Clinical Care Concerns: Understanding the Most Common Type of Notification

A clinical care concern is about the quality of the care you provided: how you assessed, diagnosed, treated, referred and followed up a patient. Across the professions, Ahpra and National Board data consistently show clinical care as the most common category of concern, ahead of communication, medicines, health impairment and boundaries. That is unsurprising. Clinical care is what practitioners do all day, and outcomes are not always good even when care is reasonable.

Concerns in this category typically include:

• assessment that was too brief, or did not consider serious alternative diagnoses;
• a missed or delayed diagnosis;
• failure to act on an abnormal finding or test result;
• treatment that continued without reassessment when the patient was not improving;
• procedures performed without adequate training or outside scope;
• poor follow-up, handover or safety-netting; and
• records too thin to show the reasoning behind a decision.

Most notifications come from patients and their families. Clinical care concerns are also raised by colleagues, employers, coroners and other regulators. Practitioners and employers must make a mandatory notification if they reasonably believe a practitioner has placed the public at risk of harm by practising in a way that is a significant departure from accepted professional standards.

A clinical care concern is not judged against perfection or against hindsight. The question is whether your knowledge, skill and judgement, and the care you actually provided, met the standard reasonably expected of a practitioner with your training and experience, in your setting, at the time. An expert opinion is often obtained if the matter is investigated, and you will usually have the chance to respond to it.

The National Law describes several levels of concern. A one-off lapse in otherwise sound practice is usually managed without regulatory action, particularly if you and your workplace have already responded to it. Where knowledge, skill or judgement is significantly below the expected standard, the concern may be framed as unsatisfactory professional performance. Clinical care that is grossly substandard, or combined with dishonesty or disregard for patients, can reach the threshold of professional misconduct.

Two separate tests often matter. Being permitted to do something and being competent to do it safely are different questions. Scope of practice in Australia is shaped by registration and endorsements, state and territory law, employer credentialing and your individual training and recency. A practitioner can be legally permitted to perform a procedure that is outside their current competence. Both answers need to be yes.

Once Ahpra has enough information, it assesses the concern against what it knows about you, your setting and your type of practice. The risk assessment takes into account your regulatory history, your response and the actions you have taken, and the support your workplace provides. Your clinical records are almost always requested, and they are usually the most important evidence about what you did and why.

At the end of assessment, the Board or its delegate may take no further action; take regulatory action such as a caution, an undertaking or conditions; refer the matter for investigation; or require a performance assessment. Ahpra aims to complete most assessments within 60 days. A performance assessment, carried out by independent assessors, is used where the Board believes your knowledge, skill or judgement may be below the expected standard. It is a tool for understanding risk, not a punishment.

Ahpra's published guidance for practitioners indicates that most notifications, around 85 to 90 per cent, do not result in regulatory action. That is not a promise about any individual matter, but it is a useful counterweight to the catastrophising many clinicians experience when the letter arrives.

Clinical care concerns often follow an incident. How you act in the hours and days afterwards matters both for the patient and for any later review. The sequence that the safety and quality frameworks describe is straightforward: make the patient safe, support those affected, report the incident through your organisation's system, and take part in a review that looks at contributing factors across the patient, task, individual, team, environment and organisation.

Every National Board code expects open disclosure: acknowledging what happened, explaining it honestly, apologising, listening and reviewing. The Australian Open Disclosure Framework was revised in June 2026 and now distinguishes initial disclosure, which is appropriate for all harm, from formal open disclosure after serious harm or on request. All Australian jurisdictions have apology laws, although their scope differs. Notify your insurer or MDO promptly, but never let that delay care or the initial acknowledgement. Our page on communication and consent concerns covers disclosure in more depth.

Clinicians involved in adverse events commonly experience distress. Seeking support through colleagues, your own GP, employee assistance or confidential practitioner support services is part of practising safely, not a sign of weakness.

The missed fracture

A GP sees a patient with a painful wrist after a fall and diagnoses a sprain. A scaphoid fracture is found weeks later. The notes do not record examination of the anatomical snuffbox, though the GP believes he did it. Leaving the record untouched, explaining honestly what is recorded and what he recalls, and describing the changes he has made to his examination template and safety-netting advice keeps this a clinical matter, rather than a dishonesty matter.

The results that went nowhere

A locum orders bloods for a patient and finishes the placement before the results return. The abnormal result is filed without action. The concern raised is about the practitioner, but the contributing factors include the practice's results system. A good response addresses both: what the practitioner now does to hand over pending results, and what the practice has changed.

The expanded role

A physiotherapist in an extended scope role is asked to perform a procedure she has seen but not been trained to do. Declining, explaining why and offering an alternative, then raising the training gap with her manager, is the safe path. Agreeing because the department is busy is the path that appears in notifications.

For clinical care concerns, profession-specific clinical education from your college, association or employer is usually the most direct way to address a knowledge or skill gap. Our courses focus on the professional layer around clinical care: competence and patient safety systems, the standards behind unsatisfactory performance, documentation, open disclosure and how to show insight and lasting change. They complement clinical training; they do not replace it.

Our courses are independent and are not accredited and not approved by Ahpra or any National Board. If education is part of an undertaking or condition, confirm with Ahpra that a course is acceptable before you begin. No course can guarantee any regulatory outcome. Record the actual time you spend against your own CPD plan.