A matter of ensuring practitioner competence

By GILLIAN DURHAM*

If you were diagnosed with gallstones 10 years ago, you could anticipate spending two weeks in hospital for relatively invasive surgery to remove the offending bits. You would then recuperate for six to eight weeks, after which you would probably be cleared to return to work.

Today, the same diagnosis will see you in hospital for three days or less for keyhole surgery. You should be able to return to work - with a considerably smaller scar than if you had been diagnosed and operated on 10 years ago - in two weeks.

In another 10 years, it may well be different again as technology, demographics, patterns of disease and ways of treating them change.

One thing that will not change, however, is the patient's right to expect that the health professional caring for them is registered to carry out whatever service he or she is offering, is competent and is up to date so that treatment is in line with what constitutes best practice at the time.

New legislation tabled before the election, the Health Practitioners' Competence Assurance Bill, is designed to achieve just that. It mandates registration authorities - the Nursing Council, for example - to determine what qualifications and competencies its registered members need to carry out a defined scope of practice.

In nursing there could be a range of scopes from practitioners who provide basic levels of care up to practitioners who have advanced qualifications to perform more complex interventions where there is a greater risk of potential harm.

Some scopes of practice might overlap within a profession. In the dental profession, for example, there will be scopes for dentists, dental therapists, dental hygienist and dental technicians.

There may also be overlaps between practitioners in different fields. For example, some activities a doctor is registered to perform may also be performed by an advanced nurse practitioner.

Underpinning the bill is a significant new feature: a requirement that registration authorities establish and implement systems to ensure that practitioners maintain the level of competence required for their scope of practice throughout their careers.

The principle underlying the bill is a positive one, emphasising what practitioners can do rather than what they cannot do. To meet the challenges of the future, we will need to use all available skills to achieve the most efficient and safe health services.

The new bill will replace as many as 11 different statutes - two of which date back to 1949 - that now regulate health professionals. In many cases, these are out of date, inflexible, prescriptive and meet neither the needs of consumers nor those of the professionals to whom they apply.

Regulating health professions is about protecting the public from harm. The Health Practitioners' Competence Assurance Bill will, as the name implies, provide an assurance for consumers that a practitioner who is registered under the act is competent to practise.

As well as provisions for registration and ongoing competence, the bill contains safeguards which would make it illegal for registered practitioners to practise outside their particular scope. A dispensing optician, for example, would not be able to do things outside the scope of practice determined by the Optometrists and Dispensing Opticians Board.

It would also be against the law for anyone who is not registered to claim to be a practitioner of a particular kind or do anything that is calculated to suggest that they are practitioners of a particular kind.

The bill also provides added protection where members of the public risk serious or permanent harm if an activity is performed by persons other than registered health practitioners.

The bill gives the Minister of Health power to recommend that such activities be restricted to practitioners registered to do so according to their scope of practice.

The bill does not, however, restrict practitioners who are not registered, but who are qualified in other areas, from performing activities where there is no risk of harm to the public.

It is intended the legislation will contain checks and balances to ensure that professions do not take advantage of the statutory responsibilities given to them to protect their patch.

No system is perfect and mistakes will happen. Recognising this, the bill also mandates consistent complaints processes across professions, designed to be fair to both the complainant and the practitioner.

Complaints will go initially to the Health and Disability Commissioner for assessment. A single Health Practitioners' Disciplinary Tribunal will hear complaints that are found to warrant such action.

Both the tribunal and the registration authorities will include a mix of health practitioners and lay people. Dominant in their deliberations should be consideration of the main purpose of the bill: "To protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions."

* Dr Gillian Durham is the Ministry of Health's deputy director-general of sector policy.