The Health Practitioners Competence Assurance (HPCA) Act is now law and, despite strenuous opposition from the New Zealand Medical Association (NZMA) and the Association of Salaried Medical Specialists (ASMS), will govern the practice of medicine in New Zealand, possibly for the next 20 years. The 1968 and 1995 Medical Practitioners Acts were both supported by the medical profession; this is the first time both the NZMA and ASMS have withdrawn their support from the principal legislation governing medical practice.

The NZMA believes that the new Act is a missed opportunity for improvements to medical practice and offers no assurance of further benefits to patients. It will increase political influence and bureaucratic involvement in the practice of medicine, with a consequent decrease in professional self-regulation, which has been at the core of the development of safe healthcare for New Zealanders. The organisation of healthcare based on either state or corporate control imposes different goals and values than models structured on professionalism.

Although the basis of the new Act was to have been the 1995 Medical Practitioners Act, accepted by the profession as a modern and effective piece of legislation, cumbersome bureaucratic requirements have been added to the HPCA, together with a seeming determination to increase political control over health practitioners.

After intense lobbying from many health practitioner groups, three important changes were made:

While these changes are welcome, they do not alter the essential nature and direction of the Act, which will introduce untested concepts, undermine self-regulation, make quality assurance a highly bureaucratic process, and allow much greater levels of political interference into professional processes than before.

Self-regulation is a cornerstone of medical practice, but the Minister of Health has removed the medical profession’s right to elect some members to their regulatory authority. We do not see that the provision allowing the profession to nominate members for the Minister of Health’s consideration for appointment to the authority is equivalent to the profession electing its own representatives.

The NZMA recommended that Scopes of Practice be removed from the Bill, or that the Bill be changed to emphasise broad Scopes of Practice and avoid focus on narrow or individual scopes. Although the preamble to the Bill when it returned from the Select Committee talked of broad scopes, the numerous amendments within the Act make it clear that the opportunity exists for narrow, codified descriptions of each individual’s practice to be developed.

The NZMA and ASMS support the Medical Council of New Zealand’s current intention for medical scopes of practice to be broad. However, the NZMA continues to have strong reservations about the effects on scopes of practice of the decisions of future authorities appointed by the Minister of Health, determinations by case law and consequent changes in other statutes. We fear that, with time, these will make scopes of practice more restrictive and task oriented.

Already, we are seeing examples of this. A letter from the Ministry of Health was sent out on 17 September setting out a proposed new regulatory framework for designated prescribers. The proposal states, ‘for each designated scope of practice’ a list of approved medicines would be developed. This, by implication, will codify and limit an individual practitioner’s scope of practice.

This Act brings professional disputes into the political arena, with the Minister of Health as final arbiter of disputes on overlapping scopes of practice. There have always been issues relating to boundaries between the scopes of practice of various health practitioner groups, although we have not previously needed legislation to address them. Sometimes they persist because there may be no right or wrong answer.

The political agendas of governments and good healthcare that rests on medical ethical values do not always coincide. The professions must be autonomous in setting their ethical rules and it is of huge concern that this Act legislates for statutory regulatory authorities appointed by the Government to set ‘standards of ethical conduct’. The recent debate on euthanasia is a prime example of potential conflict between government and medical ethics.

The HPCA Act was assented to on 18 September 2003, with QAA changes coming into effect on 16 October. In three months, all authorities have the ability to gazette their scopes of practice. In the same timeframe, the first round of new applications for groups not currently covered by the Act, but seeking to be recognised as registered health practitioners, will also be considered and gazetted.

Healthcare systems can actively promote professionalism – or they can discourage it. The NZMA believes that the HPCA Act is a backward step for the promotion of professionalism in medicine. We are establishing a monitoring process to assess the effects of the Act on both doctors and their patients so that we will be prepared for the planned review in 2006.

Author information: Tricia Briscoe, Chairman, New Zealand Medical Association

Correspondence: Dr Tricia Briscoe, NZMA, PO Box 156, Wellington. Fax: (04) 471 0838; email: nzma@nzma.org.nz