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Heather Roy's Diary: The Doctors Want Out

The Doctors Want Out
Heather Roy's Diary
18 July, 2003

ACT is dedicated to enabling New Zealanders to have more opportunities and choices in their own lives. We promote political and economic freedom, strong families and communities, smaller government, and greater empowerment of individuals.

This week's diary is an indulgence by one who has recently left the highly respected ranks of Health Professionals and entered that of politicians - just below the respect level of a used car salesman. This is a sobering thought.

The Doctors Want Out

Parliament is currently in recess, but some heavyweight legislation is expected next week. My particular interest will be the Health Practitioners Competence Assurance (HPCA) Bill, which aims to ensure the competence of doctors, dentists, nurses, pharmacists, dieticians, physiotherapists, occupational therapists and other health professionals. However, it is a challenge to define competence and, in this case, the challenge seems to have been too great with no definition included. The Act is dominated by procedures for punishment.

The subject of discipline and punishment doesn't seem very appetising for health practitioners, but many professional groups lobbied for inclusion. Being left out seemed like a lack of status and respectability. The psychotherapists pushed hard to be included, and the Health Select Committee even received submissions from animal psychologists and embalmers.

Doctors, who are likely to take the largest burden of complaints, have now decided that they want out of this Bill, and I think they're right to do so. The New Zealand Medical Association, and the Association of Salaried Medical Specialists, have both stated on their members' behalf that they wish to retain the Medical Practitioners Act which - despite its faults - is a better piece of legislation. It could easily be amended to meet the challenges of modern practice. What seems to have been overlooked is that the way to guarantee public safety (if such a thing is at all possible) when being treated by a health professional is to provide them with a safe working environment - one that is conducive to Best Practice and encourages excellence.

The HPCA bill is huge, and will repeal 11 Acts currently governing the role of Health Practitioners. Originally the HPCA Bill was to have taken the existing Medical Practitioners Act for the doctors and applied it to all Health Practitioners. The Bill, however, is so far removed from this that it is barely recognisable - hence the doctors' change of heart. The criticism of the Bill during public submissions ran along similar themes. The Ministerial power is too great. "Scopes of Practice", which will determine the areas in which a health practitioner can work, are untested in New Zealand and have failed overseas. Quality Assurance Activities are better provided for under the Medical Practitioners Act. Restricted Activities, which limit areas in which a health professional may work, are to be determined by the Minister of Health.

The Bill does have some positive aspects. Complaints, in the first instance, will all go through the office of the Health and Disability Commissioner. It is thought that this will speed up the complaints process significantly. The new Multi-Disciplinary Tribunal for hearing complaints of a serious nature was also viewed in a positive light, but there is no reason why this couldn't be set up separately from this piece of legislation. The main benefit of such a tribunal is to see complaints in a timelier manner for the benefit of all involved. Complaints currently take an inordinate length of time to be heard, sometimes years.

So what of the other Health Professionals? Pharmacists are dealing with many battles at the moment, and the Bill would see many changes for them. Dentists too will face challenges and, for these two groups as well as the doctors, the current situation of some elected members on their registration bodies is in question. Again, it is the Health Minister who has the power to decide.

Those professions smaller in number and scope have given their support to the Bill. For some, updating their legislation has been a long time in coming. The Physiotherapists and Occupational Therapists are currently working with Acts passed in 1949 and the Dieticians a 1950 Act. Clinical practice has changed dramatically in the past 54 years, and these professions must have relevant legislation governing them - but it must be appropriate. This Bill will serve neither them, nor the public, well. They would be better off each amending their current Acts, than having to deal with the demands of umbrella legislation that tries to be all things to all professions.

Many hopes are pinned on the Health Practitioners Competency Assurance Bill. The Minister and Health Ministry see it as a mechanism to save the health system. They should heed the warnings of those who will have to work within its confines. Doctors, nurses, dentists, pharmacists, physios, occupational therapists and other professions covered by the Bill are well respected by the public. Like the Government, they too want to protect the public and provide New Zealanders with competent treatment. In fact, most would say they want to give their patients excellent treatment. Good treatment rests on co-operation and trust between practitioner and patient. This Bill will not allow this to happen.


Heather Roy is an ACT List MP. She was elected to Parliament in July 2002. Heather is a former Physiotherapist and Medical Research Co-ordinator. She was also Publicity Officer for the New Zealand Portrait Gallery. Her portfolio areas are Health, ACC, Women's Affairs, Youth Affairs, Senior Citizens, Arts Culture and Heritage and Internal Affairs. Heather is married to Duncan, a Psychiatrist and they have 5 children. She was attracted to ACT because of the principles of freedom, choice and personal responsibility.

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