Mandatory Notification – Doctors
What are mandatory notifications?
- A legal requirement under the Health Practitioner Regulation National Law (the National Law).
- Purpose: Protect the public from risk of harm posed by a practitioner’s impairment, intoxication, unprofessional conduct, or sexual misconduct.
- Managed by Ahpra and National Boards.
- Focuses on conduct that poses a current or future risk, not historical events without ongoing relevance.
🔹 WHO MUST MAKE A MANDATORY NOTIFICATION?
| Category | Legal Obligation | Examples |
|---|---|---|
| Treating practitioners | Yes | GP treating another GP |
| Non-treating practitioners | Yes | Colleague, manager, supervisor |
| Employers | Yes | Practice owners, hospitals, corporate clinics |
| Others (patients, public) | No (Voluntary) | Can make voluntary notifications |
🔹 WHAT MUST BE REPORTED (4 KEY CONCERNS)
| Type of Concern | Description |
|---|---|
| Impairment | A physical or mental condition that detrimentally affects or is likely to affect safe practice. |
| Intoxication | Practising while under the influence of alcohol, illicit drugs, or medications affecting safe care. |
| Significant departure from accepted professional standards | Serious deviation from codes of conduct, guidelines, clinical protocols, or ethical standards. |
| Sexual misconduct | Any inappropriate sexual behaviour connected to practice, including activity with a current or former patient. |
🔹 REASONABLE BELIEF – THE THRESHOLD
- Must have direct knowledge or reliable first-hand information.
- Based on facts that would lead a reasonable, cautious practitioner to believe the concern exists.
- Not sufficient: Hearsay, gossip, innuendo, suspicion without evidence.
🔹 REPORTING THRESHOLDS BY NOTIFIER TYPE
| Concern Type | Treating Practitioner | Non-Treating Practitioner | Employer |
|---|---|---|---|
| Impairment | Must notify if public is at substantial risk of harm | Must notify if public is at risk of substantial harm | Must notify if public is at risk of substantial harm |
| Intoxication | Must notify if public is at substantial risk of harm | Must notify regardless of risk level | Must notify regardless of risk level |
| Standards | Must notify if public is at substantial risk of harm | Must notify if public is at risk of harm | Must notify if public is at risk of harm |
| Sexual Misconduct | Must notify if there’s a reasonable belief of past/current/potential misconduct | Same | Same |
🔹 TREATING PRACTITIONERS — ADDITIONAL DETAIL
- Applies when providing care to another practitioner (e.g. GP-patient).
- Higher threshold: Must report only when there’s a substantial risk of harm, except for sexual misconduct.
- Rationale: Encourage help-seeking by practitioner-patients.
🔸 WA Exception
- In Western Australia, treating practitioners are legally exempt from mandatory notification.
- Still encouraged to make voluntary notification if risk is present.
🔹 DEFINITIONS OF KEY TERMS
🔸 Impairment
- Defined in National Law as: “A physical or mental impairment, disability, condition or disorder (including substance abuse/dependence) that detrimentally affects or is likely to affect the person’s capacity to practise.”
- Not all illness = impairment (e.g. a controlled condition under treatment ≠ notifiable).
🔸 Intoxication
- No formal definition; ordinary meaning applies.
- Practitioner is intoxicated while practising, i.e., affected by substance use during the provision of healthcare.
🔸 Significant Departure from Professional Standards
- Breach must be serious and obvious to reasonable peers.
- Includes clinical errors, unethical behaviour, unsafe prescribing.
- Innovation or alternate care plans ≠ notifiable, unless they breach accepted standards and place public at risk.
🔸 Sexual Misconduct
- Includes any:
- Sexual activity with current patients (even if consensual)
- Sexualised comments or inappropriate behaviour
- Touching without clinical indication
- Intimate relationships soon after treatment, depending on power imbalance
🔹 EXEMPTIONS FROM MANDATORY NOTIFICATION
You are exempt from mandatory notification if:
- You are:
- A lawyer acting under a professional indemnity policy.
- Giving advice about legal proceedings or preparing legal advice.
- A member of a legislatively approved QA committee with privilege protections.
- You reasonably believe someone else has already made a notification and safeguards are in place.
🔹 LEGAL PROTECTIONS
- Section 237 of National Law:
- Protection from civil, criminal, and administrative liability if acting in good faith.
- Protection from breach of privacy, confidentiality, or professional ethics claims.
- Bad faith notifications (malicious or vexatious):
- May result in regulatory action against the notifier (e.g., caution or disciplinary action).
🔹 HOW TO MAKE A NOTIFICATION
- Through AHPRA portal: www.ahpra.gov.au
- By phone: 1300 419 495
- Notifications should be made as soon as practicable.
🔹 VOLUNTARY NOTIFICATIONS
Anyone may make a voluntary notification if they reasonably believe that:
- A practitioner’s conduct or health places the public at risk, OR
- A practitioner is practising unsafely.
🔹 CONSEQUENCES OF FAILURE TO NOTIFY
- Not criminal, but National Board may take regulatory action (e.g. caution, education order).
- For employers: Failure to notify must be reported to the Minister and may result in external investigation.
Significantly departing from accepted professional standards
This refers to serious, not minor, deviation from:
- Clinical practice guidelines
- Regulatory codes of conduct (e.g. MBA’s Good Medical Practice)
- Ethical standards
- Duty of care obligations
- Competency expectations for the profession
❌ Not:
- Innovative but evidence-based practice.
- Slight or occasional variation from guidelines.
- Inter-clinician variation with no public harm risk.
🔹 Examples of Significant Departure (AHPRA-context)
| Scenario | Reasonable belief established? | Notes |
|---|---|---|
| A GP encourages cancer patients to stop chemotherapy and use unproven herbal treatments instead | ✅ Yes | Unsafe, unapproved, unethical – serious deviation |
| A practitioner repeatedly administers incorrect medication doses, despite being advised and harming patients | ✅ Yes | Repeated unsafe practice with known consequences |
| A colleague’s prescribing practice consistently contradicts national guidelines, leading to adverse events | ✅ Yes | Consistent pattern and harm = reportable |
| A peer uses an alternative therapy, but it aligns with accepted guidelines and is clinically justified | ❌ No | Not a departure from accepted standards |
| You disagree with a colleague’s choice of antidepressant in a low-risk patient | ❌ No | Clinical variation alone is not reportable |
🔹 Risk Threshold – Must ALSO Cause Harm (Except for Sexual Misconduct)
To be mandatorily notifiable, the significant departure must:
- Place the public at risk of harm (non-treating/employer), or
- Place the public at substantial risk of harm (treating practitioner).
Minor errors, particularly if corrected and without consequence, do not meet the threshold.
🔹 Common Features of Reportable Departures
- Lack of insight or refusal to change practice.
- Repeated behaviour or pattern of concern.
- No appropriate supervision, review, or control measures.
- Resulted in patient harm, or risk of harm is ongoing.
- Practised in isolation without peer review or governance.