Registration

The pandemic response sub-register was set up last year to fast track the return to the workforce of experienced and qualified health practitioners to help in the response to the COVID-19 pandemic. It was intended to remain in place for 12 months. In early April 2021, at the request of Health Ministers, National Boards agreed that medical practitioners, nurses, midwives, pharmacists and Aboriginal and Torres Strait Islander Health Practitioners would remain on the sub-register for up to another 12 months (to 5 April 2022) to help with the COVID-19 vaccination program.

The sub-register for psychologists, physiotherapists and diagnostic radiographers closed on 19 April 2021. All professions could apply for ongoing registration through a transition pathway before the sub-register closed. Practitioners who did not apply cannot practise.

There are 26,595 Aboriginal and Torres Strait Islander Health Practitioners, medical practitioners, midwives, nurses and pharmacists on the sub-register.

This is something we are working with others to change

• Aboriginal and/or Torres Strait Islander participation in the regulated health professions was 1.1%.
• This is well short of the 3.3% Aboriginal and Torres Strait Islander representation in the general population.
• Increasing participation in the registered health workforce is a goal of the Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy.
• 100% of Aboriginal and Torres Strait Islander Health Practitioners identified as being Aboriginal and/or Torres Strait Islander. It is a requirement for registration in that profession.
• Paramedicine had the second highest representation with 1.7% of their workforce identifying as Aboriginal and/or Torres Strait Islander.
• Midwifery (including dual-registered midwives and nurses) was next with 1.4%, closely followed by nursing (including dual-registered) with 1.3%.

In the graduate customer experience survey we asked how can we improve the process for Aboriginal and Torres Strait Islander applicants.

Survey participants who identified as Aboriginal and/or Torres Strait Islander (2.6%) suggested:

• an Aboriginal and/or Torres Strait Islander Liaison Officer as an alternative contact
• additional information and support for Aboriginal and/or Torres Strait Islander registrants entering the health workforce.

• 189,786 students were studying to be health practitioners through an approved program of study or clinical training program
• All National Boards, except the Psychology Board, register students. Psychology students receive provisional registration. The student register isn’t public.
• Education providers supply student information so students can be registered. 

All applications

• Ahpra received 84,607 applications for registration
  • this is an increase of 3.9% from last year.
• 91.7% (77,566 applicants) sought practising registration.
• Applications for registration as a specialist in the medical profession increased by 116.7% from 4,122 to 8,931 applications as a result of changes to the Health Insurance Act 1973.
• We finalised 84,232 applications
  • Of these, 2.3% resulted in conditions being placed or a refusal of registration.
  • There was an 87.0% reduction in the refusals of registration (353 this year compared to 2,713 last year) as only 229 nurses were refused registration compared to 2,579 nurses last year. This decrease was expected and likely due to the new registration application process for internationally qualified nurses, which enables an initial self-assessment before lodging an application. 
• The time to decide the outcome of an application for registration was reduced:
  • median time of 2 days (4 days in 2019/20)
  • average of 17 days (19 days in 2019/20).

Specialist registration of GPs

• We experienced a significant short-term increase in medical specialist applications from general practitioners (GPs) because of Commonwealth Government changes to the Health Insurance Act 1973. 
• From 16 June 2021, Services Australia started using Ahpra’s Register of practitioners to confirm GP specialist registration, required so their patients were eligible to retain access to Medicare rebates. 
• We identified approximately 3,400 GPs as likely to be qualified for specialist registration because they were qualified for Fellowship of the Royal Australian College of General Practitioners (FRACGP) or Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) but had never applied for specialist registration. 
• This led to a surge in specialist applications. At 24 June, 99.3% of the affected GPs had applied for and were granted specialist GP registration. On average, applications were finalised in two days from receipt.

Arrivals of overseas graduates

• The number of new registration applications received from overseas qualified applicants was affected by the Australian border closures. It continues to be difficult for applicants to travel to Australia, so the number of overseas applicants with in-principle approval who are waiting to travel to Australia to finalise proof of identity requirements continues to be higher than before the pandemic.
• We received 2,531 applications from international medical graduates (IMGs), 22.6% fewer than the 3,271 applications received last year. 
• The number of requests from IMGs currently working in Australia, with limited or provisional registration, to change their employment circumstances has dropped by 11.9%. A request for a change in circumstances is typically made when an IMG with limited or provisional registration seeks a change to their approved employment and/or supervision arrangements. A streamlined process enables eligible IMGs with limited or provisional registration to be redeployed without a formal application to the Medical Board of Australia. This measure continues to facilitate IMGs being quickly available to work where the Australian health system needs them.]

Some applicants sit an exam

Internationally qualified nurses and midwives

From March 2020, internationally qualified nurses and midwives (IQNMs) who wish to apply for registration in Australia are required to complete an online assessment of their qualifications. Those who hold qualification/s that are substantially equivalent or based on similar competencies to an Australian graduate (and who meet the mandatory registration standards) progress to an application for registration.

IQNMs who hold relevant but not equivalent qualification/s must successfully complete an outcomes-based assessment before being eligible to apply. These IQNMs complete two exams: 

• a multiple-choice question examination (MCQ) (knowledge test) 
• an objective structured clinical examination (OSCE) (behavioural test). 

The MCQ examinations are:

• enrolled nurse (EN) – a paper-based exam coordinated by Ahpra that is yet to be delivered 
• registered nurse (RN) – an online exam, the National Council of State Boards of Nursing (NCSBN) National Council Licensure Examination – Registered Nurse (NCLEX-RN) conducted at Pearson VUE testing centres in more than 20 countries including Australia – 1,799 candidates sat the exam  Candidates who have sat and passed the National Council Licensure Examination – Registered Nurse (NCLEX-RN) in the past 10 years are not required to re-sit the exam
• midwife – an online exam conducted at Aspeq managed facilities in Australia, New Zealand and internationally – 16 candidates sat the exam. 

The OSCEs for IQNMs are coordinated by Ahpra at Adelaide Health Simulation. A total of 109 internationally qualified registered nurses participated in the RN OSCE offered in February, April and June. The EN OSCE and a midwife OSCE are yet to be delivered. 

The delivery of all these exams has, to varying extents, been affected by restrictions related to the COVID-19 pandemic. 

Pharmacy, psychology and medical radiation practice exams

Ahpra coordinated the following exams:

• 1,873 pharmacy interns were assessed in the oral examination (practice) in October, February and June. Victorian candidates sat the exam online in October 2020. NT candidates sat the exam online throughout 2020/21 as examiners have not been able to travel due to COVID-19.
• 67 oral exams were held for pharmacy practitioners holding limited or general registration with conditions on their registration requiring the completion of an examination in practice, or in law and ethics. These exams were offered monthly.
• 927 candidates sat the quarterly national psychology examination. These exams were offered by dual delivery, meaning candidates could choose to sit the exam in a test centre (where available) or by online supervision.
• 54 candidates sat the quarterly national medical radiation practice examination. The exams were offered by dual delivery, meaning candidates could choose to sit the exam in a test centre (where available) or by online supervision.

An early start to the new graduate campaign

The graduate campaign opened two weeks earlier (in mid-September) in response to advice from stakeholders that clinical placements for some students may be delayed due to COVID-19, which in turn could affect graduation dates and potentially employment start dates. 

By opening the graduate campaign early, our aim was to:

• more evenly spread out the applications received in the peak registration period for new graduates qualifying at the end of the calendar year
• still meet our goal of registering graduates within two weeks of receiving their graduate results
• get health practitioners registered (and into the health workforce) earlier and in greater numbers than in previous years.

Our early preparations focused on recruiting and training new staff and supporting students with new resources, including an animated video to help them complete their applications correctly. 

Targeted communication strategies also included:

• a direct email campaign to nursing, medicine and pharmacy students asking them to apply early
• a series of webinars for nursing and pharmacy students
• some frequently asked questions and answers published on the website. 

The webinars were well attended with registrations for the nursing webinars reaching the 1,000-maximum capacity. The webinars were then published on our website.

We successfully conducted our second ‘applicant experience’ survey of graduates with 27,275 registrants invited to participate in the voluntary survey and we achieved an improved response rate of 22.4% (compared to 15.8% last year). Overall the feedback was positive, with almost 80% of respondents satisfied with how their application was managed.

Most respondents commented favourably on the timeliness of their assessment, felt they were generally well informed about their application status, had positive interactions with our Customer Service team and found the online form, process and website easy to understand.

One of our checks is of criminal history

• 69,571 results received from domestic and international criminal history checks of practitioners and/or applicants
  • this decrease of 10.4% was likely due to reduced applications from internationally qualified practitioners linked to COVID-19, specialist registration applications from GPs, and other registration changes where a check is not required.
• 3.9% indicated a disclosable court outcome
  • three cases where the check resulted in registration being granted with conditions
  • two cases where the check resulted in refusal to grant registration
  • one case where the check resulted in a refusal to renew registration.
• National Boards can place conditions on a practitioner’s registration or refuse an application entirely.

Renewals

• Ahpra renewed registration for 738,659 practitioners¹ 
• 99.6% of all eligible practitioners renewed online.
• Only practitioners who are suitably trained and qualified to practise in a competent manner are registered 

Changes to renewals

• We updated the online renewal information and the renewal questions on the online form to help practitioners better understand what they need to do to renew their registration. 
• For the first time, we asked practitioners to make a declaration about their compliance with advertising requirements. 
• A new risk-assessment model is proving to be very successful in identifying risk early and in timely decision-making about declarations made by practitioners when renewing.
• For the first time, health practitioners in all professions did not receive a paper registration certificate at renewal. Instead all registered practitioners can print a registration certificate from their online services account after they have renewed. 

A service for employers to check registration

• 136 government departments, public and private hospitals, healthcare businesses, pharmaceutical companies, medical insurers, and nursing and aged care agencies subscribed to the Practitioner Information Exchange (PIE), a secure web-based system that enables bulk checking of registration status.

Financial hardship support

• In June, we introduced the Policy – financial hardship for payment of registration fee for all professions. 
• People are considered to be experiencing financial hardship when they are unable to provide for themselves, their family or other dependants: food, accommodation, clothing, medical treatment, education, and/or other basic necessities.
• Applicants and practitioners can apply for financial hardship support before applying for registration or renewal of registration. This doesn’t apply to recent graduates for Chinese medicine, medical, nursing or midwifery because a reduced application or registration fee already applies.
• The policy balances both the needs of people who are keen, but not able, to easily register or renew so they can be part of Australia’s health workforce, and that the scheme is funded through practitioner fees. 

Online upload service to continue

Ahpra offices have remained closed to the public due to ongoing public health restrictions. Applicants and registered health practitioners continue to submit applications and other forms online, along with supporting documents. This process has significantly reduced hardcopy submissions and enables practitioners to join the healthcare workforce sooner by reducing the time required to mail and process information, so we will continue with this approach.

¹This was incorrectly reported in last year's report as 693,751 practitioners, as we missed including paramedics in the total. With paramedics, 713,402 practitioners renewed their registration in 2019/20.

Audits

The timing of audits was affected by COVID-19. We completed 1,055 audits. 

• 97.9% of practitioners were found to be in full compliance with the registration standards being audited.
• 0.1% of practitioners did not quite meet the registration standard, but were able to provide evidence of achieving full compliance during the audit period.
• 0.9% of practitioners required no audit action
  • 0.8% changed their registration type to non-practising or failed to renew their registration; usually these were practitioners residing overseas, and those no longer practising but maintaining registration
  • 0.1% were referred to a co-regulatory jurisdiction to manage.
• 1.0% were found to be non-compliant with one or more standards.

The standards that may be audited are:

• continuing professional development
• recency of practice
• professional indemnity insurance arrangements
• criminal history.