Dealing with a regulatory complaint

• Contact us for advice as soon as you become aware of a complaint to Ahpra, the Medical Board of Australia, the HCCC, the OHO or another health complaints entity.
• Receiving a complaint from a regulator is not uncommon and the majority are resolved with no further action.
• It is critical that you look after yourself through the process of dealing with a complaint.

Being the subject of a complaint can be a stressful and confronting experience. It is a common misconception that good doctors do not receive formal complaints. In our experience every doctor can expect to receive a complaint at least once or twice in their career.

We encourage you to try to view a complaint as a chance to reflect on your professional practice. While at first it may feel like a direct attack on your personal and professional integrity, there is often at least one thing you can learn from the feedback you receive in the form of a complaint.

The regulatory system may differ depending on your location. Our table below outlines the key features of medical regulators in Australia. This factsheet focuses on the process regulators take in response to complaints. 

Ahpra and the Medical Board 

In most states and territories, the Australian Health Practitioner Regulation Agency (Ahpra) is responsible for managing complaints about an individual practitioner's health, conduct or performance. Ahpra does this for all registered health practitioners in conjunction with the relevant national boards, such as the Medical Board of Australia. Ahpra and the Medical Board have shared responsibility for dealing with complaints against medical practitioners.

Complaints to Ahpra are called notifications, while complaints to other entities are referred to as complaints. In this factsheet we refer to all types as complaints.

Ahpra receives complaints and manages the complaints process while the Medical Board makes decisions about the outcome of a complaint. Some complaints can be referred to a health complaints entity who can consider whether a resolution process is appropriate. For more information see Australian Health Practitioner Regulation Agency - Other health complaints organisations (ahpra.gov.au). 

You might be asked by Ahpra to provide a response to or reflect on the complaint. Ahpra will share your response or reflection with the Medical Board who will decide whether the complaint requires any action to be taken. The Medical Board’s role in relation to complaints is to evaluate the complaint, make findings and take regulatory action in relation to the doctor's health, conduct or performance, or refer to a tribunal or other responsible body, for instance in a case of possible professional misconduct. 

If conditions are placed on a doctor's registration, Ahpra is responsible for monitoring compliance. 

New South Wales

The Medical Council of NSW and the Health Care Complaints Commission (HCCC) work together to assess and manage complaints about practitioner's conduct, health and performance for behaviour that occurred in NSW. The HCCC also deals with complaints against health services.

Ahpra and the Medical Board of Australia do not manage complaints in NSW.  Ahpra does however have a role in managing some other aspects of medical regulation in NSW including: 

• accepting mandatory notifications and referring them to the HCCC  
• considering possible advertising breaches  
• ensuring that all NSW complaints and their outcomes are recorded in the national database to promote information sharing. 

Queensland

In Queensland there is a dual regulatory system. The Office of the Health Ombudsman (OHO) is an independent statutory body and works with Ahpra to oversee and regulate registered health practitioners. The OHO receives all notifications about health care complaints in Queensland. It considers the complaint and will liaise with Ahpra about whether the OHO or Ahpra and the Medical Board will manage the complaint.

Generally, the OHO will manage complaints about minor issues through its local resolution process, and will also manage the most serious complaints about performance or conduct issues.  Matters that, at first assessment, fall somewhere in the middle, particularly those that relate to concerns about clinical practice are usually referred to Ahpra, as it has medical advisers on its team whereas the OHO does not.  Ahpra also manages complaints that relate to concerns that a practitioner may have an impairment.   

The National scheme - notification process in each state and territory

Reproduced with permission Australian Health Practitioner Regulation Agency - Annual report 2022/23 (ahpra.gov.au) Page 73

First contact from the regulator 

Initially, someone from the regulator may telephone you to let you know there has been a complaint. At this time, listen to what the caller has to say and take down any notes you may need, including their name and contact details. They may confirm your contact details to send the written complaint and may offer you wellbeing support at this time.  

The phone call may come as a shock, and your first reaction may be to try and respond quickly. Even if you think the matter can be easily clarified, it’s best not to offer any further information at this stage. 

There can be some confusion about contact from a regulator, especially given the stress the situation may cause.  Be clear about the purpose of any call or contact you receive given the different functions of each of the organisations [see table above].  

As an Avant member, once you become aware of a complaint, you should contact us and let us know about it. We are here to help. 

 If you do receive a regulatory complaint, do not speak about the complaint with the patient or person who has made the complaint directly, as this could be interpreted as interfering with the complaint process. Dissuading people from complaining could be considered inappropriate conduct and may be an offence depending on the jurisdiction and the specific circumstances.  

The subsequent email or letter from the regulator may come with a copy of the complaint enclosed. When you receive the written complaint, it is important not to ignore it and provide it to us promptly, as it does take time for us to help to formulate your response.  Do not try to resolve the issue on your own without Avant’s assistance.  

It is most common for a complaint to be made by a patient, but anyone can make a complaint including a relative of the patient, a colleague or an employer. Sometimes the complaint comes from another body such as the coroner, the Commonwealth Department of Health and Aged Care (following a Medicare audit), or a state or territory health department (following a prescribing issue).  

Serious matters 

For some serious cases, you might receive notice that the regulator intends to impose a condition on your registration, or even suspend your registration, while an investigation occurs.  This action can be taken quickly and there are time limits in which to respond.  Contact us as soon as possible if you receive a letter or email about this so we can help you respond.  

Your first response 

It can be very difficult to maintain your objectivity in the face of a complaint about your professional care and therefore it is in your interests to allow us to review any response you have prepared before you provide it to a regulatory or complaints body. Providing a draft response and other relevant materials to us as soon as possible will allow time for us to review the response and discuss recommended amendments with you. Effective responses are those which are objective, supported by medical records and demonstrate a level of insight.

We can liaise with the regulator or complaints body on your behalf if you wish.

If the complaint is made by someone other than the patient, we will consider whether it will be a breach of patient confidentiality to provide a response and records, and provide guidance about this.

Although most complaints can be resolved once the regulator has your response, sometimes the regulator will need to gather more information before the complaint can be closed.  

This does not necessarily mean that further action will be taken against you. Often, the extra information will help the regulator to determine that there is no need to do anything further.   

The regulator might ask for the following additional information: 

• clinical records from the patient, a hospital or another practitioner 
• a statement or information from other people who were present at a relevant time about what happened 
• a report from another practitioner who has been asked to review the case and provide an opinion. 

Any information that is gathered will be shared with you and you will be able to respond to it.  We can assist members to review and respond to this information.  

If the complaint is being managed by Ahpra and the Medical Board, you may be given the opportunity to meet with Ahpra to discuss the case.  This is called a case discussion and is usually held via video, or occasionally by phone. This is best done after you have had time to consider the matter and review the medical records. We will assist you to determine if this is appropriate and will generally attend with you.  

Possible outcomes after a complaint process

The regulator can take the following action:

• decide no further action is required, 
• issue a caution
• accept undertakings
• impose conditions on your medical practice
• carry out a health or performance assessment
• referral to hearing before a panel or state or territory tribunal.

Referral to a tribunal (which is similar to a court) will only occur in the most serious cases, where the regulator considers suspension or cancellation of a doctor’s registration may be appropriate. Only tribunals have the power to do this. 

Less than one percent of doctors have their registration cancelled or suspended at the conclusion of regulatory action. 

The majority of complaints are closed with no action being taken against the doctor. This is confirmed by our experience and the data from regulators. 

Risk education

Sometimes we recommend to members that they voluntarily engage with our Risk Advisory Service before the regulator makes a decision about the complaint.  In our experience, this can (but not always) lessen the likelihood of the regulator deciding regulatory action is required. Our Risk Advisory Service may provide recommendations to reduce your risk of further complaints.

We aim to support our members through this process. We recognise that it can be confronting to receive a complaint, and it can be stressful for you and those close to you.

Our claims managers, lawyers and medical advisers can assist you manage the complaint and answer questions you might have about your matter, or the process involved.

It is critical that you look after yourself through the process of dealing with a complaint. We strongly encourage you to have your own GP that you engage with regularly, especially during stressful times.

Avant’s Key Support Services include a range of options to help you through this time.

To hear an Avant member talk about his firsthand experience with the disciplinary process, listen to our podcast: It happened to me: the disciplinary process 

For more resources about doctor’s health and wellbeing, particularly during a medico-legal complaint, please visit Avant’s Doctors’ Health and Wellbeing site.

For medico-legal advice, please contact us here, or call 1800 128 268, 24/7 in emergencies.