Last year AHPRA took ‘immediate action’ against 413 health practitioners—including suspending registration or imposing other conditions while investigations are still underway. A further 86 immediate action cases were pending, according to AHPRA’s 2024 annual report.  

The regulatory overseer has the power to impose sanctions before wrongdoing is confirmed in cases where “there is a serious risk to public safety,” or it’s otherwise “in the public interest,” for example if a practitioner is charged with or convicted of serious criminal behaviour. 

But critics worry they are wielding this power too freely, without accountability or oversight, and without regard for the serious ramifications that befall doctors whose lives and careers are left in limbo while investigations stretch on for years. 

Are appropriate safeguards in place?  

More than half of GPs (53%) in a Healthed poll last month felt safeguards against ‘immediate action’ are inadequate – but many also noted that they aren’t fully informed about the issue and/or have never had any experience with it. Fifty seven percent of 2097 GP respondents felt AHPRA overused this power without appropriate justification at least some of the time. 

The survey follows the release of several submissions to the National Health Practitioner Ombudsman’s (NHPO) investigation into delay and procedural safeguards for practitioners who are subject to immediate action.  

In response, the AMA, RACGP and Australian GP Alliance (AGPA) have all raised concerns, as have other stakeholders such as the medical defence organisation Avant. 

The ombudsman launched the investigation after identifying a rise in complaints year on year – with 84 issues recorded in 2023-24, up from 51 the previous year, and 24 the year before that. 

Doctors stuck in purgatory for years  

The Health Practitioner Regulation National Law Act does not mandate any specific timeframes in which AHPRA must complete the investigation, stating only that it must be done “as quickly as practicable.” 

And it seems AHPRA is in no hurry. 

In its submission, Avant states that its “conservative estimate” is that it takes a minimum of around two years to finalise immediate action matters. “Often it can take more time than this,” they add, noting one case that remains unresolved eight years on. 

The AMA’s consultation with doctors brought similar experiences to light. 

“We heard examples of the power being used when it was unclear what the risk to the public was, and of practitioners left waiting for years with minimal communication from Ahpra. Clearly, Ahpra needs greater accountability when it takes immediate action,” AMA president Dr Danielle McMullen said. 

There were “stories of doctors languishing for years — some resorting to driving Ubers — while they wait to hear from Ahpra on the progress of their case,” the AMA submission explained. 

The RACGP agreed, stating that “While immediate action itself is often implemented swiftly, the subsequent investigation and resolution of these matters often extends far beyond what could reasonably be considered ‘as quickly as practicable.’” 

Guilty until proven innocent 

The power to suspend a practitioner or impose conditions based on allegations that have not yet been proven can and does have serious ramifications. 

“Such an action implies guilt before innocence can be proven, and can inflict irreparable damage to a practitioner’s reputation, derailing their career and their relationships with patients, colleagues, and employers,” Dr McMullen noted. 

Not only that, but there is “no real course of redress,” the AMA submission explains.

Inconsistent approach 

The AMA points out that “in nearly half of the cases where immediate action was taken, no final regulatory measures were given, suggesting immediate actions might have unnecessarily disrupted the personal and professional lives of these doctors.” 

“While some practitioners are treated fairly and the process is well managed, there are far too many cases where this does not occur.” 

Communication from AHPRA is sparse, and while it can take as long as it wants to investigate, practitioners are often given tight deadlines to provide evidence. “One member stated they were given two weeks to find a lawyer to prepare to testify, only for Ahpra to not respond or provide communication to this practitioner for 10 months.” 

Doctors are often not even told the reason when immediate action is taken. 

Serious consequences 

“During this time, a practitioner can have their medical career on hold, or be subject to restrictive conditions, even before the matter has been investigated by Ahpra or considered by a Tribunal,” Avant explains. 

Dr Mukesh Haikerwal, deputy chair of the AGPA and former AMA president, agrees.  

“The repercussions are immediate, immense, career threatening and possibly career ending with a devastating outcome on the individual and their family,” he wrote in his submission on behalf of the AGPA. 

More broadly, a recent review by AHPRA’s expert advisory group found 16 suicides and four incidents of attempted suicide or self-harm by practitioners who were involved in a regulatory process over a four year period. 

Dr Haikerwal says that while the immediate action process should be fair, transparent, competent, well-governed and robust—with accountability and a presumption of innocence—”the manner in which the agency performs its work and the outcomes that are delivered can be lacking in these parameters.” 

What would a fair system look like? 

For a start, Dr Haikerwal says AHPRA should be bound by the same safeguards that exist in the legal system. 

“And indeed the investigatory processes that apply in the police force should also apply in the medical profession. You should not lose your civil liberties for being medically qualified.” 

Investigation should begin immediately, and practitioners should get regular, frequent updates on the status of their case. 

Dr Haikerwal, the AMA, RACGP and Avant all agree that a time-limit, and consistent, regular communication are essential. Moreover, they argue that AHPRA should be accountable for its actions.  

In its submission, Avant sums it up this way: “Notwithstanding the catastrophic effect immediate action can have on a practitioner, currently, there are no consequences for Ahpra and National Boards when investigations are not expedited after immediate action has been taken. There is therefore limited, if any, incentive for a more timely investigation process.” 

“Without a legislated timeline for the conduct of the substantive matter, there is no accountability for the Ahpra and the National Boards to investigate and act in a timely manner. In the meantime, the practitioner may be unable to work or has had their practice restricted, sometimes for many years.” 

Submissions for the NHPO’s investigation have closed, but the investigation is ongoing, and recommendations have yet to be released.