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. What is known about the topic? Although selected aspects of the national registration scheme have been the subject of comment, a global critique of the strengths and weaknesses of the national registration scheme has not been published previously. What does this paper add? This critique identifies several legislative flaws in a scheme that has not met the aims set for it and that is not truly national. What are the implications for practitioners? Recommended changes to the scheme have the potential to increase practitioner confidence in the scheme while reducing costs.