The impact of regulation

How would regulation impact on me?

The biggest difference would be that you would be personally responsible for your professional competence.

There would be a nationally consistent scope of practice which you would have to work within and national standards for qualifications, competency criteria and a complaints procedure.

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How else could the regulation impact on me?

You would have to be registered if the work you do was covered by the scope of practice set by the Responsible Authority.

Your employer would also expect you to be registered and have a current Annual Practising Certificate.

A focus of the HPCA Act is that you are responsible for maintaining your competence to work within your scope of practice. This means you would personally have to make sure you remain competent.

You would have to meet the clinical and cultural competencies and the ethical standards of conduct set by the Responsible Authority.

If there are concerns about your ability to practise across the whole scope of practice (for example if you had come from overseas and did not have all the qualifications, training and experience comparable to that of a registered New Zealand practitioner) the Responsible Authority may put conditions on your practice to limit what you can do. They must consult with you and hear what you have to say before doing this.

If there is a complaint about your practice you may have to deal with the Responsible Authority on this matter as well as to your employer and/or the Health and Disability Commissioner as happens now.

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‘Cultural competency’

Cultural competence has been defined by Mason Durie as ‘the ability of health practitioners to be competent at the interface between their own culture, and the culture of others’.

Cultural competence is broad in its application and extends beyond ethnic groups to include age or generation, sexual orientation, occupations and social economic status, ethnic origin or migrant experience, religious or spiritual belief.

Under the HPCA Act, the Responsible Authority can do a competence review of your practice – which is a process designed to review your practice and then assist you if your competence is lacking. They would involve you in this process.

If the Responsible Authority received a complaint that you had not acted appropriately or within the required standard of practice, it may set up a professional conduct committee to investigate the matter. Your views and information would be sought. If the professional conduct committee consider that it is a serious matter they may refer the case to the Health Practitioners Disciplinary Tribunal where again you would be able to answer and give your perspectives.

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What are some other aspects that need to be considered if clinical personnel are regulated?

Registered clinical personnel would need to work within a defined scope or scopes of practice and have the required qualifications set by the RA, though this would be similar to working within your current ‘authority to practice’.

As the HPCA Act is designed to make sure health practitioners are competent, its requirements impact on you directly, rather than your employer.

You will need to keep up with learning to keep current and make sure you are competent.

If you had a complaint laid against you, it could be investigated by your employer, the Health and Disability Commissioner and the Responsible Authority – in other words, there is one more channel for complaints to be lodged with, and investigated by.

You, not your employer, would have to respond to the complaint or concern, if you were registered under the HPCA Act.

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How would regulation impact on my relationship with my employer?

Very little would change in your relationship with your employer.

Most registered ambulance officers and medics will be employed or volunteer for one of the service providers in the ambulance sector and will still have to meet their employer’s requirements, standards, rules and policies.

You would also have to meet the requirements of the regulator or the Responsible Authority.

It is very likely these two requirements will be the same or at least extensively overlap.

Employers would still develop job descriptions, human resource policies and set their own expectations of professional development and designate levels of ‘authority to practice’ or ’credential’ staff.

If employers wanted their clinical people to carry out tasks that were covered by the scope of practice set out by the Responsible Authority they would have to employ people who are registered under the HPCA Act and who have an Annual Practicing Certificate.

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Would regulation impact on my working under delegation of a medical adviser or medical director?

You would still have to abide by the policies of your employer and this may include working within policies and guidelines set by the Medical Advisor/director.

If you were a registered clinical person you would be responsible for your own actions. So if you were registered and had an APC you may not have to work under the same standing orders or delegated duties as now.

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Can I be registered if I am a volunteer?

Yes, there is nothing in the HPCA Act to prevent volunteers being registered under the HPCA Act, as long as they meet the requirements to practice as a registered health practitioner under the HPCA Act.

The decision as to whether somebody would need to be registered would be based on whether their practice level was included in the scope of practice covered by the HPCA Act. This would equally relate to paid or volunteer staff.

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What would happen if I am already a regulated health practitioner such as a nurse or medical practitioner?

If your scope in that profession covered the work you do, your employer may decide you do not need to be regulated as a paramedic as well as being a registered medical practitioner or nurse.

However it is possible to have dual registration. The employer could require this.

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Does the HPCA Act stop those who are not registered from practicing?

If ‘paramedic’ was the term used to describe the registered people in the sector, an unregulated person could not call themselves a paramedic or ‘hold themselves out to be ‘a paramedic’ or imply they were a registered paramedic unless they were registered.

Also, an unregulated person could not claim to be practising in the profession as a paramedic.

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Would other private providers such as SPS (now called IA) medics be covered?

Yes, if their staff worked within the scope of practice agreed under the HPCA Act and their staff used titles that covered by the HPCA Act they would need to be registered practitioners.

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What happens if I had to do something outside my scope of practice in an emergency or I was not regulated under the agreed scope?

Generally, the HPCA Act says no health practitioner may perform a health service unless the service is within their registered scope of practice and they do not have conditions that limit their work within the scope.

However the Act does also have a section that means health practitioners to be able to do tasks within another scope:

  • in an emergency, or
  • as part of a course of training or instruction, or
  • in the course of an examination, assessment, or competence review.

In terms of the ambulance sector it is unlikely this clause would could be used to justify working outside the person’s scope if the clinical person was on a on a usual call out in the usual course of business.

But the clause could be used to justify actions if the person was off duty that is they would be able to assist in the best way possible.

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How would regulation impact on managers in the sector?

Managers would need to be familiar with the HPCA Act and make sure they considered the HPCA Act requirements when dealing with registered staff.

If managers worked within the scope of practice set by the Responsible Authority they would also have to be registered and have an APC.

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How would regulation impact on medical advisers or directors working in the services?

Very little would change. Medical advisers or medical directors would still be needed in the sector to advise employers on standards, policies and delegations related to the prescription of medications, in particular.

They would also continue to be involved in ‘credentialing” what clinical personnel can do or setting the “authority to practise’ for groups of clinical personnel.

This happens now in District Health Boards, for example, where the hospitals employ a doctor or nurse and set what that person can do in that job. This is usually a narrower range of tasks or services than the doctor or nurse could do under the scope of practice set by their regulator, the Medical Council or the Nursing Council.

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Are there any conditions that could be placed on my practice?

Conditions can be placed on a scope of practice. These conditions are what an Responsible Authority considers is required to make sure there is competent practice. They may include a condition that the applicant:

  • practise under supervision
  • practise under oversight
  • not perform any task of a stated kind or only perform those tasks only in stated circumstances
  • practise only in a stated capacity, for example, as an employee of a nominated person
  • practise in association with one or more nominated persons
  • practise only for a specified period
  • attain one or more further stated qualifications or attain further experience of a stated kind
  • Anything the RA believes on reasonable grounds to be necessary to protect the safety of the public.

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What would my rights be if the Responsible Authority did not register me or wanted to cancel my Annual Practicing Certificate?

A Responsible Authority does have to act within the rule of law which requires them to treat everyone equally and be fair. They have to listen to all affected parties, have good processes, be open-minded and unbiased and only reach decisions on the evidence before them - and provide reasons for their decisions.

To do this they would need to give you notice of any hearing, make sure you are heard, disclose any relevant material and allow you to comment.

The HPCA Act also sets out rights of Appeal. This covers appeals to a District Court against any decision or direction of a Responsible Authority to:

  • decline to register a person
  • decline to authorise a change to the existing scope of practice
  • decline to issue a practising certificate to the person
  • suspend a practising certificate or registration
  • cancel registration with the authority
  • include conditions in the person's scope of practice
  • vary any conditions in the person's scope of practice.

A person may appeal to the High Court on findings, orders and decisions made by the Tribunal.

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What are the advantages for employers and others in the sector?

If ambulance officers and NZDF medics were registered under the HPCA Act, this means they are regulated in the same ways as other health sector professions could help to increase coordination of care across the ambulance sector and with other health services and so improve patient outcomes and safety.

If those working in the ambulance sector are recognised as registered health care providers, ambulance services may be more likely to be included in discussions about different models of delivering pre hospital and primary health care. This may open up new avenues for funding and new opportunities for delivering different services.

For example it may give entitlement to a different basis for funding from the health budget delivering ‘on site’ services in the community or to work in different ways with District Health Boards to reduce use of emergency departments which in turn will have benefits for the heath sector as a whole.

Regulation would provide an opportunity to gain alternative funding from ACC, as it usually links funding for “treatment providers” to health professionals covered by regulatory authorities and scopes of practice.

Under regulation it is more likely those entering the profession would gain a qualification before they are employed in the sector , which happens with other health professionals, rather than depending on the employer to provide clinical education. This is already a trend in the in the ambulance sector.

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What other considerations are there for employers and the sector?

On the other hand, the cost of funded the Annual Practising Certificate (APC) is covered by the employer, as happened elsewhere in the sector, this may mean there is less money to address other needs in the sector.

Employers would need systems to make sure clinical people who are registered hold an up to date Annual Practicing Certificate and that the practitioner works within their regulated scope of practice.

The Responsible Authority would be involved in some matters that now are dealt with internally by the employer such as:

  • Making sure all ambulance officers and medics are competent to practice within their scope
  • investigating complaints about registered practitioners, which may be done differently or more slowly than the employer
  • Requiring registered practitioners to refresh certain skills or gain further skills if this has been shown to be necessary.

Most existing Responsible Authorities work with employers to solve matters of mutual concern and nothing an Responsible Authority does could prevent the employer fulfilling its employer responsibilities as it sees fit.

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