Health Practitioners Competence Assurance Act 2003

Review of the HPCA Act

Christchurch Workshop Summary, Friday 11 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:

Scopes should be eliminated altogether.
Consultation between other RAs, employers and practitioners should take place before a scope changes; this could aid in limiting unnecessary overlap.
The list of restricted activities need review/improvement.
Sections 7 and 9 need to be reviewed at the same time as scopes.
Consistency of scopes should be encouraged. Where there are overlaps, memorandums of understanding can be encouraged between RAs to encourage the consistency of core competencies.
Scopes don’t work for patients; they need more information.
There should be a body to oversee RAs, or perhaps act as an appellate body; this could be an Ombudsman or Fairness Commissioner (the latter similar to international models).
Scopes should be descriptive, as opposed to prescriptive. This allows for growth/development. They should reflect the necessity to provide for public safety, not patch protection for professions.
Scope-wide, not everyone carries out all areas of practice, and therefore does not carry out all competencies. This should be audited.

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:

The Ministry should provide funding to HRANZ to enable:
- Passing on of skills/experience from existing boards to new boards
- Nurturing of newly registered professions by existing RAs
- Training for boards
- Encouragement of co-operation between RAs.
There are some inconsistencies between RAs in certain places. There needs to be standardisation of:
- The format of annual reports. Additionally, it should be compulsory to publish annual reports upon the RAs’ websites.
- The form and date of APCs
- Best practice standards
As costs affect smaller authorities disproportionately, shared secretariat costs for common areas could be considered. However, it is important to maintain separate RAs. It is particularly felt that the number of smaller boards could be reduced. Alternatively, administrative and regulatory functions could be separated within all boards, and the administrative costs shared.
The Ministry needs to consult more closely with RAs before appointing board members. At present, the Ministry is seen as ignoring requests (ie the information surrounding skill sets required). This means assertiveness is seen as required to achieve any input.
Alternatively, although the boards need input on their appointments, some believe the boards need to provide more information on their requirements.
Chairs need to be appointed for more than a year. Two or three years is seen as a good term.
Consistency would be improved if the Ministry were to provide seed funding and advice on systems etc to new boards. The latter, in particular, would avoid the boards reinventing the wheel.
The Ministry/Parliament need to provide information on reporting requirements. However, there is concern that such requirements can alter behaviour.
The appointment process needs to be more transparent.
Some board members should be elected to improve ownership and engagement from the profession. Appointed members would still exist, but not make up one hundred percent of the board.
Independent chairs could be appointed to the boards (not a professional or lay member of the board). This would provide governance expertise. A few chairs could move between the various authorities. This would promote consistency between the authorities, and ensure the goal of public safety was maintained as the ultimate goal. However, as they would not be a professional or lay member, a chair of this nature should not hold voting rights.
It was also suggested that lawyers could be appointed to boards, in the same manner as independent chairs, in order to provide legal advice on the interpretation of the legislation. However, there is not consensus on this suggestion.
An Ombudsman or Fairness Commissioner could be appointed to oversee the boards.
Boards should be subject to the Official Information Act, and the legislation should be changed to allow for this. However, there is not consensus on this issue.
Board members need to be trained, especially in governance. This would assist in the necessary application of consistency in governance and applying the legislation.
A study could be conducted on the minimum number of registrations that would make a board cost efficient; this would aid in decision-making when new authorities were to set up.
A new structure for boards was suggested. This model would have three layers: an overarching governance board, then individual professional boards, then a common secretariat/administrative body.

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 cost of registration and continuing professional development (CPD) can be onerous for part-time practitioners; this is something that needs to be resolved in order to ease workforce pressures.
RAs need a template to define appropriate professional development criteria, so that CPD meets individual need and professional requirements.
The cost in some professions for CPD is high, whether to the practitioner or to the employer. RAs should be encouraged to look at IT solutions for CPD to combat this. Alternatively, RAs could recommend preferred providers for CPD.
The Ministry could part-fund atypical registration costs for those who are not routine applicants.
Sections 12 (Qualifications must be prescribed) (2) (d) and (e) of the HPCA could be used more in the registration of overseas-trained practitioners. Sections 21 (Authority may authorise scope of practice or changed scope of practice) and 22 (Contents of authorisation of scope of practice) may be used to register overseas practitioners with restrictions.
For overseas practitioners, experience should be realised for registration/supervision purposes.
The New Zealand Qualifications Authority should approve overseas qualifications.
DHBs should pay for cost of recertification programme (assuming the practitioner is a DHB employee).

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:

Costs of professional conduct committees (PCCs) need to be controlled. This would mean that the cost of registration and APCs would be controlled.
An advocacy service could be created for health professionals to receive advice regarding complaints, particularly in relation to insurance issues.
To speed up the progress of complaints, a health complaints screening committee could be created. Complaints could be heard by this committee prior to progression to a PCC. The screening committee could then ensure the complaint is forwarded to an appropriate place.
Section 36 (When authority may review health practitioner’s competence) (4) should be reviewed; this clause leaves too much discretionary power in the hands of RAs when determining competence.
Employers should be informed if there is a risk of an employee endangering public safety, either through health or fitness to practice issues.
RAs should conduct an analysis of complaints every two years or so (without identifying individuals); this analysis should be released to the public and to the profession.
A full-time PCC could be formed. This would work across all the professions regulated under the Act and create efficiencies.
RAs need to create an acceptable protocol/process that is transparent and time-bound for dealing with complaints. To this end, RAs should be funded to co-operate on development of policy and procedure on complaints.
The identity of those examined on educational/competency issues should not necessarily be made public, and any process should be restorative as opposed to punitive. However, those who have been found guilty of a discipline issue should have their name published, although it is emphasised that the decisions of the HPDT in regards to publication should be considered on a case-by-case basis.
Low-level mediation and resolution forums should be considered by the RAs and the Health and Disability Commissione as an alternative to full investigation in less serious cases. This could involve peer review.

Suggestions from final session

“Patient need” as opposed to “service delivery” needs to remain the focus of the Act.
HRANZ could be further developed. It could facilitate:
- Consistency
- Information
- Networking
- Strategic thinking
However, it is important that HRANZ remains subsidiary to the RAs, and does not become an overall body.
It is too early for heavy-handed restructuring of the Act; it should be allowed to “let live” for some time yet.
There is a need for a auditing/ombudsman function. A commissioner could investigate where an RA is not performing. However, these suggestions need to be tagged to specific sections in the Act. Specificity is important.
The problems with the Act lie in its operation and interpretation by the RAs, not with the Act itself.

Page last updated: 7 May 2008