Health Practitioners Competence Assurance Act 2003

Review of the HPCA Act

Auckland Workshop Summary, Tuesday 8 April

Session 1 – Scopes of practice and qualifications

The Ministry outlined the issues raised during the first phase of the review. These included:

Information about how scopes are supposed to work, and what information they should include, is not publicly available.
There is a great deal of inconsistency in the way scopes are being developed between professions.
Current scopes have often been informed by professions. They often reflect what the profession wants to be doing, and do not always reflect the practice environment. As such, some practitioners and employers can be constrained in the services they can deliver.
Overlaps in scopes between professions are not always underpinned by common competencies.
It is not clear to practitioners, employers and the public where overlaps between scopes and professions exist.

Following discussions the following proposals for addressing these issues were made:

Principles to underpin the development of scopes could be developed by HRANZ and used by all RAs.
HRANZ and/or the Ministry could develop information on scopes and publicise this.
Scopes should be informed equally by professions, employers, education institutions and consumers.
Consultation practises need to be improved across RAs. This could be through more prescriptive requirements in the Act, or through the development of consistent best practice guidelines that all RAs use when consulting.
An independent board/organisation could be established to monitor RAs and provide a right of appeals mechanism for those who are dissatisfied with a RAs decisions. This should be government funded.
RAs could be subject to the Official Information Act.

Session 2 – Authority structures and governance

The Ministry outlined the issues raised during the first phase of the review. These included:

The concern over the proliferation of RAs. Too many RAs create inconsistencies in the way the Act is put into operation.
The most significant costs come from supporting RAs (ie secretariat support).
There is concern that the current appointments process is not open and transparent, and that there is no scope for input from the professions.

Following discussions the following proposals for addressing these issues were made:

A new structure for RAs was suggested. This would consist of an overarching RA (which would primarily perform administrative functions), and separate boards below. These boards would deal with scopes of practice, competencies etc. Separate professional competencies would need to be maintained. Administrative functions could be shared. This could create economies of scale in areas such as IT.
There was also a suggestion that RAs could be joined in groups covering similar competencies, such a RA covering complementary medicine (medical herbalism, acupuncture, etc).
Boards need a mechanism to separate public interest from the interests of the professions.
An Ombudsman/Fairness Commissioner could be appointed to overlook the RAs. This would be one method of addressing concerns that RAs are inadequately monitored.
The process of appointments to boards must be more transparent. Appointments should be brought under the OIA. The Minister’s office should publish guidelines as to how it appoints board members.
Annual reports need more consistency. A template should be developed, or the Minister should specify more clearly what is expected from/in annual reports.
Capability/performance of board members is mixed. Governance training must be provided for those on boards, and the necessity to avoid conflicts of interest must be made clear.
There was a strong feeling from some of the professions that members should be elected to boards, which would then have a mixture of elected and appointed members.
Terms on boards should be limited to two terms of three years each. Once these terms have been completed, these members could be appointed to other boards to make use of their governance experience.
Where RAs can go for support should be considered. In particular, where RAs can get the funding needed to establish an authority for a newly-registered profession, such as the Psychotherapy Board, needs thought.
Clear and robust criteria for professions seeking registration under the Act should be developed. These should include:
- Size of membership of the profession
- Average income
- Potential for harm to the public by the profession.

Session 3 – Registration and recertification

The Ministry outlined the issues raised during the first phase of the review. These included:

Registration requirements and processes are inconsistent between RAs.
The bar for registering overseas trained practitioners is too high and the administrative processes costly and burdensome.
Recertification requirements are inconsistent between RAs.
Recertification is having a significant impact on rural practitioners who find it difficult and costly to meet requirements.

Following discussions the following proposals for addressing these issues were made:

The bar for registration should be the same for all regulated professions; get HRANZ working to develop consistent policy and establish a general secretariat to operationalise it consistently.
RAs need to be able to issue interim practicing certificates to allow practitioners to practise under supervision (or in a limited scope) until they can satisfy the requirements for full registration.
RAs with very general scopes need to use sections 22 (Contents of authorisation of scope of practice) and 23 (Assessment of practitioners practising under supervision) to register practitioners in limited scopes to recognise their specialist skills.
Recertification programmes and processes need to be standardised through consistent RA policy (which HRANZ could develop) and consistently operationalised by a single secretariat.
Part-time and rural practitioners need to be consulted in order to determine what would make recertification more attainable. However, it must be remembered that there is no such thing as part-time competence! Online recertification programmes may help address cost/travel issues for isolated practitioners.
The RAs could enable overseas practitioners to practise in New Zealand by allowing them to work in limited scopes of practice; this would recognise specialist skills overseas practitioners may hold in a particular area, and the fact they may not be practising in an area where all competencies required for a broader scope of practice are used.
Competency assessments could be randomly audited to make sure that they are of consistent quality across the RAs.
The HDC should adopt a more inquisitorial, as opposed to adversarial, method of dealing with complaints. This could lower costs associated with lawyers/legal representation, and prove swifter (both in finding out information and decision making).
A centralised secretariat would streamline the provision of expert and legal advice.
The process for dealing with incompetent practitioners could change dramatically; once an incompetent practitioner is identified, the RAs could then inform the Ministry, even if the practitioner was registered. The Ministry could then inform the board of what action it should take accordingly.

Session 4 – Competence, fitness to practice, complaints and discipline

The Ministry outlined the issues raised during the first phase of the review. These included:

The process for making a complaint is not clear, particularly to members of the public.
The process for investigating and making determinations on competence and fitness to practise concerns is time consuming, costly and overly legalistic.
Competence and fitness to practise processes are inconsistent between RAs.
Policies relating to the release of information pertaining to competence or fitness to practise concerns are inconsistent and not transparent.

Following discussions the following proposals for addressing these issues were made:

The timeframe of the complaints process needs to be realistic, and an initial assessment to decide the nature of the issue may be helpful.
All information regarding the complaint should be released, with the exception of information that would identify the complainant. This should happen if the complaint is upheld by the professional body. There should be consistency across all RAs with the information that is released.
A register of practitioners who have been struck off should be kept.
The Chair of a PCC should be trained (and does not necessarily have to be a member of the profession), to ensure consistency and knowledge of the PCC process. A complaints body does not need professional expertise in all domains, and could draw on professional advice when required.
The use of lawyers and getting legal advice can be extremely costly for the RAs. To assist with the RAs’ costs, the Crown Law office or the Ministry of Health could provide legal services to the RAs.
Professionals could be randomly audited for competency requirements.
Legal/expert advice could be streamlined by a centralised structure, including a central complaints body.
In terms of costs for the complaints process, local resolution of a complaint is faster and cheaper.
It should be essential for self-employed practitioners to be insured.
It could be encoded in legislation that any future employer must be informed of any disciplinary/competency breaches in the past.
There is concern that PCCs are being conducted on an “ad-hoc” basis, and that due to this, those who sit on the PCCs are not adequately trained (particularly laypeople). This could be managed another way, i.e. with an overall PCC body that could call on a body of trained laypeople when required.

Suggestions from final session

The review process is silent on cultural competency – where does this feature? Whether or not a lack of cultural competency is a weakness across the boards is difficult to know, as the issue is surrounded by silence. Cultural competency needs to be discussed.
It is possible that more standardisation across boards (ie as would happen with an overarching structure) would put the different contexts of the RAs at risk. It is too soon to impose an overarching structure. However, there could be appropriate aggregation of RAs; similar RAs could be clustered, as opposed to adding another layer. However, there is no consensus surrounding this idea.

Page last updated: 7 May 2008