Regulating the unregistered: an analysis of negative licensing regulatory arrangements for unregistered complementary practitioners in Australia

Abstract

Purpose: An increasingly large part of healthcare delivery in Australia is provided by unregistered health practitioners, who have not been historically subject to formal regulatory arrangements. This is partly due to the promotion of multidisciplinary health teams, but is also driven by the increasing presence of complementary and alternative health providers, for whom many governments are hesitant to extend formal regulatory arrangements. The Australian state of New South Wales has implemented a statutory Code of Conduct for unregistered practitioners, known as a negative licensing model, to extend protection to the public with respect to unregistered health practitioners. Methods: All complaints (n=22440) to the New SouthWales Health Commissioner between 2008 and 2013. All 20 public prohibition orders issued under the negative licensing legislation were reviewed and analysed thematically. Results: Treatment issues formed 40.3% of complaints against registered practitioners, but only 19.7% of complaints in unregistered practitioners (p<0.001) whilst professional conduct issues formed only 15.7% of complaints against registered practitioners but 44.7% of complaints against unregistered practitioners (p<0.001). The majority of the acts resulting in prohibition orders would have been preventable had appropriate probity measures and barriers to entry to practice (such as criminal history checks andminimum levels of education) been in place. Conclusion: These results are consistent with the hypothesis that negative licensing offers no proactive public protection, but is a reactive mechanism. Negative licensing does offer a great safety net protections than previous models in instances were statutory registration is not practical, it should not be viewed as a replacement for extension of statutory registration to newhealth disciplines, but rather as a complementary measure to existing and new statutory registration arrangements. Governments should continue to focus on statutory regulatorymechanisms for all health professions with significant presence in the community to ensure public safety. Contact: Jon Wardle, jon.wardle@uts.edu.au