Update on progress 14 May 2016

1. Countdown to
Paramedic registration
Status – 14 May 2016
@Arban70
https://www.facebook.com/ParamedProf

2. An independent authority registers and controls:
̶ Who enters the profession – i.e. who gets on the register; making
sure that those who are registered are fit and competent - entry
̶ Who stays on the register - ensure those on the register are able
to practice safely and maintain their competence - monitoring
̶ Who is removed from the register - those shown to be lacking
ability or fitness to practice – removal
̶ The outcomes are open to public scrutiny - transparency
How does registration work ?
Registration involves transparency, objectivity & due process

3. The National Registration & Accreditation Scheme (NRAS)
was established under individual jurisdictional legislation to:
− protect the public by ensuring that only suitably trained and qualified
practitioners are registered
− facilitate workforce mobility across Australia
− enable the continuous development of a flexible, responsive and
sustainable Australian health workforce
The NRAS is administered by AHPRA* and a number of
professional regulatory Boards. It provides independent:
− protection of title
− a register of practitioners
− established registration standards
− investigation of complaints
− accreditation of courses
What is NRAS registration ?
*AHPRA - see https://www.ahpra.gov.au/

4. The Regulatory Impact Study for paramedics has undergone
many iterations on the way to its current resolution - with
other regulatory developments also part of the mix
Health Ministers in 2015 agreed to adopt a national Code of
Conduct for unregistered health workers - http://bit.ly/1yS81vA
This would apply to paramedics if not registered
Three states (SA, Tas & NSW) have introduced legislation
protecting the title of ‘paramedic’ but using different legislative
frameworks: in SA – the NRAS; in Tas – the Ambulance
Service Act; and in NSW – the Health Services Act
Separately, Senator Glenn Lazarus secured support for an
Inquiry into paramedic registration on 20 August 2015
http://on.fb.me/1PqdSvx - see 15 submissions bit.ly/1PHnjrP
The regulatory journey 1

5. Paramedic registration under the NRAS was supported by all
states & territories except NSW at the COAG meeting on 7
August 2015 – but delayed - see http://bit.ly/1Nee6VE
Health Ministers on 6 Nov 2015 agreed to support registration
under NRAS with jurisdictions able to ‘opt-in’. NSW has
reserved its decision but other jurisdictions have declared
their intention to participate – see http://on.fb.me/1NYNskM
Victoria’s Department of Health & Human Services (DHHS) is
the responsible lead agency for progressing the paramedic
registration project - see on.fb.me/1oszXBU
The NSW Health Services Amendment (Paramedics) Bill 2015
for protection of paramedic title came into effect on 1 February
2016 – see http://on.fb.me/1O0wnZg
The regulatory journey 2

6. Consultation with selected stakeholders is being undertaken to
develop the ‘roadmap’ for registration, necessary legislative
changes and relevant AHPRA mechanisms
These steps will include establishment of a regulatory Board
which in turn normally determines registration standards
To facilitate this process the Victorian DHHS team is obtaining
advice from government agencies and an invited stakeholder
Reference Group
Concurrently, changes are being introduced to the NRAS itself
following a Review – see http://bit.ly/1PVs3vv
The Ministerial Council will need to approve the developments
(section 12) involving jurisdictional legislation and other steps
– with implementation planned for September 2018
The current status 1 (14 May 2016)

7. The first meeting of the Reference Group was held on 4 April
2016 and a general information Bulletin issued - see
http://ow.ly/LqKG300avuW
The Senate Legal & Constitutional Affairs References
Committee examining the national registration of paramedics
also held a public hearing in Canberra on 20 April 2016 – see
http://bit.ly/1SnpWOI
The Senate Committee released its Final Report on 9 May
2016 fully supporting national registration under the NRAS
and recommending that all jurisdictions participate, including
NSW – see http://bit.ly/1TOe7DL
The second meeting of the DHHS team with the Reference
Group is scheduled for the week of 16 May 2016
The current status 2 (14 May 2016)

8. The DHHS paramedic registration project team can be
contacted as follows:
Meredith Carter
Manager Legislative Reform Projects, Workforce Regulation
Victorian Department of Health and Human Services
Phone: 03 9096 1852
Email: Meredith.Carter@dhhs.vic.gov.au
or
Anne-Louise Carlton
Manager, Workforce Regulation
Victorian Department of Health and Human Services
Phone: 03 9096 7610
Email: Anne-Louise.Carlton@dhhs.vic.gov.au
Further details

9. For additional information on regulatory and general matters
affecting paramedicine follow Twitter on @Arban70 or The
Paramedic Observer https://www.facebook.com/ParamedProf
Information on paramedic practice is also available on the
websites and social media channels of (in alpha order):
─ Australian and New Zealand College of Paramedicine (ANZCP)
─ Australian Paramedics Association (various jurisdictions)
─ Council of Ambulance Authorities (CAA)
─ National Council of Ambulance Unions (NCAU)
─ Paramedics Australasia - also see their dedicated ‘registration’ channels
Twitter @ParaRegAU and Facebook http://bit.ly/1MCfS0d
─ Private Paramedicine Australia (PPA) http://on.fb.me/1OSq0Uq
A summary of some issues involved in registration follows
Other information

10. Amendments to
National Law
(enabling steps in
recognition as a
discrete field of
professional
health care)
Basic name of practitioner 5 Paramedic
Establishment and name of
National Board
31 Paramedicine Board of Australia
Title(s) to be protected 113 Paramedic as an additional listed health
professional under the NRAS
Exemptions (to cater for
possible ‘holding out’ offences
and common usage/signage)
116 Suggest enable ADF use of ‘medic’
terminology and proper names for
providers (review status of students and
interns with potential ‘mixed’ titles)
Divisions of the register 222 None - no differentiation within profession
(treat NSW & NZ as external jurisdictions)
Commencement date 250 Subject to legislative progress, National
Board appointment & registration
decisions – plan nominally 1 Sept 2018
Some likely steps in processes towards NRAS registration
Phase Issue Section Indicative Policy Position
What needs determination 1 ?

11. Establishment of
the National Board
and subsidiary
units
Size & composition of Board
(Existing legislation provides
guidance - including regional /
rural representation &
practitioner members to be
from participating jurisdictions)
See also discussion including
potential NRAS amendments
at: http://bit.ly/1VBdfWB
Section
5
33, 34
Proceed with enabling legislation for a
single Board that is representative of
stakeholders including for example:
8 practitioner members
- 6 members with skills and experience
in State and Territory public sector
paramedic practice (sector role)
- Minimum 2 members with skills and
experience in paramedic practice outside
the State and Territory public agencies
- Minimum 2-3 community members
Board members appointed
after public call for
nominations
33, 34 Nominations to be called across key
groups following initial enabling
legislative changes
State & Territory Boards 36 National Board to determine (apply
existing NRAS provisions)
What needs determination 2 ?
Some likely steps in processes towards NRAS registration
Phase Issue Section Indicative Policy Position

12. Accreditation
functions
Establishment of an
independent accreditation
body meeting the
requirements of best practice
under the national scheme
(practitioners may work in
private sector as well as
public - so CAA is not long
term representative)
43, 44,
301
Support creation of new independent
accreditation entity drawing on the CAA
administered work to date, including
retention of current status of programs
National Board to determine with a
formal transition agreement resulting in
establishment of new entity.
Determine whether external
entity or Board committee
43, 44 Best practice supports an external
accreditation entity (possibly sharing
administrative resources with other
similar entities in the national scheme)
Accreditation standards 46, 47
et seq
Board determination in conjunction with
accreditation entity
Some likely steps in processes towards NRAS registration
Phase Issue Section Indicative Policy Position?
What needs determination 3 ?

13. Registration issues
and standards
Should there be specialist
recognition?
13 Not for basic registration – single register
Restricted acts or practices
(protection)
121-
123A
No practices have been raised as being
exclusive to paramedic practice (currently
only dental, optical, spinal manipulation
and birthing practices are protected)
Should there be an
endorsement for scheduled
medicines?
14, 94 Board determination. Could be later –
see work by HWA on HPPP
http://bit.ly/1Oum3WG
Should there be
endorsements for areas of
practice?
15 Board determination - may reflect
additional training & experience. ICP &
ECP endorsements might parallel nurse
practitioners & midwives, and be carried
across from beginning of registration
Responses to registration
Some likely steps in processes towards NRAS registration
Phase Issue Section Indicative Policy Position?
What needs determination 4 ?

14. Registration
standards
(some are largely
common with
other professions)
See also
http://bit.ly/1jZChif
Professional indemnity
insurance standard
38 (1)(a) Board determination – see AHPRA and
especially read http://bit.ly/253zz0c
Criminal history standard 38 (1)(b) Board determination – based on AHPRA
precedents
Continuing Professional
Development (CPD) standard
38 (1)(c) Board determination following
consultation – not in legislation
English language skills
standard
38 (1)(d) Board determination – see AHPRA
precedents / commonality
Recency of practice standard 38 (1)(e) Board determination - see AHPRA
precedents such as nursing (minimum
period of practice within last 5-years)
Responses to registration
Some likely steps in processes towards NRAS registration
Phase Issue Section Indicative Policy Position?
What needs determination 5 ?

15. Eligibility for
registration
(the basic principle
to follow is for
decisions to be
made objectively by
a National Board –
to maintain public &
professional
confidence, there
should be no direct
Ministerial
involvement in
professional issues)
Eligibility for registration
including any supervised
practice and internship
requirements
52 - 56 Board decision during initial / foundation
consultation activities
Grand parenting
provisions - see AHPRA
precedents
53, 303 Board determination – a 3 year period
should be appropriate – keep standard
provisions already in NRAS – but also see
http://bit.ly/1NV4ZKI
Eligibility for
endorsements of
registration
124(3)(b)
225 (m)
225 (n)
Board determination - with inclusion for
those already carrying particular
skills/designations
Student registration - to
commence during course
(note internships impact)
229 - 230 Board determination following consultation
– base on patient contact and precedents
which provide guidance
Responses to registration
Some likely steps in processes towards NRAS registration
Phase Issue Section Indicative Policy Position?
What needs determination 6 ?

16. Other
organisational
responses
Enabling of cross border
practice under different
regulatory regimes (e.g. in
event NSW is not a
participating jurisdiction)
NRAS Contingent enabling legislation to allow
limited & specific emergency practice
across borders based on nominated/
principal place of practice (note national
providers and ADF provisions) Facilitate
MoU arrangements between providers from
both public and private sectors. Provide for
mandatory application of cross border
prohibitions & practice conditions
Society professional roles in
a registered practitioner
environment
Society roles may include provision of
accredited CPD and other member
services
CPD development – role /
accreditation
CPD programs to meet external
accreditation requirements
Professions / providers must be able to
support their offerings as meeting
accreditation under NRAS
Responses to registration
Some likely steps in processes towards NRAS registration
Phase Issue Section Indicative Policy Position?
What needs determination 7 ?