Protection of the Public: National
Registration and Accreditation
Professor Mary Chiarella
Sydney Nursing School,
University of Sydney
Board Member NMBA
Date: 16th September 2010
1
Outline…
• Overview of national scheme
• Role of National Boards
• Role of Australian Health Practitioner Regulation Agency
(AHPRA)
• Update on implementation & transition
2
Where we were before July
1st 2010…
• Eight States and Territories
• >85 health profession boards
• 66 Acts of Parliament
3
Where we are as of July 1st
2010…
• One national scheme (except WA)
• 10 health profession boards
• One Act of Parliament
4
The Challenge
5
The World’s
Largest Jigsaw?
Idenk
Who are our people?
•
•
•
•
•
•
495 ongoing staff
Av service 2.62 years
45% from medical boards
30% from nursing boards
5% dental/ pharmacy
27 legacy industrial
agreements
7
Architecture
Ministerial Council
AHPRA Agency
Management Committee
National
Boards
Health
Workforce
Advisory
Council
Advisory Council
Advice
Accreditation
Accreditation
Authorities
Authorities
Contract
Support
National
National
Committees
Committees
State/Territory/Regional
Boards
Support
Support
AHPRA National Office
AHPRA State
and Territory
Offices
Roles
• National Boards
– Protect the public
– Powers governed by the National Law
– Sets policy and standards – professional and registration
• State Boards and Committees
– Administer National Law by delegation from National Bd
– Make registration and notification decisions about
individual practitioners
• AHPRA
– Support the work of the Boards (people and process)
– Administer National Law by delegation from National Bd
– Has a Health Professions Agreement with every Board
– Advises Ministerial Council about the National Scheme
9
Role of AHPRA…
• all functions in line with the objectives and
guiding principles of the scheme
• provide support and administration services
to National Boards and committees, through
one organisation with a National office and
State/Territory offices
• Health Profession Agreements with National
Boards:
– employ staff
– manage contracts
– own and manage property
10
Joining the dots…..
National Board Policy and Standards
AHPRA Operations
State Boards
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Professional Liability:
What is the purpose of a
protective jurisdiction?
• Forms part of the branch of law known as
administrative law
• Very different function from criminal law,
which exists to “punish offenders and deter
potential offenders”
• Although sometimes the toll on individuals
may be high in terms of both money and
emotional stress, that is not the purpose of a
protective jurisdiction
Guiding principles…
• national scheme to operate in transparent,
accountable, efficient, effective and fair way
• registration fees to be reasonable (having regard to the
efficient and effective operation of the scheme)
• restrictions on practice to be imposed only if necessary
to ensure health services provided safely and of
appropriate quality
13
In practice…
• Mobility: Register once, practise across Australia
• Uniformity: Consistent national standards – registration
and professional conduct
• Efficiency: Less red tape - streamlined, effective
• Collaboration: Sharing, learning and understanding
between professions
• National online registers – showing current conditions on
practice (except health)
14
National Consistency
• No post code lottery
• Not ‘one size fits all’
• Consistency of
registration processes
and regulatory
outcomes
15
Health Professions…
July 2010
July 2012
•
•
•
•
•
•
•
•
•
•
•
chiropractors
dental care (including dentists,
dental hygienists, dental
prosthetists & dental therapists),
medical practitioners
nurses and midwives
optometrists
osteopaths
pharmacists
physiotherapists
podiatrists
psychologists
•
•
•
Aboriginal and Torres Strait
Islander health practitioners
Chinese medicine
practitioners
medical radiation
practitioners
occupational therapists
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Legislation…
• Act A – The Health Practitioner Regulation
(Administrative Arrangements) National Law Act
2008 (Queensland) – in force now
• Act B – Health Practitioner Regulation National Law
Act 2009 - Full provisions for operation of the
scheme, commenced 1 July 2010
• Bills C – Adoption and Consequential Bills
– passed in all states
– WA will join the scheme in October 2010
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Key features
• Criminal history and identity checks
• Student registration (after March 2011)
• Independent accreditation functions (to
restructured ANMC)
• Mandatory continuing professional development
• Mandatory professional indemnity insurance
• Handling of notifications and complaints (NSW has
co-regulatory model)
– Health, performance and conduct matters
– Mandatory notifications –consistent nationally
• National registration fee for each profession ($115
for annual renewal) NSW will be subsidised because
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of complaints) ($104)
Mandatory notifications…
• Practitioners and employers must report a registrant
who they believe has engaged in notifiable
conduct (some exceptions)
• Belief formed through the practice of the profession
• Notifiable conduct is:
– practising while intoxicated by drugs or alcohol
– engaging in sexual misconduct in professional
practice
– placing the public at risk of substantial harm
through a physical or mental impairment
affecting practice
– placing the public at risk of harm through a
substantial departure from accepted
professional standards
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Who does what…
National Boards:
• Set national standards, codes and guidelines for
profession
• Determine requirements for registration and register
health practitioners who meet the requirements
• Approve accredited programs of study
• Oversee assessment of overseas trained
practitioners
• Oversee receipt and follow-up of notifications on
health, performance and conduct
• Maintain registers (with Agency)
20
Who does what…
State/ Territory/ Regional Boards:
NMBA will have 8 members on each State and Territory
Committees after July 2011
• Profession specific structures
• In general – make decisions on individual registrants
(registration and notification), based on national board
policy
• In NSW also a Council to manage complaints/ notifications
(co-regulatory system)
AHPRA:
• Supporting Boards by managing registration, investigation/
notification and administrative
21
Progress so far…
National Boards:
• Collaboration and cooperation between
professions (through Board Chairs)
• Committee structures set
– Policy working group
– Finance and governance group
– Accreditation oversight group
– Accreditation and education group
• Proposals developed, consulted on, revised and
submitted to Ministers (some decisions pending) on:
• Registration standards
• Endorsements
• Codes and guidelines adopted
22
NMBA Members
Clinicians:
Angela Brannelly
Mary Chiarella
Anne Copeland (chair)
Lynette Cusack
Denise Fassett
Lynne Geri
Louise Horgan
Mark Kirk
Consumers:
Gillie Anderson
Christine Murphy
Heather Sjoberg
Margaret Winn
EO – Anne Morrison
NT
NSW
Qld
SA
Tas
Vic
WA
ACT
Logo
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Key decisions so far…
• CPD (20 hours per year minimum)
• Recency of practice (3 months full-time in 5
years or assessment)
• Eligible midwife endorsement
• Eligible midwife administration of medications
endorsement
• NP standard (guidelines to follow) go to website
now)
25
CPD requirements
• Requirements
• 1. Nurses on the nurses’ register will participate
in at least 20 hours of continuing nursing
professional development per year.
• 2. Midwives on the midwives’ register will
participate in at least 20 hours of continuing
midwifery professional development per year.
• 3. Registered nurses and midwives who hold
scheduled medicines endorsements or
endorsements as nurse or midwife practitioners
under the National Law must complete at least
10 hours per year in education related to their 26
CPD requirements (cont)
• 4. One hour of active learning will equal one
hour of CPD. It is the nurse or midwife’s
responsibility to calculate how many hours of
active learning have taken place. If CPD
activities are relevant to both nursing and
midwifery professions, those activities may be
counted in each portfolio of professional
development.
• 5. The CPD must be relevant to the nurse or
midwife’s context of practice.
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CPD requirements (cont)
• 6. Nurses and midwives must keep written
documentation of CPD that demonstrates
evidence of completion of a minimum of 20
hours of CPD per year.
• 7. Documentation of self-directed CPD must
include dates, a brief description of the
outcomes, and the number of hours spent in
each activity. All evidence should be verified.
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CPD requirements (cont)
• It must demonstrate that the nurse or midwife has:
• a) identified and prioritised their learning needs,
based on an evaluation of their practice against
the relevant competency or professional practice
standards
• b) developed a learning plan based on identified
learning needs
• c) participated in effective learning activities
relevant to their learning needs
• d) reflected on the value of the learning activities or
the effect that participation will have on their
practice.
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CPD requirements (cont)
• 8. Participation in mandatory skills acquisition
may be counted as CPD.
• 9. The Board’s role includes monitoring the
competence of nurses and midwives; the Board
will therefore conduct an annual audit of a
number of nurses and midwives registered in
Australia.
30
Recency of practice
• Nurses and midwives must demonstrate, to the
satisfaction of the Board, that they have
undertaken sufficient practice, as defined in (2)
below, in their professions within the preceding
five years to maintain competence.
• 2. Nurses and midwives will fulfil the
requirements relating to recency of practice if
they can demonstrate one, or more of the
following:
31
Recency of practice (cont)
• a) practice in their profession within the past
five years for a period equivalent to a minimum
of three months full time
• b) successful completion of a program or
assessment approved by the Board, or
• c) successful completion of a supervised
practice experience approved by the Board.
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• 3. Practice hours are recognised if evidence is
provided to demonstrate:
• a) the nurse or midwife held a valid registration with a
nursing or midwifery regulatory authority in the
jurisdiction (either Australian or overseas) when the
hours were worked, or
• b) the role involved the application of nursing and/or
midwifery knowledge and skills, or
• c) the time was spent undertaking postgraduate
education leading to an award or qualification that is
relevant to the practice of nursing and/or midwifery.
• 4. Extended time away from practice due to illness or
any type of leave will not be counted as practice.
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Definition of Practice
• …means any role, whether remunerated or not, in
which the individual uses their skills and knowledge
as a nurse or midwife. For the purposes of this
registration standard, practice is not restricted to
the provision of direct clinical care. It also includes
working in a direct nonclinical relationship with
clients, working in management, administration,
education, research, advisory, regulatory or policy
development roles, and any other roles that
impact on safe, effective delivery of services in the
profession and/ or use their professional skills
34
Endorsements
• Nurse practitioners (will require a Masters)
• Eligible midwives
• Eligible nurses – declined and RIPN
endorsement in place for transition
• Midwife practitioners – no standard developed at
this time as little benefit to be gained– in
negotiation
35
What about me…
• Automatic transition for practitioners who are
registered on 30 June 2010
• Individual practitioners advised of their category
and type of registration late April 2010
• Process in place to resolve anomalies
• Registration renewal processed after 1 July
managed by AHPRA (new national registration
renewal process)
• Current registration continues until expiry
36
We are on the move!
• Over 2400 new registration applications completed
• Over 460,000 registrants on the national registers
• 27,000 renewals successfully completed
• 75% of renewals occurring on line
• 2000+ notifications under active management
• 80%+ calls now addressed at first contact
37
“Regulation touches the point between the public
and the personal. Over regulation is seen as an
interference in personal conduct; under regulation
is seen as an abdication of public responsibility.
When harm happens we blame ineffective
regulation but when we are stopped from doing
something risky we say regulation is excessive. The
public, media and politicians often face both ways
wanting more or less regulation depending on the
moment and the mood”.
Harry Cayton, Chief Executive, Commission for
Health Care Regulatory Excellence, UK
More information…
• Website -http://www.nursingmidwiferyboard.gov.au
• Questions and correspondence Ph: 1300 419 495
• [email protected]
• [email protected]
• Australian Health Practitioner Regulation
Agency (NSW office)
– Postal Address
AHPRA
G.P.O. Box 9958
Sydney NSW 2001
– Office Location
Level 51, 680 George Street
Sydney NSW 2000
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