Professional regulation and patient safety systems: parallel planets or partners in improvement?

Summary

Over the past 15 years, Martin Fletcher has been part of transformational change in professional regulation through his tenure as Chief Executive of the Australian Health Practitioner Regulation Agency (Ahpra). In this blog for the hub, Martin shares Australia's regulatory journey and reflects on the UK's more gradual path to reforming their legislative frameworks. He highlights both countries' shared common goals and the challenges faced along the way. He ends the blog with three priorities for future action: integrating professional regulation into system safety, better use of data to anticipate risk and embedding equity and cultural safety.

Content

Effective regulation is a cornerstone of safe, quality healthcare, regardless of the health profession or practice context. We all know that healthcare is changing rapidly and regulation of health professionals must evolve with it.[1] This means that adaptability and the ability to pivot are essential competencies for any professional regulator.[2]

Establishing the Australian Health Practitioner Regulation Agency

Over the past fifteen years, I have been part of transformational change in professional regulation through my tenure as Chief Executive of the Australian Health Practitioner Regulation Agency (Ahpra). In 2010, Australia launched the National Registration and Accreditation Scheme, consolidating 85 separate registration boards and 65 pieces of legislation into a single national regulatory scheme.[3] The goals were clear: to create national consistency, support workforce mobility, raise standards for public protection and promote greater integration between professional groups delivering health and care.[4] Through this reform, Ahpra was established to administer these national regulatory arrangements in partnership with 15 National Boards, which now cover over 930,000 health practitioners across 16 professions.

The UK's path to reform

Transformational change in professional regulation is rare and the UK has taken a more gradual path to reform. Over a number of years, UK regulators have called for action to modernise their legislative frameworks. In response, the UK government’s consultation on Regulating Healthcare Professionals, Protecting the Public underscored the need for faster, more flexible regulation that supports innovation while safeguarding safety.[5] Yet, legislative change has been much slower, sometimes taking years to come to fruition, and, unlike Australia, the UK continues to deliver professional regulation through 10 independent regulatory bodies with differing legislative frameworks.

Regulatory work is highly situational and dependent on numerous stakeholders, at times with competing views of public interest.[6]  And in both Australia and the UK, there is ongoing debate about the timeliness, responsiveness and proportionality of regulatory responses to fitness to practice concerns and the issues to consider in assessing the suitability of someone to be a registered health practitioner.[7]

Common goals

Despite differences in the pace of change and the structure of professional regulatory arrangements, both countries share common goals: protecting patients, supporting the professionalism and ethical conduct of practitioners, responding to public expectations, and ensuring regulation keeps pace with the changing health care landscape and responds to workforce needs.

The Covid-19 pandemic exposed both the strengths and limitations of our regulatory systems. In both countries, regulators responded quickly—fast-tracking registration pathways, adjusting accreditation requirements and convening stakeholders to support a surge workforce. This demonstrated that regulation can be agile when safety is at stake. The crisis reinforced the importance of collaborative regulation—where professional oversight is part of a broader safety ecosystem.

Connecting professional regulation with system-wide efforts

Nonetheless, one of our shared challenges is better connecting professional regulation with system-wide efforts to improve patient safety. Traditionally, professional regulation has focused on the conduct, competence and performance of individual health practitioners. As I saw from my tenure as Chief Executive of the NHS National Patient Safety Agency, patient safety is shaped by a range of factors, including clinical governance, team dynamics, design of systems and processes, technology and organisational safety culture.

The rapidly growing cosmetic practices sector illustrates these challenges vividly. In both Australia and the UK, reviews have shown that regulating practitioners alone isn’t enough.[8][9] Products, procedures, facilities, social media, information asymmetry and weak professional ethics all contribute to risk of harm to patients. Without coordinated action across agencies, patients remain vulnerable.

More widely, the rise of entrepreneurial models of care, telehealth, unregulated medicines for sale online, social media and AI-driven diagnostics has introduced new risk profiles to which traditional regulatory frameworks and approaches to patient safety must adapt. These shifts demand new thinking around safety, accountability, transparency and equity.

A way forward

Let me suggest three priorities for future action:

1. Integrate professional regulation into system safety: We must work more closely with service, product and system regulators, and improvement bodies. Shared goals and aligned actions are critical. When regulators operate in silos, we risk missing the bigger picture. At the same time, patient safety system advocates must give due recognition to the critical role of ethical, safety-conscious, competent and accountable health professionals at the frontline of care.
    
2. Better use of data to anticipate risk: Ahpra and UK regulators hold vast datasets. By investing in analytics and research, we can shift from reactive to proactive regulation. Notifications and complaints are often lag indicators—we need to get ahead of emerging risks of harm, especially in the face of the many healthcare disruptors we face.
    
3. Embed equity and cultural safety: Regulation must reflect the many communities we serve. That means listening to lived experience and addressing systemic barriers. In the Australian context, this has meant facing the ugly reality of racism in the healthcare system for Aboriginal and Torres Strait Islander Peoples. The naming of racism in the National Law, which underpins the regulatory arrangements in Australia, has been a powerful catalyst for action.[10] Undoubtedly, the UK faces similar challenges in addressing racism in a multicultural society.[11]

Regulation is more than rules—it’s about trust, transparency and care. As Australia marks 15 years of national regulation and the UK continues its reform journey, it is essential to place patient safety at the heart of everything we do and close the gap between professional oversight and system-wide efforts to improve safety.

References

1. Professional Standards Authority for Health and Social Care. Reviewing right-touch regulation: discussion paper. London: PSA; March 2025.
2. Institute of Regulation. Rapporteur report: annual conference of the Institute of Regulation 2025. London: Institute of Regulation; 2025.
3. Australian Health Practitioner Regulation Agency. Annual Report 2009-10. Melbourne: Ahpra; 2010.
4. Fletcher M. Reflections on 15 years of National Health Practitioner Regulation in Australia. Australian Health Review 2025; 49, AH25131. https://doi.org/10.1071/AH25131
5. Regulating healthcare professionals, protecting the public: consultation response - executive summary - GOV.UK
6. Austin Z. Regulation of wicked problems: opportunities, responsibilities, and threats. J Med Regul. 2023;109(3):6–11. doi:10.30770/2572-1852-109.3.6
7. National Health Practitioner Ombudsman and Privacy Commissioner. Investigation into delay and procedural safeguards for practitioners who are subject to immediate action. Melbourne: NHPPC; June 2024.
8. Brown A, Duggan A, Kirkland A, McCausland R. Independent review of the regulation of medical practitioners who perform cosmetic surgery: Final report. Melbourne: Australian Health Practitioner Regulation Agency; August 2022.
9. The regulation of non-surgical cosmetic procedures in England - House of Commons Library
10. Australian Health Practitioner Regulation Agency. Joint statement: Aboriginal and Torres Strait Islander health and cultural safety at heart of National Law changes Melbourne: AHPRA; October. Accessed 15 June 2025.
11. Royal College of Nursing. RCN reports 55% rise in members facing racist abuse. 27 October 2025.

About the Author

Martin Fletcher was the Chief Executive of the Australian Health Practitioner Regulation Agency (Ahpra) for 15 years, finishing his appointment in December 2024.  Prior to joining Ahpra, Martin was Chief Executive of the NHS National Patient Safety Agency. From 2004-2007, Martin worked with the World Health Organization (WHO) to establish a global patient safety programme. 

Martin holds a Master of Management degree in public sector management, an Honours degree in behavioural sciences and an undergraduate degree in social studies.

Martin holds an honorary appointment as adjunct Professor with the School of Health and Biomedical Science at RMIT University. He was also a co-Director of the WHO Collaborating Centre for Health Workforce Regulation in the Western Pacific Region hosted by Ahpra.