June 2019

Issue 20 - June 2019

• Message from the Chair
• Board news 
  • Chiropractic Board announces interim policy on spinal manipulation
• Registration 
  • Have you identified your CPD requirements for this year?
• Regulation at work
  • Latest court and tribunal cases
• National Scheme news 
  • Practitioners’ responsibility to support public health programs
  • ‘Let’s talk about it’ videos launched
  • Legislative amendments on mandatory reporting and fake practitioners
  • Titles in health advertising – how to get it right
  • AHPRA launches WHO Collaborating Centre for Health Workforce Regulation
• Keep in touch with the Board

Message from the Chair

Welcome to our June newsletter. In this issue, we highlight some essential matters for chiropractors, including a reminder for new graduates about their obligations as registered practitioners and information on the Board’s interim policy on spinal manipulation for infants and young children.

 The role of the Board is to protect the public and set standards to guide the profession. One way we protect the public is to receive and deal with complaints (notifications) made by the public about misleading advertising and the conduct and performance of chiropractors.

A significant new resource now available to chiropractors is the titles tool. This can help remove any uncertainty about what titles can be used in advertising – read more below. 

The Board is committed to ensuring that the public has access to, and receives, safe, ethical and competent care from registered chiropractors. We regularly review our published guidance to ensure that our expectations on what constitutes effective care are clear and based on the best available evidence. Make sure you check our website often.

 As always, your feedback is welcome.

Dr Wayne Minter AM
Chiropractor
Chair, Chiropractic Board of Australia

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Board news

Chiropractic Board announces interim policy on spinal manipulation

The Board has set an interim policy on spinal manipulation for infants and young children while an independent review of the practice is carried out by Safer Care Victoria.

The Board awaits with keen interest the outcome of an independent expert review of the current best evidence for the efficacy of spinal manipulation to treat childhood illnesses or health concerns in infants and young children. Safer Care Victoria has established an advisory panel to support the review . The panel will consider the available evidence, is currently taking public submissions from practitioners, stakeholders and the broader community and will provide advice to Safer Care Victoria during the review, which is expected to be completed by November 2019.

The review outcomes will be used to inform future policy on the regulation of spinal manipulation for infants and young children for public protection.

The Interim policy – spinal manipulation for infants and young children is to protect the public until the outcomes of the expert review are known, and a final policy is developed on the issue. The interim policy clearly outlines the Board’s expectation that chiropractors not use spinal manipulation to treat children under two years of age, pending the recommendations arising from the review.

The Board expects chiropractors to comply with the interim policy, in addition to following the guidance provided in the Statement on paediatric care (2017) and the Code of conduct for chiropractors (2014).

The interim policy is available as a position statement under Codes and guidelines on the Board’s website.

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Registration

Have you identified your CPD requirements for this year?

As we are nearly halfway through the year it is important to have identified and started your continuing professional development (CPD) in order to meet the Board’s registration standard. This is particularly important if you are a new graduate starting your career in chiropractic in 2019.

Board Chair, Dr Wayne Minter AM, said CPD was a fundamental part of professional practice.

‘Learning is ongoing throughout a chiropractor’s career and continuing education is an important foundation for the lifelong learning that helps chiropractors maintain their competence,’ he said.

‘Patients trust chiropractors to provide them with the best healthcare and advice possible and expect all chiropractors to stay up to date and further their knowledge and skills.’

Under the National Law, the Board is required to set CPD requirements and to ensure that chiropractors comply with those standards. Your obligations are set out in the Board’s CPD standards and guidelines on the Board’s website.

Current evidence suggests that chiropractors learn more from their professional development when they reflect on their learning needs and plan their goals and the activities that they will do to achieve those goals. Professional development activities should be practical and relevant to your area of practice and you need to reflect on what you have learned and how you should change your practice as a result.

Feedback from audits suggests that chiropractors do not provide enough information about their reflection on their CPD activities. The Board provides examples of how to record your reflections in a CPD log book  in the Codes and guidelines section of its website.

Formal learning activities

The Board’s CPD registration standard requires chiropractors to complete 25 hours of CPD for each registration period and provides you with flexibility when choosing what activities best suit your learning needs. At least 12.5 of your CPD hours need to be formal learning activities (FLA) to ensure you are doing activities of a high quality.

The standard defines FLA as ‘evidence-based activities that encourage or enhance evidence-based clinical practice and contribute to the maintenance and development of both clinical competencies and clinical practice, with the expectation that these activities will contribute to minimising risk and improving patient safety and health outcomes’.

You can choose FLA previously assessed by the Chiropractors’ Association of Australia or the Chiropractic and Osteopathic College of Australasia or you can assess the activity yourself. Formal learning activities must contain balanced, evidence-based information, should be patient-centred and contribute to developing and maintaining clinical competencies. FLA may include activities such as tertiary courses, distance education modules, conferences and seminars, online learning and research.

Self-assessing formal learning activities

To reach your learning goals you may also do formal learning activities that have not been assessed. When this is the case you must assure yourself that the activities meet the Board’s criteria for FLA.

To meet the standard, you must be able to thoroughly explain how the activity met the Board’s criteria, including whether the content was consistent with ethical and professional standards and with the clinical competencies of chiropractors, how the activity enhanced evidence-based clinical practice and how it improved patient safety. Finally, you need to reflect on the activity, what you learned and how you might change your practice to provide better health outcomes for your patients. In its CPD guidelines, the Board provides additional guidance and a self-assessment tool to help chiropractors who are self-assessing their FLA.

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Regulation at work

Latest court and tribunal cases

We regularly publish court and tribunal summaries for their educational value for the profession. You can find links to past and recent court and tribunal cases on the new Chiropractic regulation at work: court and tribunal decisions page of the Board’s website. Here are some recent cases.

Former chiropractor's appeal leads to ten-year disqualification

National Scheme news

Practitioners’ responsibility to support public health programs 

Australia’s health regulators have reminded health practitioners about their responsibility to support public health programs, including vaccination.

Regulators have spoken out to support public safety, given mounting concerns about a five-year high in measles cases and an early spike in flu cases this year.

AHPRA and the National Boards for 16 professions have urged more than 740,000 registered health practitioners to take seriously their responsibilities for public health, including by helping patients to be protected from preventable illnesses.

AHPRA CEO Martin Fletcher reminded practitioners that supporting public health programs, including vaccination and immunisation, and not promoting anti-vaccination views were regulatory responsibilities.

‘Registered health practitioners have a regulatory responsibility to support patients to understand the evidence-based information available,’ Mr Fletcher said.

National Boards set codes, standards and guidelines, including about protecting and promoting the health of individuals and the community, which they expect registered health practitioners to meet.

‘Practitioners are of course entitled to hold personal beliefs, but they must ensure that they do not contradict or counter public health campaigns, including about the efficacy or safety of public health initiatives,’ he said.

Chiropractic Board of Australia Chair, Dr Wayne Minter AM, considers practitioners have a duty of care to make the needs of their patients their first concern and must practise in an evidence-based and patient-centred manner.

‘It’s important that chiropractors get the right information to their patients. We expect practitioners to provide patients with evidence-based information in accordance with established guidelines for vaccinations. I encourage all patients seeking vaccination advice to speak to their medical practitioner in the first instance,’ he said.

Regulatory action to manage risk

If practitioners do not comply and meet the professional standards set by their National Board, regulators can and do take action.

National Boards and AHPRA have taken action to manage risk to the public, in response to a number of concerns raised about practitioners (including medical practitioners, nurses and chiropractors) who have advocated against evidence-based vaccination programs. This has included restricting practitioners’ practice pending further investigation, when there was a serious risk to the public.

Regulatory action to manage public health risk has included requiring a practitioner to remove comments or material from websites, restricting practitioners from promulgating non-evidence-based anti-vaccination material and cautioning practitioners against publicly advocating a position that is not evidence based.

‘We take seriously any case of practitioners spreading dangerous and misleading anti-vaccination information including on social media. They will face regulatory action or prosecution. We are asking the public to tell us if their practitioner is doing this. If you raise your concerns with us we can investigate and protect others,’ Mr Fletcher added. 

Anyone who has a concern about a registered health practitioner is encouraged to report this to AHPRA so the concerns can be investigated, by calling 1300 419 495 or visiting the AHPRA website: www.ahpra.gov.au. 

The Board has published information to provide clear guidance about practice with respect to vaccinations.

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‘Let’s talk about it’ videos launched

AHPRA has launched a series of new videos to support the public and registered health practitioners as they go through the notification process.

The video series, called ‘Let’s talk about it’, explains what happens when concerns are raised with the regulator, gives easy-to-follow information about the notifications process and addresses common questions, so consumers and health practitioners know what to expect when they interact with AHPRA and National Boards.

There are three videos:

Legislative amendments on mandatory reporting and fake practitioners

The Health Practitioner Regulation National Law and Other Legislation Amendment Act 2019 (Qld) (the Act) has been passed by the Queensland Parliament. The amendments include revisions to the mandatory reporting requirements for treating practitioners and an extension of sanctions for statutory offences.

The changes to the National Law¹ intend to support registered practitioners to seek help for a health issue (including mental health issues). They will also increase the penalties (including the introduction of custodial sentences) for some offences under the National Law, including where a person holds themselves out to be a registered health practitioner when they are not. 

AHPRA and National Boards will now work to implement these amendments. This will require working closely with professional bodies, employers and state and territory health departments to help spread the message that practitioners should be supported to seek help about their health issues. 

The passing of the Act in Queensland marks the second set of legislative amendments to the National Law since the start of the National Scheme in 2010. When they take effect, the amendments will apply in all states and territories except Western Australia, where mandatory reporting requirements will not change. 

Read a news item about the amendments on the AHPRA website or the Act on the Queensland Legislation website.

1 The Health Practitioner Regulation National Law, as in force in each state and territory.

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Titles in health advertising – how to get it right

AHPRA and National Boards have published a new resource to help practitioners understand their legal obligations when using titles in health advertising.

The titles tool addresses the uncertainty some practitioners might have around this issue and outlines some of the common pitfalls that can result in titles being considered misleading under the National Law.

Misuse of a protected title, specialist title or endorsements is an offence under sections 113-119 of the National Law or may constitute behaviour for which health, conduct or performance action may be taken against a registered health practitioner under Part 8 of the National Law. However, advertisers should also be aware that while use of some titles may not necessarily breach title protections under sections 113-119, they may be considered false, misleading or deceptive under the advertising provisions in the National Law (section 133).

The titles tool is the latest in a series of resources and support materials developed to help health practitioners, healthcare providers and other advertisers of regulated health services check and correct their advertising so it complies with the National Law.

The titles tool is available in the Advertising resources section of the AHPRA website.

April 5 was the official launch of the Australian Health Practitioner Regulation Agency's (AHPRA) designation as a World Health Organization (WHO) Collaborating Centre for Health Workforce Regulation at the Australian National University, Canberra.

AHPRA, working in partnership with the National Boards, joins a list of over 800 institutions in more than 80 countries supporting WHO programs in areas such as nursing development, communicable diseases, mental health, chronic diseases and health technologies.

Strengthening the regulation of the health workforce is an important part of the WHO’s global strategy to build the human resources needed for access to safe and quality healthcare across the world. 

In describing AHPRA’s role as a designated collaborating centre, CEO Martin Fletcher said: ‘Australia’s National Registration and Accreditation Scheme for health professions is recognised as a leading model for regulating the health workforce.

‘We also know that the global health workforce crosses country borders and is mobile, including in Australia where thousands of overseas-qualified practitioners are registered and take up practice here. It’s important that regulators from different countries work together to improve regulation of the global health workforce.

‘As a designated WHO collaborating centre for health workforce regulation, we’re excited by the opportunity to share expertise and promote dialogue that collectively improves the standard of regulatory practice within the WHO Western Pacific Region,’ Mr Fletcher said. 

As a WHO collaborating centre AHPRA will:

• help the WHO in providing technical support to strengthen health workforce regulatory systems in member states 
• support the WHO in promoting the adoption of contemporary regulatory approaches to health workforce regulation, and
• strengthen the capacity, skills and knowledge of regulators in member states under the WHO’s guidance.

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