practitioner’s cognitive function, so you arranged an assessment. The practitioner resigned as they were unwilling to undergo the assessment. While the practitioner was under close supervision at work, the risk of harm to the public was managed, but now that the practitioner has resigned, there are no controls in place to manage the risk, and they may work somewhere else and not reveal any past issues. You make a mandatory notification, as there is now a high risk of harm to the public.
Factors including circumstance, practice context, extent of engagement with treatment, controls such as breaks from work, and other arrangements can affect the level of risk –– and the need to report. The risk assessment for a high risk of harm should holistically consider all relevant factors, with some factors weighted more heavily than others, depending on the circumstance.
Use the following chart to help assess the level of risk. The list of factors is designed to identify issues that may be relevant when deciding if a mandatory notification is necessary. The list is not exhaustive. It is not possible to list all the factors that may be relevant to a case and there may be other factors that you need to consider on a case by case basis. This list highlights some common factors relevant to assessing the risk of harm, however, as an employer, you may not have access to detailed information about all the factors listed below.
You must make a mandatory notification if you form a reasonable belief that an employee practitioner is practising while intoxicated by drugs or alcohol.
Example 1: You receive a report from an employee that over the weekend, they saw their colleague (an employee practitioner) with a group of people smoking marijuana. You wonder if this is also going on at work. As you have not formed a reasonable belief that the employee is intoxicated at work, there is no need to make a mandatory notification.
Example 2: Your staff have told you that an employee practitioner came back from a long lunch smelling of alcohol, unsteady on their feet and slurring their speech. Because you have a report from reliable sources about signs of intoxication, you may need to make a mandatory notification.
For more on what intoxication while practising means under the National Law, see section 2.4 What is intoxication while practicing?
You must make a mandatory notification if you form a reasonable belief that a practitioner is placing the public at risk of harm by practising in a way that departs significantly from accepted professional standards.
A practitioner may practise in a way that departs significantly from professional standards, but this is not enough to trigger a mandatory notification. You need to make a mandatory notification only if the practitioner is placing the public at risk of harm.
Mandatory notifications should not be used as a performance or risk management measure. The requirement to make a mandatory notification in some circumstances is an independent legal obligation. Performance management alone does not meet the threshold for mandatory notifications.
Example 1: Your employee practitioner failed to follow protocols and made a substantial error with medicines. As part of their performance management plan, they are provided with relevant resources, you implement training, restrict their practice until they demonstrate competency and put in place supervision arrangements to monitor them closely. Although their practice may have departed significantly from professional standards, the risk of harm to the public is negligible because adequate controls and other strategies are in place. You do not need to make a mandatory notification.
Example 2: You are short staffed and employ a practitioner through the locum service. A number of reports are made to you from colleagues about the locum’s practice. These range from avoidable errors to practice that is substantially different to accepted standards. You have not yet been able to investigate the claims, but believe that if the reports are accurate, and the locum works somewhere else, the public could be at risk of harm. As you are not able to put in place any controls to manage the risk, you decide to make a mandatory notification. The employee(s) who initially reported the concerns to you may consider that they still need to make a mandatory notification if they still do not believe that the risk to the public is adequately managed. It can therefore be helpful to appropriately clarify how risk to the public is being managed.
Use the following flowchart to help you assess whether to make a mandatory notification.
You must make a mandatory notification if you form a reasonable belief that a practitioner has or is engaging in sexual misconduct in connection with the practice of their profession.
Impairment, in relation to a person, means the person has a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect—
Education provider means—
A National Board may develop and approve codes and guidelines—
Example
An approved registration standard for a health profession, or a code or guideline approved by a National Board, is admissible in proceedings under this Law or a law of a co-regulatory jurisdiction against a health practitioner registered by the Board as evidence of what constitutes appropriate professional conduct or practice for the health profession.
In this Division—
notifiable conduct, in relation to a registered health practitioner, means—
Any entity that believes that a ground on which a voluntary notification may be made exists in relation to a registered health practitioner or a student may notify the National Agency.
[Note: See section 237 which provides protection from civil, criminal and administrative liability for persons who, in good faith, make a notification under this Law.]
Ahpra supports the Boards to set standards and policies for registered practitioners. We manage notifications, register practitioners and students2.
To protect the public from the risk of harm, registered health practitioners and education providers must report concerns about registered students. This is a legal requirement under the National Law. This document sets out:
It also explains the circumstances that do and do not trigger a mandatory notification. The guidelines recognise that deciding whether to make a mandatory notification can be a difficult decision and requires a balanced judgement which should holistically consider relevant risk factors. The guidelines also provide information about who may assist in making this decision (see section 1.5 How do I make a notification?).
There is only one ground for a mandatory notification about students.
Practitioners and education providers only need to notify us when they have a ‘reasonable belief’ that a student has an impairment that, when undertaking clinical training, may place the public at substantial risk of harm (a very high threshold for reporting risk of harm to the public). This document explains what reasonable belief is and what impairment means in this context.
The requirement to report is also based on the level of risk. This document also gives more advice about when impairment must be reported, and the obligations of notifiers.
1 The National Boards developed these guidelines under section 39 of the National Law (see Appendix A).
2 The exception for student registration is in psychology, where students are registered as provisional psychologists. In this case, the Guidelines: Mandatory notifications about registered health practitioners apply.
These guidelines explain the requirements for making a mandatory notification about a student under the National Law. This protects the public by ensuring that risks posed by students undertaking clinical training are reported.
Under the National Law, certain groups must make mandatory notifications about students under some limited circumstances. These guidelines cover:
They do not cover when practitioners or employers of practitioners must report practitioners. For more details please read our Guidelines: Mandatory notifications about registered health practitioners.
For more information on how the National Law defines students and education providers, see the Ahpra website.
Under the National Law, a student is someone enrolled in an approved program of study and is registered as a student with their respective National Board (education providers are responsible for providing information to enable students to be registered)3.
3 However, someone who holds provisional registration as a Psychologist and is undertaking a postgraduate approved program of study or internship, is not considered a student for the purposes of these Guidelines. Anyone considering a mandatory notification about a Psychologist with provisional registration should consult the Guidelines: Mandatory notifications about registered health practitioners.
These groups may need to make a mandatory notification about students:
Treating practitioners in Western Australia providing a health service to a student are exempt from the requirement to make a mandatory notification but may still be obliged to make a notification as a non-treating practitioner.
All three groups must report students who, by undertaking clinical training with an impairment, are placing the public at substantial risk of harm. A substantial risk of harm is a very high threshold for reporting risk of harm.
Employers and other people or organisations do not have to make a mandatory notification about students, but they can consider whether to raise concerns by making a voluntary notification about a student if they believe the student’s impairment could have a detrimental effect on their clinical training.
The National Law does not require students to make a mandatory notification. If they have concerns about a practitioner or another student, they may wish to discuss this with the education provider.
If, after reading this guideline, you are still unsure about whether to make a mandatory notification, seek advice from your insurer, legal advisor, or professional association.
The National Law protects anyone who makes notifications in good faith. ‘Good faith’ has its ordinary meaning of being well intentioned or without malice.
There are exemptions to mandatory notifications for practitioners where they:
Treating practitioners in Western Australia providing a health service to a student are exempt from the requirement to make a mandatory notification. However, these practitioners still have a professional and ethical obligation to protect and promote public health and safety, so they may consider whether to make a voluntary notification.
You might not need to make a mandatory notification if there are safeguards in place to reduce the risk of harm to the public. An education provider may have its own process for mandatory reporting obligations. To assess whether the process or circumstances reduce the risk of harm to the public, a practitioner who is an employee of an education provider, may find it helpful to talk to their employer and or their professional association about the concern. The employee practitioner might still have to make a mandatory notification.
The National Law also allows anyone to make voluntary notifications about a student. Anyone (including practitioners and education providers) can make a voluntary notification about a student if they believe the student’s impairment could have a detrimental effect on their clinical training.
The National Law provides only limited circumstances for a voluntary notification about students. Concerns about intoxication (not amounting to an impairment), sexual misconduct and significant departure from accepted professional standards are not grounds for a mandatory or voluntary notification about a student. If you have concerns about these matters you can consider whether to raise these with the education provider.
For more information about making a voluntary notification, please go to our website, see: www.ahpra.gov.au/ notifications, or call us on 1300 419 495.
This section defines impairment, the only issue that may trigger a mandatory notification about a student, and the concept of ‘reasonable belief’. It explains your obligations, when you must make a mandatory notification about a student and when you do not need to report.
Read this section to help assess whether you need to make a mandatory notification.
A mandatory notification about a student can only be triggered by concerns about impairment. The National Law defines ‘impairment’ as ‘a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect the student’s capacity to carry out clinical training:
A health condition and impairment are not the same thing. An illness or condition that does not have a detrimental impact on a student’s capacity to undertake clinical training is not an impairment.
You must assess if there is a substantial risk of harm to the public when deciding whether to make a notification. In this context, ‘the public’ means:
Concerns about intoxication, standards of practice or sexual misconduct cannot trigger a mandatory notification about a student. Although they are not grounds for a mandatory (or voluntary) notification under the National Law, an education provider or health service provider would typically deal with such concerns under their own policies and processes. If you have concerns about these matters you can raise them with the education provider.
Before making a mandatory notification, you must form a ‘reasonable belief’. To do so, you generally need direct knowledge (not just a suspicion) of the incident or behaviour that led to the concern. As a practitioner or education provider, you are most likely to do this when you directly observe the incident or behaviour. Speculation, rumours, gossip or innuendo are not enough to form a reasonable belief.
You may have a report from a reliable source or sources about incident or behaviour they directly experienced or observed. In that case, you should encourage the person with the most direct knowledge to consider whether to make a mandatory notification themselves.
You must make a notification if you form a reasonable belief that a student, undertaking clinical training with an impairment, is placing the public at substantial risk of harm (a very high threshold for reporting risk of harm to the public).
Not all impairments need to be reported. A student may carry out clinical training with a mental health condition, physical health condition or physical illness, but that is not enough to trigger a mandatory notification.
Similarly, if the student’s impairment affects their capacity to carry out clinical training but does not place the public at substantial risk of harm, you do not need to make a mandatory notification.
You should only make a notification if you believe there is a substantial risk of harm. A substantial risk of harm is a very high threshold for reporting risk of harm to the public.
Example 1:
You have been made aware that one of your students has been diagnosed with a mental health condition, which at times has required hospitalisation. The condition is now responding well to treatment, and the student is compliant with the treatment plan. The student is due to go on clinical placement next month, however, having considered the risk factors, as there is not a very high risk of harm to the public, you decide a mandatory notification is not required.
Consider if the risk to the public is controlled or managed through effective treatment or other strategies. If so, this decreases the risk of harm – and the need to report.
Controls that reduce the risk and severity of harm to the public affect the obligation to report. You do not need to report if there are effective safeguards to manage the impairment, such as:
Use the following chart to help assess the level of risk. Factors including circumstance, practice context, controls such as oversight and incident reporting, and other arrangements can affect the level of risk and the need to report. The risk assessment for a very high risk of harm should holistically consider all relevant factors, with some factors weighted more heavily than others, depending on the circumstance.
There are consequences for practitioners and education providers who fail to make a mandatory notification when they have to, although this is not a criminal offence under the National Law:
Mandatory notification obligations only extend to an education provider’s (organisation’s) staff if the staff member is also a registered practitioner. An education provider is expected to have processes and protocols in place to assess when and how it would make a mandatory notification.