A national registration scheme for health professionals was introduced in Australia 5 years ago, replacing the long-standing state-based schemes. This review examines whether the scheme has delivered what it promised and makes recommendations for change. The available evidence indicates that the scheme's design and its implementation were rushed and that the legislation has serious flaws. Two parliamentary inquiries and the experience of registrants confirm that the system is more expensive, remote and bureaucratic than the previous state-based systems. The scheme has delivered benefits only in relation to portability of registration and a single national register. In addition, with two large jurisdictions participating in a 'co-regulated' mode, it is not truly a national scheme. To restore the confidence that health professionals need to have in the regulator, it is recommended that all jurisdictions seek to be 'co-regulated' and that the Australian Health Practitioners Registration Authority be pared back to providing a central database for national portable registration.