By Ruth Townsend and Michael Eburn
In November 2015, after years of lobbying, the Australian Health Workforce Ministerial Council, comprising of the health ministers of all state and territories and the commonwealth, announced that paramedics would finally be included in the National Registration and Accreditation Scheme (NRAS) for the health professions. The NRAS is administered by the Australian Health Practitioner Regulation Agency (AHPRA).
The key piece of legislation that is required to be amended to make provision for this change is the Health Practitioner Regulation National Law Act 2009 (Qld). This Act has either been adopted, or copied, by all states and territories to provide uniform, national regulation of health professionals. Notwithstanding the attempt at uniformity, there are some anomalies. New South Wales and Queensland have their own complaints and disciplinary mechanisms. In New South Wales, the health professional councils work with the NSW Health Care Complaints Commission to assess and manage concerns about practitioners. In Queensland, the Office of the Health Ombudsman manages concerns about practitioners.
Amendments to the Act (contained in the Health Practitioner Regulation National Law Amendment Bill 2017) are expected to pass through the Queensland parliament in mid-2017. The law will authorise the national regulation of paramedics. It will protect the title ‘paramedic’ allowing only those registered under the National Law to use it. It will also protect the title ‘paramedicine’. It will provide for single-point registration of paramedics so that registered paramedics will be recognised anywhere in Australia. Finally the amendments will provide legal authority for the establishment of the Paramedicine Board of Australia. The Board will be responsible for regulating paramedics and paramedicine by determining the registration process, setting national minimum education and accreditation standards, and establishing procedures for management of health, performance and conduct issues related to registered paramedics (with the exception that complaints handling and disciplinary functions in Queensland and New South Wales will be undertaken by their respective co-regulatory mechanisms).
National registration will allow:
- the establishment of a consistent set of minimum qualification standards (subject to the discussion below about New South Wales)
- the profession itself to determine who meets the criteria for entry into the profession and who does not
- the profession to establish its performance, character and competency standards
- a panel of peers to make determinations as to the suitability of a person to practise paramedicine and the appropriate disciplinary action for those who are found to be performing poorly or engaging in misconduct. This process will be transparent and in so doing improve accountability for those working in both the public and private sectors.
Registration will provide an avenue for the continued professionalisation of the discipline by, for the first time, providing an avenue for the discipline to self-regulate.
Despite these aims there is one significant limitation on the profession’s ability to self-regulate that was necessary to bring New South Wales into the scheme. The proposed Act will require the Board to recognise qualifications issued by the Ambulance Service of NSW as meeting the requirements for registration as a paramedic. This will mean that New South Wales graduates, holding a Diploma of Paramedical Science, Diploma of Paramedical Science (Ambulance), Advanced Diploma of Paramedical Science (Ambulance), Diploma in Paramedical Science (Pre-Hospital Care) or Advanced Diploma Paramedical Sciences (Pre-Hospital Care) issued by the Ambulance Service of NSW will be registered regardless of the standards imposed by the Paramedicine Board for graduates in other jurisdictions. Regardless of entry qualifications, all paramedics will be required to meet the registration standards to be developed by the Paramedicine Board of Australia that will likely include the need to demonstrate the completion of annual continuing professional development requirements, English language proficiency requirements, professional indemnity insurance requirements for those who need it and evidence of recency of practice.
Registration fees for paramedics will be set by the National Board and AHPRA. The fees for a particular profession are determined by a number of factors such as the size of the profession, the level of risk associated with practising the profession, and the cost to administer the profession including the disciplinary (complaints) and governance (Board) arms of the profession. Apart from annual fees, there will be an additional fee payable upon initial registration that pays for the background checks that need to be carried to ensure that the applicant is ‘a fit and proper person for general registration in the profession’ (section 55(h)).
The ‘appropriate person’ standard is be a requirement of registration that a practitioner discloses to the Board, as soon as it is reasonable to, that they have been convicted of a criminal offence that is determined by the Board as being a notifiable offence.
It is anticipated that the Law will come into effect in late 2018 and the very first day of operation will be referred to as the ‘participation day’. Prior to that day, the Paramedicine Board will be authorised to carry out certain functions including the development of registration, education and accreditation standards, the development of a code of conduct – which is required to ‘provide guidance to practitioners and other matters relevant to the exercise of the function of the Board’ (section 39). The National Board must ‘ensure there is wide-ranging consultation’ about the contents of the proposed Code of Conduct (Health Practitioner Regulation National Law Act 2009 (Qld) section 40).
The Ministerial Council will appoint paramedic members to the Board who have the relevant skills and experience in paramedicine to undertake the Board’s functions because, until the participation day, there will not be any registered paramedics. At least half, but not more than two-thirds, of the members of the National Board MUST be practitioner members.
The law will also include ‘grandparenting’ provisions that will enable the existing paramedic workforce to obtain registration under the National Scheme if, critically, they have practised paramedicine for at least five years during the preceding 10 years and satisfy the Board that they are competent to practise paramedicine.
The inclusion of paramedics under the NRAS is a massive step forward for the professionalisation of paramedicine because it is the closest the profession has come yet to self-regulation. Where formerly paramedics have been beholden to their employer to make determinations about education, accreditation, character, conduct, competency, performance, ethical and entry-to-the-profession standards, it will now be the members of the profession itself that make those determinations. It is anticipated that paramedic registration will commence some time in the latter half of 2018.
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.2 Autumn 2017.