Keynote presentation by Stiofan Mac Suibhne at the 2010 AOA annual conference on the development of the New Zealand scope of practice within the NZ legislative framework with a comparison to the Australian legislation

1. Stiofán Mac Suibhne

2. 
Trans Tasman Mutual Recognition Principle

Scope of Practice in Australian NZ
Healthcare Regulation

Scope of Practice Conceptual Framework

Vocational / Extended Scopes of Practice

3. AUSTRALIA
NEW ZEALAND
To provide for the
protection of the public
by ensuring that only
health practitioners
who are suitably
trained and qualified to
practise in a
competent and ethical
manner are registered;
The principal purpose of
this Act is to protect the
health and safety of
members of the public by
providing for
mechanisms to ensure
that health practitioners
are competent and fit to
practise their
professions.

4. Part 1 (9)
This Law does not affect the operation
of an Act of a participating jurisdiction
providing for the application of the
Trans-Tasman mutual recognition
principle to occupations.
Trans-Tasman Occupations Tribunal

5. Section 158
Application of Trans-Tasman Mutual
Recognition Act 1997 Except as otherwise
provided in Schedule 4 of the Trans-Tasman
Mutual Recognition Act 1997, that Act
prevails over this Act
Trans-Tasman Occupations Tribunal

6. The meaning & function of scope of practice is
not given in the Act
Scope of Practice may be inferred from:
•
•
•
•
•
•
General Registration
Endorsements
Specialist Registration
Codes of Practice
Registration standards
Accreditation standards

7. Division 2: Section 35
( 1) Functions of National Boards:
(d) to approve accredited programs of
study as providing qualifications for
registration or endorsement in the health
profession

8. Division 3: Section 39
(2) Subject to subsection (3), a National
Board may also develop, and recommend
to the Ministerial Council, one or more
registration standards about the following:
(b) the scope of practice of health
practitioners registered in the profession.

9. Division 3: Section 39
(3) A registration standard may not be about
a matter for which an accreditation
standard may provide

10. Schedule 1, Part 2, Section 15
Approval of areas of practice for purposes of
endorsement
The Ministerial Council may, on the
recommendation of a National Board, approve
an area of practice in the health profession for
which the Board is established as being an
area of practice for which the registration of a
health practitioner registered in the profession
may be endorsed.

11. Section 11
Authorities must specify scopes of practice
(1) Each authority appointed in respect of a
profession must, by notice published in the
Gazette, describe the contents of the
profession in terms of 1 or more scopes of
practice.

12. Section 12
Qualifications must be prescribed
(1) Each authority must, by notice published in
the Gazette, prescribe the qualification or
qualifications for every scope of practice that
the authority describes under section 11.

16. Global Mobility of Osteopaths: challenges in developing a model for assessment of overseas practitioners based on capability not qualification review
Caroline Stone, D.O.(Hons), MSc(Ost), MEd, Stiofán Mac Suibhne, BSc (Hons) Ost, PGCE, PG DIp Health Sc.

17. Registered osteopaths are primary healthcare practitioners
who facilitate healing through osteopathic assessment,
clinical differential diagnosis and treatment of dysfunctions
of the whole person.
Osteopaths use various, recognised techniques to work with
the body's ability to heal itself, thereby promoting health
and wellbeing.
These osteopathic manipulative techniques are taught in the
core curriculum of accredited courses in osteopathy. The
ultimate responsibility for recognition of practice lies with
the Osteopathic Council of New Zealand.

18.  Osteopathy is a weak brand – we need a USP
 Field of manual medicine is crowded.
 Osteopathy is defined by its philosophy not technique.
 Stakes a claim for Osteopaths and their role in the
healthcare system.
 The formless no scope scope of practice is not serving us well.
 The formless scope or a restricted scope statement is a form
of prohibition.

19.  The Osteopathic Council has a legal duty to specify scopes of
practice.
 No other competent authorities have specified a scope of
practice for the Osteopathic profession.
 Wide ranging review of the scope began in 2007 prompted by
the inadequacy of existing statement. Extensive consultation
processes.
 Concerns that the restricted nature of the statement was
inadvertently placing osteopaths outside of the law.
 Concerns over the representing the diversity of osteopathic
practice in a single scope statement.

20.  Single Scope of Practice is unrealistic.
 Osteopathy is a maturing and diversified profession – needs
to be reflected in vocational scopes.
 No clear relationship between training pathways and
competency in practice: Vocational / Extended Scopes.
 30% of NZ Osteopaths were using needling techniques in
practice without standards / minimum training requirements
being determined.
 ACCORB accreditation standards specify no minimum
requirements for paediatric practice.

21. Western medical acupuncture is a therapeutic modality
involving the insertion of fine needles; it is an
adaptation of Chinese acupuncture using current
knowledge of anatomy, physiology and pathology, and
the principles of evidence based medicine.
WMA has evolved from Chinese acupuncture, its
practitioners no longer adhere to concepts such as
Yin/Yang and circulation of qi, and regard acupuncture
as part of conventional medicine rather than a complete
‘‘alternative medical system’’.
White, A. R. (2009). Western Medical Acupuncture: A definition. Acupuncture in Medicine, ;27, :33–35.

22. Western Medical Acupuncture and Related Needling
Techniques.
Prescribed qualifications:
Post Graduate Certificate Western Medical
Acupuncture – Auckland University of Technology
& University of Herts, UK
British Medical Acupuncture Society’s Code of
Practice adopted.

23.  The changing demographic – Western societies are graying.
 Increased demands on resources means reduced public
sector involvement in direct service provision.
 Reduced doctor time will require maximising the services
delivered in primary care by allied health professionals.
 Need to align the osteopathic scope of practice with the
strategic direction.
 Life long learning. Current trends in tertiary education to
distant / block attendance are favourable for osteopaths.

24. OCNZ Statutory duty to determine scope.
Facilitate leadership on scope issues
Professional Bodies: AOA, BOA, ISOP, OSNZ.
Australian Osteopathic Council
Senior students & faculty from Unitec
NZ Ministry of Health

26.  Additional scopes of practice required to formally recognise
skills acquired in post pre-professional training through postgraduate study.
 Need to reform the pre-professional training pathway and
determine minimum skill set to commence professional life.
 Formal training ought not to stop at the point of
registration. Externally recognised hierarchy of knowledge
 Public register ought to allow patients / third party refers to
identify practitioners with advanced standing in certain
areas of practice

27. Advanced standing and post graduate study /
specialisation in areas of practice that remain within the
general scope of practice.
There is a continuum of skills / knowledge from novice
to expert. Pre-professional training prepares
osteopaths to commence practice.
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Child health / Paediatrics
Gerontology
Occupational Health
Pain management
Rehabilitation
Sports injuries

28. An extended scope of practice is required when it is
explicit that pre-professional training does not
prepare a registrant for competent practice. These
areas are excluded from the general scope.
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Western Medical Acupuncture
Osteopath Prescriber
Injection therapies
Advanced Diagnostic Competencies

30. OCNZ has organised a follow up event November
2010
Preliminary report from the PaediatricsCapabilities
Research Project
Vocational scopes:
Gerontology
Pain Management