This section explains your obligations as a treating practitioner.
A treating practitioner is a practitioner who becomes aware of the concern while providing treatment to another practitioner.
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.
3.1 What are my obligations?
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:
- are practising with an impairment and placing the public at substantial risk of harm
- are practising while intoxicated by alcohol or drugs and placing the public at substantial risk of harm
- are practising in a way that significantly departs from accepted professional standards and placing the public at substantial risk of harm, or
- have engaged in, are engaging in or might engage in sexual misconduct connected to their practice.
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.
3.2 When must I report 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 with an impairment.
To decide if a practitioner-patient’s impairment puts the public at substantial risk of harm, consider:
- the nature, extent and severity of the impairment
- what steps a practitioner-patient is taking, or willing to take, to manage the impairment
- how well the impairment can be managed with treatment, and
- any other matter relevant to the risk the impairment poses.
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.
Treating practitioner: Impairment - Factors to help you assess the risk of harm
Factors |
Lower |
Higher |
Nature, extent and severity of impairment |
Minor |
Wide-ranging and severe |
Practice context |
Part of integrated team |
Isolated and/or sole practice |
How well the impairment can be managed with treatment |
Well-managed |
Unmanaged |
Extent of engagement with treatment |
Highly engaged and compliant |
Disengaged – likely to work when they shouldn’t |
Strategies used to manage impacts of impairment |
Highly effective |
Ineffective |
Use the flowchart to help you assess whether to make a mandatory notification.
Treating practitioner: Impairment
- Your role
Are you providing a health service to another practitioner?
- No
- You do not have to notify Ahpra as a treating practitioner.
However, consider if you need to do so as a non-treating practitioner. See section 4.2
- Yes
-
Considerations
- 1: Impairment
Do you have a reasonable belief that the practitioner is practising with an impairment? This means they have a health condition that detrimentally affects their practice.
- No
- No notification
If the condition does not have a detrimental effect on practice, it is not a ground for a notification.
- Yes
- 2: Reasonable belief
Do you have a reasonable belief that the impairment is placing the public at risk of harm?
- No
- No mandatory notification
You do not have to make a mandatory notification, but you can consider whether to make a voluntary notification.
- Yes
- 3: Risk
After considering risk factors, is there a substantial risk of harm to the public?
- No
- No mandatory notification
You do not have to make a mandatory notification, but you can consider whether to make a voluntary notification
- Yes
- Mandatory notification
You must notify Ahpra by making a mandatory notification.
For more on what impairment means under the National Law, see section 2.3 What is impairment?
3.3 When must I report 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 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:
- the intoxication impairment is being treated appropriately, and
- if you need to make a mandatory notification.
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.
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.
Treating practitioner: intoxication - Factors to help you assess the risk of harm
Factors |
Lower |
Higher |
Extent and duration of intoxication |
Minor and/or short term |
Severe and/or long term |
Practice context |
Part of integrated team |
Isolated and/or sole practice |
How often event occurs |
Isolated incident |
Pattern of behaviour |
Extent of self reflection |
Highly reflective and insightful |
In denial likely to work again while intoxicated |
Use the flowchart to help you assess whether to make a mandatory notification.
Treating practitioner: Intoxication
- Your role
Are you providing a health service to another practitioner?
- No
- You do not have to notify Ahpra as a treating practitioner.
However, consider if you need to do so as a non-treating practitioner. See section 4.3
- Yes
-
Considerations
- 1: Intoxication
Do you have a reasonable belief that the practitioner practised their profession while intoxicated by alcohol or other drugs?
- No
- No mandatory notification
You do not have to make a mandatory notification, but you can consider whether to make a voluntary notification.
- Yes
- 2: Reasonable belief
Do you have a reasonable belief that the intoxication is placing the public at risk of harm?
- No
- No mandatory notification
You do not have to make a mandatory notification, but you can consider whether to make a voluntary notification.
- Yes
- 3: Risk
After considering risk factors, is there a substantial risk of harm to the public?
- No
- No mandatory notification
You do not have to make a mandatory notification, but you can consider whether to make a voluntary notification
- Yes
- Mandatory notification
You must notify Ahpra by making a mandatory notification.
For more on what intoxication while practising means under the National Law, see section 2.4 What is intoxication while practising?
3.4 When must I report a significant departure from professional standards?
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.
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.
Treating practitioner: departure from professional standards - Factors to help you assess the risk of harm
Factors |
Lower |
Higher |
Practice context |
Part of integrated team |
Isolated and/or sole practice |
Capacity to judge the extent of the departure |
Few shared competencies |
Same profession |
Action underway to redress gaps in practice |
Actively engaging in bridging gap |
Unwilling or unable to take action to address issues |
Extent of self reflection |
Highly reflective and insightful |
No insight or reflection |
How often event occurs |
Isolated incident |
Pattern of practice |
Attitude towards compliance with professional standards |
Committed to compliance |
Decided not to comply |
Extent of harm |
Minor |
Severe |
Use the flowchart to help you assess whether to make a mandatory notification.
Treating practitioner: Significant departure from accepted professional standards
- Your role
Are you providing a health service to another practitioner?
- No
- You do not have to notify Ahpra as a treating practitioner.
However, consider if you need to do so as a non-treating practitioner. See section 4.4
- Yes
-
Considerations
- 1: Departure from accepted professional standards
Do you have a reasonable belief that the practitioner is significantly departing from accepted professional standards in their practice?
- No
- No mandatory notification
You do not have to make a mandatory notification, but you can consider whether to make a voluntary notification.
- Yes
- 2: Reasonable belief
Do you have a reasonable belief that this departure is placing the public at risk of harm?
- No
- No mandatory notification
You do not have to make a mandatory notification, but you can consider whether to make a voluntary notification.
- Yes
- 3: Risk
After considering risk factors, is there a substantial risk of harm to the public?
- No
- No mandatory notification
You do not have to make a mandatory notification, but you can consider whether to make a voluntary notification
- Yes
- Mandatory notification
You must notify Ahpra by making a mandatory notification.
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?
3.5 When must I report sexual misconduct?
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.
Use the flowchart to help you assess whether to make a mandatory notification.
Treating practitioner: Sexual misconduct
- Your role
Are you providing a health service to another practitioner?
- No
- You do not have to notify Ahpra as a treating practitioner.
However, consider if you need to do so as a non-treating practitioner. See section 4.5
- Yes
-
Considerations
- Sexual misconduct
Do you have a reasonable belief that the practitioner has engaged in, is engaging in, or is at risk of engaging in sexual misconduct connected to their practice?
- No
- No mandatory notification
You do not have to make a mandatory notification, but you can consider whether to make a voluntary notification.
- Yes
- Mandatory notification
You must notify Ahpra by making a mandatory notification.
For more on what sexual misconduct means under the National Law, see section 2.6 What is sexual misconduct?