Paramedic registration and paramedic professionalisation: Where are we up to and where to next? Part 2

By Ruth Townsend and Michael Eburn

Our last article (RESPONSE Autumn 2017) discussed the process of bringing paramedics into the National Health Practitioner Regulatory Scheme. As noted in that piece, the legal amendment necessary to authorise the national regulation of paramedics is likely to pass through the Queensland parliament shortly (the Minister for Health and Minister for Ambulance Services introduced the Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2017 on 13 June). In response to the anticipated inclusion of paramedics in the national scheme, the Australian Health Practitioner Regulation Agency (AHPRA), who are the administrative arm of the scheme, have begun organising the various administrative bodies and processes that will be required to be established in order to operationalise the law.

The inaugural Paramedicine Board of Australia
One of the administrative bodies that are authorised and necessary to be established is the Paramedicine Board and to that end, AHPRA have publicly called for first appointments to the inaugural Paramedicine Board.

Under the legislation, the Board will consist of six practitioner members and three community members. There will be one paramedic member from each of the larger states (ie. Queensland, New South Wales, South Australia, Western Australia and Victoria) and one person representing the Australian Capital Territory, Northern Territory and Tasmania combined. In order to be eligible to be considered as a practitioner member an applicant must be qualified as a paramedic and practising in the state they will represent. A community member may be from any state or territory and cannot be a current or former paramedic. There is a lack of clarity as to how broadly this term will be interpreted but it is likely that if a person has practised as an ‘ambulance officer’ over 10 years ago and has not practised since or has no intention of practising as a paramedic, then it may be that they meet the ‘community member’ requirements. Ultimately it will be a matter for the Ministerial Council to decide. For applicants who have previously practised as paramedics or ambulance officers and work in academia in the area of paramedicine, it is likely that they will be considered as a practitioner members, at least for the first three years of the Board’s operation. This is because this is the standard that has applied to other health disciplines under ‘recency of practice’ standards. ‘Practice’ includes any role, whether remunerated or not, in which you use your skills and knowledge as a health practitioner in your profession. It is not restricted to the provision of direct clinical care.

Normally Board members are required to be registered in order to be eligible for appointment. However, this is not possible in the Board’s first iteration because the Board needs to establish the registration standards before the registration scheme can commence. Therefore, special arrangements will apply so that the first practitioner members of the Board will have their qualifications assessed by the Ministerial Council to determine if they have the required ‘skills and experience in paramedicine that are relevant to the Board’s functions’. From the participation day – or the first functional day of registration – practitioner members of the Board will need to become registered as a paramedic to continue their appointment.

Preparing the profession for national regulation 
Once the Board is established it will have approximately 12 months to prepare the profession for national regulation. The Board will be required to consult publicly and then develop five mandated registration standards. Those areas include the way in which paramedics will have to meet continuing professional development requirements. The Board will have to determine how a person with a criminal history is to be assessed for registration or removal from the register. The Board will have to determine and set out the English language skills standard to register as a paramedic. It will have to determine if there will be a requirement for registered paramedics to hold professional indemnity insurance or under what circumstances a registered paramedic will be required to gain professional indemnity insurance. And finally, the Board will have to determine the Recency of Practice requirements necessary for registration as a paramedic. In addition, the Board will need to develop the ‘grandparenting’ process for those practitioners who will use this pathway to general registration in the first three years of the scheme.

The Board will be required to consult, develop and approve a code of conduct for the profession that will establish the conduct standards expected of paramedics. This document is critical to the professional development of paramedics because it does many things. A code of conduct can help to establish the identity of the profession because it is a public document that sets out the profession’s values –what it will and will not do. It will also establish the standard of conduct the community could reasonably expect from the profession broadly as well as individual practitioners. This is critical information that should also be included in and used to shape paramedic curricula. It is important to also note that the conduct standards are admissible in disciplinary proceedings “as evidence of what constitutes appropriate professional conduct or practice for that health profession” and so should clearly set out what that appropriate professional conduct and practice is.

The Board is also required to develop the standard for entry to the register. This includes making a determination about the minimum qualification or credential and level of experience required for a paramedic to become eligible for registration. The Board will then be able to authorise an accreditation body to exercise the accreditation functions for the profession that include approving appropriate programs of paramedic study. The Board will determine if student paramedics should be registered and it will also determine the application fee for registration and the annual registration fee.

Once the Board has completed all these tasks it will be able to commence registering suitably qualified and competent persons as paramedics. The responsibility associated with this task should not be underestimated. The establishment of the inaugural Paramedicine Board of Australia is a serious and complex undertaking and there is a lot of work to be done. It is to be hoped that paramedicine’s ‘best and brightest’ will be selected to undertake this work and that towards the latter half of 2018 we will see a health profession emerge that has a clear identity that is shaped by its unique purpose, its body of knowledge, its code of conduct, and one that is ready to regulate itself, just as all true professions do.

Ruth Townsend BN, LLB, LLM, DipParaSc, is a Lecturer in Law and Sociology at Charles Sturt University, New South Wales.
Michael Eburn BCom LLB, BA(Hons), LLM, MPET, PhD, is an Associate Professor at the Australian National University College of Law.

This article originally appeared in RESPONSE Vol 44, No.3 Winter 2017.