The Health Ministers, through the Registration and Accreditation Implementation Project team, issued a series of consultation papers on matters associated with the registration of practitioners under the new scheme. The papers presented a number of proposals on which input was sought to support the development of national legislation to regulate the scheme. A number of these proposals would result in significant changes to the current registration arrangements for psychologists. The main proposed changes are detailed below, together with the response to these proposals that has been presented by the APS in formal submissions.
It has been proposed that recognition of specialties and specialists within professions be achieved through identification on the registers of practitioners, rather than through legislation. The National Boards of each profession would endorse or ‘notate' the professional registration of suitably qualified practitioners to indicate specialist status based on appropriate criteria. General statutory offences would prevent unregistered or unauthorised persons from using any title that could induce a belief that the person is endorsed as a specialist when he/she doesn't meet the criteria. Recognition of new specialties or specialty areas of practice on professional registers would be subject to approval by the Ministerial Council. It is understood that a further proposal regarding specialist titles will be presented for consultation in February 2009.
The APS has generally supported the proposal of specialist titles for appropriately qualified psychologists which for the psychology profession would potentially use the nine specialist titles corresponding to the nine Colleges of the APS.
The consultation paper proposed to include the capacity for National Boards to adopt a non-practising category of registration to enable more transparent distinction between registrants who are and are not in active practice. It was further proposed that registrants granted this type of registration would be required to not practise at all or they would be in breach of the conditions of their registration.
The APS has supported this proposal as a means of providing clarity to the community about registrants who are not in active practice and the activities that such non-practising registrants are and are not authorised to do. The APS suggested that ‘practising' be defined as a professional engaged in the application of psychological knowledge to provide psychological services to a client (individual, group or organisation).
It has been proposed that the legislation include provision to register and regulate students who are undertaking professional training that involves contact with clients/patients. This would empower National Boards to deal with students whose ability to undertake professional training is affected by physical or mental impairment, or drug or alcohol dependency.
This proposal has been supported by the APS, but with the recommendation that student registration should only be mandatory for students who are at the point in their course where they are in direct contact with clients.
The consultation paper outlined a proposal to require criminal history checking of new applicants and existing registrants, and offered four options relating to this.
The APS has strongly supported the practice of criminal history checks for practitioners working with the most vulnerable members of the community. However, the appropriateness of a blanket ruling for all health professionals when there is significant variation in the vulnerability of clients, service settings and professional practices has been questioned. In addition, there are significant issues associated with the management of information gathered from a police check and the protection of the rights of individual practitioners. The position endorsed by the APS is that only new registrants should undergo a criminal history check, and that renewing registrants should have to sign a declaration that they have no criminal history or, if they do have a history, to provide appropriate information.
The consultation paper proposed that all registrants should be required to be covered by professional indemnity insurance arrangements as a condition of ongoing registration to practise.
The APS has supported this proposal for compulsory professional indemnity insurance as a condition of registration, and concurs that the National Board for each profession should determine what constitutes acceptable arrangements for this insurance.
It has been proposed that the National Boards will establish requirements for registrants to demonstrate continuing competence as a condition of annual registration renewal.
The APS has strongly supported the notion of ensuring continuing competence of registrants and believes the most practical procedure for this is a requirement to engage in continuing professional development as a stipulation of ongoing registration.
The consultation paper proposed a streamlined process for practitioners to be reinstated to the register within a two-year period after they have let their registration lapse. This was proposed to facilitate re-entry to practise for those who can demonstrate recent practice but who hold older qualifications that may no longer be suitable for registration purposes.
The APS has endorsed this proposal to support senior practitioners that might otherwise not be eligible for re-registration, but has recommended that the lapse period be for three rather than two years.
Major proposed new arrangements for registration aspects of the national scheme
The consultation paper proposed that a ‘notifications management system' be established to protect the public from practitioners who are incompetent, unethical, or impaired in their capacity to practise. Where matters regarding the professional performance, health or conduct of a practitioner are brought to the attention of a National Board, it has been proposed that Boards pursue the matter through three separate streams: performance management (competence), health management (impairment) or conduct management (discipline).
The key steps in the proposed scheme are as follows:
The consultation paper proposed mandatory reporting obligations for registered practitioners and employers to notify the Board where there are concerns about the professional conduct of another registered practitioner. Registrants would only be expected to report major departures from professional standards where it is within their competence to make such a judgement.
The consultation paper proposed that National Boards deal with practitioners whose performance is unsatisfactory through a cooperative and educative process, rather than through a disciplinary process. It has been proposed that following notification, a practitioner would undergo a performance assessment and then be provided with a plan to address any identified deficits in skills or knowledge through further education or supervised practice. A formal Board hearing may be conducted if the matter is sufficiently serious, and a practitioner may be referred to the health management stream or conduct management stream for further investigation.
It has been proposed that National Boards deal cooperatively and flexibly with practitioners who have a health condition or whose use of alcohol or other drugs is compromising their capacity to practise. Following an assessment, the Board would have the option to enter into an agreement with the practitioner to suspend, or impose conditions on, registration for a period, to refer the practitioner to a support program aimed at resolving the issue, or to monitor compliance with conditions placed on registration. Similar arrangements to managing performance matters would apply in terms of options for a formal Board hearing for serious matters, or referral to another management stream for further investigation.
It has been proposed that following a preliminary assessment of a practitioner's potentially unsatisfactory professional conduct, the Board will appoint an investigator to pursue the matter. Following receipt of the report of the investigation, the Board would have the power to pursue a number of options including requesting the practitioner to undertake further education or supervised practice, referring to the performance or health management streams, referring for a formal hearing, referring to the relevant Health Complaints Commissioner for conciliation, or referring to an external agency such as the police or Medicare Australia.
In responding to the consultation paper on complaints and discipline arrangements, the APS has broadly endorsed the proposals for complaints and discipline arrangements but has proposed some conditional recommendations to ensure natural justice for practitioners is achieved. In regard to mandatory reporting of practitioners with unsatisfactory professional conduct, the APS has put forward recommendations to carefully manage the processes for notification through guidelines and procedures, and to ensure that practitioners fully understand the threshold at which they become obliged to notify the National Board.
The APS has also strongly recommended that National Board and State Committee members undergo education and training to ensure that they fully appreciate the major shift in the roles and processes of ‘professional boards' under the new national registration and accreditation scheme. This will help to ensure that the new Boards are transparent and accountable, and can exercise judgement without fear or favour while upholding the interests of both the community and the practitioners for whom they are responsible.
The new National Boards and the National Agency will collect and process personal and sensitive health information about registrants in order to successfully undertake the registration functions. In addition to the usual information that is collected on registrants, it has been proposed that information on recency of practice also be included. The APS has opposed this proposal due to the difficulties in adequately defining what constitutes ‘recent practice' across the diverse profession of psychology. The consultation paper also proposed that the details of the registrant's employer be collected to enable the ability to notify employers of changes in registration status or conditions of practice as a protection mechanism for the public.
In addition, the consultation paper proposed that each registered health practitioner be allocated a unique identifier in the new registration system to assist cross-jurisdictional processes and enable e-health developments and other information sharing in the public interest. There has been wide ranging debate regarding the privacy risks that identifiers pose because they allow the linking of various sources of information regarding individual practitioners. Separate legislation is currently under development to provide an appropriate regulatory framework for e-health, and this would be expected to cover arrangements under the national registration scheme.
It has been proposed to use a single privacy law to achieve uniform privacy treatment for all of the national scheme's information practices, as currently there are numerous information privacy laws across the Commonwealth, States and Territories that apply. The existing Commonwealth private sector privacy regime and National Privacy Principles have been put forward as the basis for the privacy arrangements in the national scheme.
The APS broadly supports the proposals in the consultation paper on arrangements for information sharing and privacy, but has stressed in submissions that the privacy arrangements that have been put in place to protect community members must also be applied for the protection of health practitioners. Although the main driver of the national registration and accreditation scheme is to ensure that public protection is paramount, it is essential that the rights and privacy of individual practitioners are not violated in the process.