June 2020

Issue 3

From the Chair
Board news
Registration
- Workforce update - latest registration data
Alert
- Victorian practitioners: information on the Voluntary Assisted Dying Act
New resources
National Scheme News
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From the Chair

Photo of Stephen Gough. Chair, Paramedicine Board of Australia The first half of 2020 has been a busy and challenging time for everyone, and I hope you are all keeping safe and well and looking after each other. We now have almost 20,000 registered paramedics. Over 17,000 paramedics successfully renewed their registration for the first time in October and November last year, and the renewal process has told us that some paramedics still don’t fully understand the requirements and obligations that come with being a registered health professional.

The Paramedicine Board will be seeking to guide and support you by providing more information and resources. We have published information on our website aimed to enhance your understanding of continuing professional development (CPD) and recency of practice requirements, which we suggest you take the time to review. Read more below on our plans for the rest of the year.

I recommend you also keep up to date with the latest advice from state, territory and Commonwealth governments on the current pandemic, protecting yourself and others including appropriate infection control measures and any additional advice applicable for health sector employees.

It is important for all of us to be vigilant, to take care and be safe.

Associate Professor Stephen Gough ASM
Chair, Paramedicine Board of Australia

Board news

Our plans for the rest of 2020

Throughout the rest of this year the Paramedicine Board will continue to develop and implement the infrastructure necessary to regulate the profession. This will include:

establishing ongoing paramedic capabilities to support the training and education of paramedics
consultation on the Code of conduct shared with other National Boards, and
approving accreditation standards for paramedic training.

We will also consult on a shared supervised practice framework and registration standards for limited registration. Keep an eye on our website for news about these and other developments.

CPD resources are available on our website

All registered paramedics must complete 30 hours of suitable CPD activities each year to comply with the CPD registration standard for paramedics. It is understandable that some paramedics have found the transition to registration challenging and to support you the Board has published resources to help you comply with your CPD requirements. These include:

tips for planning your CPD
CPD activities that meet the standard
identifying your CPD learning goals
CPD reflection
updated CPD portfolio/log book
fact sheet on CPD exemptions
CPD checklist, and
FAQs on the CPD registration standard.

You can find these on the Board’s website under Registration standards/CPD.

Supervised practice conditions

There are several reasons why the Paramedicine Board may impose a condition on a practitioner’s registration that their practice be supervised for a period of time. Often it is to provide a safe and controlled environment for that practitioner to establish their ongoing competence to practise as a paramedic.

When the Board imposes a supervised practice condition, the paramedic must not practise outside the arrangements specified in the condition. Usually the paramedic will be required to submit and have a supervised practice plan that details their supervised practice arrangements, approved by the Paramedicine Board, before they can begin to practise.

Paramedics who practise without having their supervised practice arrangements approved by the Board should note that this may be grounds for notification under s144 of the Health Practitioner Regulation National Law (National Law) and subsequent disciplinary action may be taken.

If you delay the start of a period of supervised practice, in addition to having your supervised practice arrangements approved, you must also ensure you meet requirements of the Board’s Recency of practice registration standard before starting practice.

Now that you are a registered paramedic …

There are obligations that come with being a registered paramedic. These include:

ensuring you renew your registration each year
complying with the requirements of the CPD registration standard
ensuring that you have adequate professional indemnity insurance (PII) arrangements in place anytime that you practise the profession
ensuring that you have completed the required minimum practice hours within your current scope of practice (see definition of practice below)
ensuring that you are safe and competent in any practice you carry out
ensuring you meet the ethical and professional expectations of the Paramedicine Board as outlined in the interim code of conduct, and
notifying the Paramedicine Board of certain events as required in the National Law.

Definition of practice

Practice means any role, whether remunerated or not, in which you use your skills and knowledge as a health practitioner in your profession. Practice is not restricted to the provision of direct clinical care. It also includes using professional knowledge in a direct non-clinical 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.

Notifying the Paramedicine Board within seven days of certain events is often overlooked by practitioners. These events include the following:

you are charged for an offence that might be punishable by 12 months or more in prison
you have been found guilty/convicted of an offence punishable by imprisonment
you no longer have PII arrangements in place
your right to practise at a hospital or other facility has been withdrawn due to your conduct, performance or health
your authority to administer, obtain, possess, prescribe, sell, supply or use a schedule medicine or class of scheduled medicine is cancelled or restricted
your registration as a health practitioner in another country is cancelled, restricted or made subject to a condition, or
a complaint has been made about you to:
(a) the chief executive officer under the Human Services (Medicare) Act 1973 (Cth)
(b) an entity performing functions under the Health Insurance Act 1973 (Cth)
(c) the Secretary within the meaning of the National Health Act 1953 (Cth)
(d) the Secretary to the Department in which the Migration Act 1958 (Cth) is administered, or
(e) another Commonwealth, State or Territory entity having functions relating to professional services provided by health practitioners or the regulation of health practitioners.

Also, if you change your principal place of practice, name or address you must notify the Board within 30 days.

Failure to meet these requirements may result in health, conduct or performance action being taken under Part 8 of the National Law.

There are forms to help you make these declarations when required − see the Registration section of the Ahpra website.

Paramedicine regulation at work: Protecting the public in 2018/19

A profession-specific statistical summary and a report from the Chair that covers the work of the Paramedicine Board of Australia over the 12 months to 30 June 2019 is available online. The summary draws on data from the 2018/19 annual report of Ahpra and the National Boards.

The paramedic summary provides a snapshot of the profession as at 30 June 2019 and includes the number of applications for registration and segmentation of the registrant base by gender and age.

Notifications information is also extensive and includes numbers, types and sources of complaints, mandatory notifications, criminal offence complaints and more.

To gain an insight into the profession during 2018/19 and to access the data tables visit the Board’s 2018/19 summary.

Registration

Workforce update: latest registration data

The Paramedicine Board’s registration data report is released quarterly. The latest report, for the period 1 January to 31 March 2020, shows there are 19,383 registered paramedics, 212 of whom have non-practising registration.

The highest number by age group is 25-29 years. The gender balance is 44.2% female (8,562), 55.8% male (10,807).

For more information on registration, visit our Statistics page.

Alert

Victorian practitioners: information on the Voluntary Assisted Dying Act

On 1 July 2019, the Voluntary Assisted Dying Act 2017 (Vic) began operation in Victoria. The Paramedicine Board draws specific attention to section 8 of the Act, which states that a registered health practitioner who provides health services or professional care services to a person must not, in the course of providing those services to the person:

initiate a discussion that is, in substance, about voluntary assisted dying (s 8(1)(a)), and
in substance, suggest voluntary assisted dying to that person (s 8(1)(b)).

A breach of this requirement is deemed to be unprofessional conduct for the purposes of the National Law (s 8(3)). It is noted, however, that section 8 does not prevent a health practitioner providing information about voluntary assisted dying to a person at that person’s request (s 8(2)) (emphasis added).

We encourage Victorian health practitioners who have not already done so, to review the Act and familiarise themselves with its requirements.

If you need further information, we encourage you to contact your professional association or professional indemnity insurer. Information about the Act, published by the Victorian Department of Health and Human Services, is available on the DHHS website.

New resources

Guidelines for practitioners in relation to blood-borne viruses

The Australian Health Ministers’ Advisory Council (AHMAC) has endorsed the Australian national guidelines for the management of healthcare workers living with blood borne viruses and healthcare workers who perform exposure prone procedures at risk of exposure to blood borne viruses that were developed by the Communicable Diseases Network Australia (CDNA).

To support the implementation of the CDNA guidelines and paramedics who may perform exposure-prone procedures, the Paramedicine Board of Australia, together with the Dental, Medical, Nursing and Midwifery and Podiatry Boards, has approved Guidelines for registered health practitioners and students in relation to blood-borne viruses.

There is a risk of transmission of a blood-borne virus from practitioner to patient when health practitioners who are living with a blood-borne virus perform a class of procedures called ‘exposure-prone procedures’.

When referring to blood-borne viruses, we mean hepatitis B, hepatitis C and human immunodeficiency virus (HIV).

Exposure-prone procedures are procedures where there is a risk of injury to the healthcare worker resulting in exposure of the patient’s open tissues to the blood of the healthcare worker. These procedures include those where the healthcare worker’s hands (whether gloved or not) may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.

These guidelines have been developed to:

inform all practitioners registered by the National Board that they must comply with the CDNA guidelines, as current and as revised in the future, including testing for blood-borne viruses
explain the circumstances in which a practitioner treating a registered health practitioner or student may have a responsibility to notify Ahpra that their patient is living with a blood-borne virus, and
provide information on the range of actions that a National Board may take if it receives a notification that a registered health practitioner or student is infected with a blood-borne virus and may be impaired or otherwise poses a risk to the public.

These guidelines will be published shortly. To read the public consultation paper and the submissions received in the consultation, visit Past consultations on the Board’s website.

Social media guide for health practitioners

National Boards and Ahpra have published a new guide to help registered health practitioners understand and meet their obligations when using social media. The guide reminds practitioners that when interacting online, they should maintain professional standards and be aware of the implications of their actions, just as when they interact in person.

The guide does not stop practitioners from engaging online or via social media; instead, it encourages practitioners to act ethically and professionally in any setting.

To help practitioners meet their obligations, the guide also outlines some common pitfalls practitioners may encounter when using social media.

Community trust in registered health practitioners is essential. Whether an online activity can be viewed by the public or is limited to a specific group of people, health practitioners have a responsibility to behave ethically and to maintain professional standards, as in all professional circumstances.

In using social media, health practitioners should be aware of their obligations under the National Law, the Paramedicine Board’s Code of conduct, the Advertising guidelines and other relevant legislation, such as privacy legislation.

This guide replaces the Social media policy on Boards’ codes, guidelines and policies pages and is available in the Advertising resources section of Ahpra’s website. The guide will be updated as needed.

Podcasts on the pandemic and beyond

Ahpra has released many podcasts on areas of interest to all health professionals in the Taking care podcast series. The topics covered in the podcasts include pandemic and non-pandemic-related issues.

In a recent episode on Health practitioner wellbeing in the pandemic era and beyond, psychiatrist Dr Kym Jenkins, clinical psychologist Margie Stuchbery and Dr Jane Munro, a rheumatologist, share personal and professional insights on practitioner wellbeing. They discuss practical and evidence-based strategies to safeguard and support practitioners and teams through the COVID-19 pandemic and beyond.

Ahpra releases a new episode every fortnight, discussing current topics and the latest issues affecting safe healthcare in Australia. Podcasts include:

A glimpse of healthcare in our rural and remote communities
Balancing purpose and progress in regulation: Professor Kieran Walshe
Professor Valerie Braithwaite on the importance of trust
Health practitioner wellbeing in the pandemic era and beyond
Telehealth in the pandemic era
Introducing the COVID-19 pandemic sub-register
Dr Gerald Hickson on patient safety and high-risk practitioners
Eliminating racism from the health system is a team effort
A new look at mandatory notifications
Ahpra’s role in the health system
A view of mental health from both sides
The practitioner experience of a notification
Safe, competent and ethical health practitioners
Vexatious notifications.

Download and listen to the latest Ahpra Taking care podcast episode today. You can also listen and subscribe on Spotify, Apple Podcasts and by searching ‘Taking Care’ in your podcast player.

If you have questions or feedback about the podcast, email communications@ahpra.gov.au.

National Scheme news

Protecting our health practitioners of the future: clinical education principles

National Boards, accreditation authorities and Ahpra, with the Australian Government through the Health and Education portfolios, have issued national principles for clinical education during the COVID-19 pandemic.

This unique multi-sector collaboration to protect Australia’s future health workforce is helping students learning to become health practitioners during the COVID-19 pandemic continue their studies and graduate.

Some student placements have been paused, cancelled or otherwise modified as health services respond to the pandemic. This has led to uncertainty and change for students and educators as education providers, accreditation authorities, clinical supervisors and others explore alternative options for students to progress towards graduation.

The principles aim to provide helpful guidance about how placements can occur safely, taking into account the significant changes across the health and education sectors due to COVID-19. Visit the National principles for clinical education during COVID-19 to find out more.

No place for racism in healthcare

In April, the Australian Indigenous Doctors’ Association (AIDA) issued a media release detailing instances of medical practitioners denying Aboriginal and Torres Strait Islander people access to culturally safe healthcare. They were seeking testing for COVID-19. These cases in rural New South Wales and Western Australia involved refusal of care on the grounds of patient identity and racist stereotypes of Aboriginal and Torres Strait Islanders not practising self-hygiene.

Racism from registered healthcare professionals will not be tolerated, particularly given the vulnerability of Australia’s Aboriginal and Torres Strait Islander Peoples to the virus. They continue to experience prejudice and bias when seeking necessary healthcare. Discrimination in healthcare contributes to health inequity.

We encourage Aboriginal and Torres Strait Islander people who have experienced culturally unsafe incidents of care or refusal of care by a registered health practitioner to submit a notification or complaint to Ahpra.

In February 2020, the National Scheme’s Aboriginal and Torres Strait Islander health and cultural safety strategy 2020-2025 was released, proving our commitment to achieving patient safety for Aboriginal and Torres Strait Islander Peoples as the norm and the inextricably linked elements of clinical and cultural safety. The strategy strives to achieve the national priority of a health system free of racism.

We remind all registered health practitioners that they are required to comply with their profession’s Code of conduct, which condemns discrimination and racism in health practice.

Changes to mandatory notifications requirements are now in effect

On 1 March 2020 the amendments to the National Law in relation to mandatory notifications took effect.
The amendments apply in all states and territories except Western Australia and affect the mandatory reporting obligations for treating practitioners.

The threshold for reporting a concern about impairment, intoxication and practice outside of professional standards has been raised. The threshold is now reached when there is a substantial risk of harm to the public.

The National Boards and Ahpra have jointly revised the mandatory notifications guidelines to reflect these amendments. The guidelines are relevant to all registered health practitioners, and registered students in Australia.

The guidelines aim to explain the mandatory notifications requirements in the National Law clearly so that practitioners, employers and education providers understand who must make a mandatory notification about a practitioner or student and when they must be made. They also aim to make it clearer when a notification does not need to be made.

Changes to the guidelines include the following:

A new, higher reporting threshold for when treating practitioners must make a notification about their practitioner-patients. This is to give a practitioner-patient the confidence to seek help if they need it without undue concern about a mandatory notification.
There are now two separate guidelines in place. One is for mandatory notifications about practitioners, and one for mandatory notifications about students. As there are only limited circumstances when a mandatory notification must be made about a student it was decided to develop a separate guideline that is only about students.
Restructuring of the guidelines about practitioners according to notifier type (that is, treating practitioner, non-treating practitioner, employer) so that relevant information for each notifier group is easier to find.
Updated flowcharts to help potential notifiers assess whether they need to make a mandatory notification.
Introduction of risk charts that highlight risk and mitigating factors that may be relevant to deciding if a mandatory notification is required.

To help explain the requirements and raise awareness, Ahpra and National Boards have released a range of information materials to both ensure patient safety and support practitioner wellbeing. Read the revised guidelines for practitioners and students and the additional resources developed to help explain mandatory notifications.

National Boards and Ahpra welcome policy directions

National Boards and Ahpra have welcomed two new policy directions from the COAG Health Council which reinforce that National Boards and Ahpra are to prioritise public protection in the work of the National Registration and Accreditation Scheme (National Scheme).

The two directions state that public protection is paramount and require consultation with patient safety and health care consumer bodies on any new and revised registration standards, codes and guidelines, as well as other considerations.

The first policy direction outlines the consideration that National Boards and Ahpra must give to the public (including vulnerable people in the community) when determining whether to take regulatory action about a health practitioner. It also authorises limited sharing of information with employers and state/territory health departments about serious matters involving the conduct of a registered health practitioner.

The second policy direction requires National Boards to consult with patient safety bodies and consumer bodies on registration standards, codes and guidelines when these are being developed or revised. It also provides that National Boards and Ahpra must:

consider the impacts of the new or revised registration standard on vulnerable members of the community and Aboriginal and Torres Strait Islander people, and
prepare and publish a ‘patient health and safety impact statement’ with each new or revised registration standard, code or guideline.

In implementing these policy directions, National Boards and Ahpra will continue to ensure fairness for health practitioners in regulatory processes. The policy directions can be viewed on the National Boards and Ahpra websites.

A strategy for embedding cultural safety into the health system

An ambitious strategy from Aboriginal and Torres Strait Islander health experts, regulators and health organisations committed to embedding cultural safety into the health system has been released by 43 entities including Ahpra and the National Boards.

The National Scheme’s Aboriginal and Torres Strait Islander health and cultural safety strategy 2020-2025 is endorsed by organisations, academics and individuals, including the entities who set the education standards for the 183,000 students who are studying to become registered health practitioners and the regulators of Australia’s 750,000 registered practitioners.

The strategy focuses on achieving patient safety for Aboriginal and Torres Strait Islander Peoples as the norm and the inextricably linked elements of clinical and cultural safety.

Development of the strategy was led by Aboriginal and Torres Strait Islander organisations and individuals via the Aboriginal and Torres Strait Islander Health Strategy Group, which represents all signatories to the strategy.

Aboriginal and Torres Strait Islander health and cultural safety strategy 2020-2025

The vision

Patient safety for Aboriginal and Torres Strait Islander Peoples is the norm. We recognise that patient safety includes the inextricably linked elements of clinical and cultural safety, and that this link must be defined by Aboriginal and Torres Strait Islander Peoples.

The objectives

Cultural safety: A culturally safe health workforce through nationally consistent standards, codes and guidelines across all registered health practitioners in Australia.

Increased participation: Increased Aboriginal and Torres Strait Islander participation in the registered health workforce and across all levels of the scheme regulating registered practitioners nationally.

Greater access: Greater access for Aboriginal and Torres Strait Islander Peoples to culturally safe services from registered health practitioners.

Influence: Using the Strategy Group’s leadership and influence to achieve reciprocal goals. This includes developing a nationally consistent baseline definition to be used across the scheme regulating registered practitioners nationally, which has already been achieved in partnership with the National Health Leadership Forum.

As part of the strategy, we have already reached some goals:

partnering with the National Health Leadership Forum (the forum for national Aboriginal and Torres Strait Islander health peak organisations) to develop, consult and finalise a baseline definition of cultural safety for the scheme for regulating health practitioners
commissioning high-quality cultural safety training to ensure that the regulation of health practitioners, including the development of standards practitioners must meet and the handling of notifications (concerns about registered health practitioners), is culturally safe, and
recommending and advocating for changes to the Health Practitioner Regulation National Law to ensure consistency in cultural safety for Aboriginal and Torres Strait Islander people.

For more information, read the media release.

Statement by National Boards and Ahpra on the misuse of protected titles

Protected titles are an important public safety measure and we take their misuse seriously.

While we are unable to talk about individuals, we would like to thank everyone who has helped to promote a greater community understanding of the importance of protected titles and their appropriate use.

We have recently been working with media organisations to ensure they understand their legal obligations when using titles such as ‘nurse’, ‘medical practitioner’ or ‘psychologist’.

In Australia, titles that relate to a registered health profession are protected by law. You must be registered with a national health practitioner board (National Board) to use a protected title. To be registered, you must be suitably trained, qualified and satisfy the National Board’s requirements for continuing professional education, professional indemnity insurance and recency of practice.

To use a protected title when you’re not registered, or to hold someone else out as registered when they’re not, breaches the trust the public has in their registered health practitioners. That’s because when the public sees a protected title, they trust that they’ll be receiving safe and professional healthcare and advice.

Ahpra wrote to media organisations to remind them of their obligations under the National Law, and to advise that the easiest way to check if someone is registered to practise and entitled to use a protected title in Australia, is by checking our online register of practitioners. The register, which contains the most up-to-date information about a practitioner’s registration status, is available to members of the public, employers and third-parties. It’s free, available 24/7, with updates made daily.

If you are concerned that someone might be holding themselves out to be a registered practitioner when they’re not, call 1300 419 495 or notify us via the Ahpra website.

Tougher penalties for offences committed after 1 July 2019

In February 2019, the Health Practitioner Regulation National Law and Other Legislation Amendment Act 2019 (Qld) was passed by the Queensland Parliament. The amendments included increased penalties and introduced an imprisonment term of up to three years for offences against the National Law. The penalties apply to offences committed after 1 July 2019.

The introduction of an imprisonment term means that some offences will automatically become indictable offences in all states and territories (except Western Australia).

Want more information?

Visit the Board’s website for fact sheets and FAQ resources that help answer common questions about paramedic registration, and professional standards, codes and guidelines.
For employers of paramedics, we have specific information to help you in the Fact sheet: Employer obligations under the National Law.
Lodge an online enquiry form.
For registration enquiries, call 1300 419 495 (from within Australia) or +61 3 9275 9009 (for overseas callers).
Address mail correspondence to: Associate Professor Stephen Gough ASM, Chair, Paramedicine Board of Australia, GPO Box 9958, Melbourne, VIC 3001.