Gordon Campbell | Parliament TV | Parliament Today | News Video | Crime | Employers | Housing | Immigration | Legal | Local Govt. | Maori | Welfare | Unions | Youth | Search

 

Health Competence Assurance: Scopes Of Practice

PARLIAMENTARY BRIEFING
NO: 3-03 8 AUGUST 2003

Health Practitioners Competence Assurance Bill: Scopes Of Practice

The Association of Salaried Medical Specialists (ASMS) is the professional union that represents salaried senior doctors and dentists, the large majority of which are employed by district health boards. This is the third issue of our Parliamentary Briefings to MPs that outlines our concerns on the Health Practitioners Competence Assurance (HPCA) Bill supplementing our previously forwarded Issues Paper. The previous Parliamentary Briefings covered why we believed the Medical Practitioners Act should not be repealed and the appointment of members of registration authorities. This issue discusses our concerns over scopes of practice.

*********************

By repealing the Medical Practitioners Act (MPA) the Bill incorporates a significant shift in the legislative goalposts over the approach to registration of medical practitioners that itself has not been debated or originated out of a process of engagement with the medical profession.

The premise for registration under the MPA is that the registration authority (Medical Council) sets the standard (called the scope of practice under the HPCA Bill) for each branch of medicine and the individual practitioner seeks to be recognised as being able to practice within this standard/scope. Once they have met the standard the Council indicates whether they may practice in a particular branch of medicine with or without oversight or supervision, or on a probationary, interim or temporary basis.

Under the Medical Practitioners Act there are two other means of tailoring registration or scopes of practice. First, at a workplace or employment level the credentialling process matches what a practitioner is able to do with what they can do given a particular setting. Second, through the annual practising certificate that it issues, the Medical Council can place restrictions on a doctor’s practice in response to matters such as health, competence or discipline.

The Medical Practitioners Act, being based on broad rather than narrow scopes of practice, also has the flexibility to allow vocationally registered doctors to expand into related areas of medicine (eg, general practice into secondary care, anaesthetists into intensive care).

Both the Minister of Health and the Health Select Committee state that the intention of the Bill is to maintain broad scopes of practice. But, contrary to their intent, the HPCA Bill seriously risks extending fragmentation by providing for individual doctors to be registered with a narrower, personal scope of practice without having first achieved a broad scope.

In the medium to long term the Bill therefore risks difficulty in maintaining standards, difficulty in monitoring competence and confusion for practitioners and the public as to what services and standards to expect from a medical practitioner.

The Medical Council is behaving as a responsible statutory body in ensuring that scopes of practice for medicine remain broad. But while the Council is committed to a strong priority and preference for broad scopes, the Bill itself does not distinguish in terms of priority or preference between broad and narrow scopes of practice. The Council is applying an interpretation that is permissible but it is not the only type of application.

In this context the longer term consequences of shifting the legislative goalposts should not be underestimated. It is conceivable that a different Medical Council in the future (especially one that is politically appointed) could adopt a narrow approach, the effect of which would be disadvantageous to the health and safety of the public, or could be required through successful legal challenge due to the ambiguity of the Bill’s wording.

In our view the best way of resolving this problem would be to remove medical practitioners from coverage of the Bill, retain the Medical Practitioners Act and then use the three-year review process provided in the Bill to re-examine these matters in order to get them right.

Another way would be to amend the Bill by importing the registration requirements of the Medical Practitioners Act into the Bill replacing its scopes of practice provisions either just for medical practitioners (and also dental practitioners) or for all health practitioners. This way would be an improvement on the Bill in its current form not as good as retaining the Medical Practitioners Act for medical practitioners.

A third option is to amend certain clauses in the Bill to make explicit that scopes of practice are to be broad in accordance with its intention – in particular, clauses covering purpose, definitions, principles and application.

For example, in order to remove ambiguity over the purpose of scopes of practice being broad, Clause 3 (2) (b) should be amended to:

for the determination of broad scopes of practice within which each practitioner is competent to practice

In Clause 5 the deletion of (b) in the definition of scopes of practice would also remove confusion over the broad nature of scopes. Some aspects of (b) allow for registration authorities to put limitations on scopes of practice for practitioners who are unable to practice within their full broad scope for reasons such as addiction, age and competence are already addressed in Clauses 14 (3) and 28 (2)-(3) of the Bill.

On the basis of the above recommended amendments to the purpose and definitions clauses, Clause 12 covering guiding principles would be unnecessary. This would mean that the contradictory and confusing implication of individual application for narrow scopes (not to be confused for restricting ones activities within a broad scope) would be removed.

Further, in relation to Clause 16 (application and authorisation), more explicitness and clarity would be provided if sub-clause (b) (i) was amended to read:

an indication of the scope of practice as specified by the authority under section 10 (1) within which the applicant proposes to practice…


Ian Powell

EXECUTIVE DIRECTOR


© Scoop Media

 
 
 
Parliament Headlines | Politics Headlines | Regional Headlines

Scoop 3.0: How You Can Help Scoop’s Evolution

Entering into its third decade of operation, the Scoop news ecosystem is set to undergo another phase of transformation and evolution.

We have big plans for 2018 as we look to expand our public interest journalism coverage, upgrade our publishing infrastructure and offer even more valuable business tools to commercial users of Scoop. More>>

 
 

Speaking Of Transport: Public Engagement On Wellington Scenarios

“Our work on possible solutions for Wellington’s transport future is ongoing, but has progressed to the stage where we’re ready to share our ideas with the public and seek their feedback to help guide our next steps...” More>>

ALSO:

Parental Leave: National's Time-Sharing Change Fails

National has proposed a change to the Parental Leave and Employment Protection Amendment Bill that would allow both parents to take paid parental leave at the same time, if that is what suits them best. More>>

ALSO:

Train Free Thursday: Workers Strike To Defend Terms Of Employment

"They signed up to these conditions a year ago when they got the contract for Wellington's rail services. Now they're trying to increase profits by squeezing frontline workers." More>>

ALSO:

Seclusion: Ombudsman Emphasises Importance Of Monitoring

Disability Rights Commissioner Paula Tesoriero says that while there have been changes to the Education (Update) Amendment Act 2017 to prohibit the use of seclusion, the report is an important reminder of the importance of regular monitoring of schools. More>>

ALSO:

United Future History: "All Good Things Must End"

'We’re extremely proud of what we’ve achieved over the past 15 years, working alongside the government of the day, both National and Labour.' Mr Light told members on Monday. More>>

Gordon Campbell: On The TPP Outcome, And The Hobbit Law

Somehow the Trans Pacific Partnership trade deal has come lurching back from the dead – and as predicted in this column last week, the member countries gathered in Vietnam have announced a deal in broad principle, shunted aside until a later date the stuff on which they don’t agree, and declared victory. More>>

Agreeing To Differ: Greens Maintain Opposition To TPPA
“The Green Party has long opposed the TPPA. The new proposed deal, which came out of the weekend’s talks, still contains key ISDS concessions to corporations that put our democracy at risk, so our position remains the same,” said Green Party trade spokesperson Golriz Ghahraman. More>>

ALSO:

Monitoring Report: A New Chapter For Children’s Rights In New Zealand?

The Children’s Commissioner is calling on the country to embrace children’s rights to ensure their overall well-being. More>>

ALSO:

 
 
 
 
 

LATEST HEADLINES

  • PARLIAMENT
  • POLITICS
  • REGIONAL
 
 

Featured InfoPages

Opening the Election