2008: Board consultation paper on scopes

The consultation paper

In April 2008, the Board issued a consultation paper for a review of the scopes of practice.

The cover letter to the consultation paper from the Board introduced the rationale for the consultation as follows:

The passing of the HPCA Act (2003) required regulatory authorities to describe the contents of the profession in terms of one or more scopes of practice. The Act states scopes may be described by reference to titles that are commonly understood by persons working in the health sector, by reference to an area of science or learning, and by reference to tasks commonly performed or illnesses or conditions to be diagnosed, treated, or managed. Regulatory authorities are also required to publish the necessary qualification or qualifications for any prescribed scope.

Health practitioners will have observed that regulatory authorities subsequently took a range of approaches regarding scopes. Some prescribed a single scope of practice, while others took the step of prescribing general scopes in addition to a range of vocational scopes. After considerable deliberation, in September 2004 the New Zealand Psychologists Board specified five scopes of practice: three general scopes of “Psychologist”, “Intern Psychologist” and “Trainee Psychologist”; and two vocational scopes of “Clinical Psychologist” and “Educational Psychologist”.

In the intervening three years, the Board has received a relatively steady flow of informal and formal feedback about scopes. This feedback has included diverse opinions about how well current scopes add greater protection to the public.

Coinciding with the Ministry of Health’s current review of the HPCA Act, the Psychologists Board has decided to review scopes of practice. This review includes distribution of a consultation paper and an invitation for stakeholders to make formal submissions.

The consultation paper set out a range of questions, and contained commentary by the Board for consultees to consider.

The paper contained a number of statements by the Board which were consistent with the Board’s earlier communications as to how the scopes were intended and needed to be applied. For example:

• In the context of the question “Are the existing scopes essential for public protection?”, the Board said:

“There is some feedback (gathered anecdotally) that employers find the scopes useful as a broad classification system that helps them match employment scenarios with skills/qualifications required. Indications from registration applicants indicates that contractors such as the Family Court and Accident Compensation Corporation may also use the vocational scopes to help sift out preferred providers, although the Board has been assured that is not the case.

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The arguments that the vocational scopes are not essential for public protection are:

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• • That the title is redundant as both prior to and since the introduction of scopes the Board and the client have relied on the individual practitioner to state whether or not they deem themselves competent to practise in a particular area.
• In the context of the question “Do scopes of practice unnecessarily restrict some areas of practice?”, the Board said:

The operational policy on scopes has not included any restriction on practice imposed on those without that scope. Any restrictions arise from the limits of a practitioner’s competence.

Those against the use of vocational scope titles consider scopes may create boundary disputes, fragmentation and “silo thinking”.

• In the context of the question “Do you perceive restrictions imposed by having vocational scopes? If yes, is this a cause for concern?”, the Board said:

Stakeholders such as employers and contractors may use the scope title as a tool for selection and therefore restrict the practice of those without that title. Anecdotal evidence has informed the Board that employment and provider selection by scope has had a deleterious impact on the practitioners who do not have that title. Some who are in this position have made submissions that they have safely practised within that domain of practice for some years, and some point out apparent anomalies where those with similar qualifications and experience to their own may have the scope. According to the HPCA Act and to the fairness expected in administrative law, the Board has an obligation to not impose unnecessarily restrictive mechanisms unless there are important reasons for doing so.

Competing views of NZCCP and NZPS

According to the Board’s newsletter from August 2008, the Board received approximately 220 submissions in response to the consultation paper.

The New Zealand College of Clinical Psychologists (NZCCP) and the New Zealand Psychological Society (NZPS) were among those who made submissions. It is clear from their submissions that they held different views on the need for and merits/demerits of the vocational scopes. In a nutshell, the NZCCP disagreed with the Board’s approach to scopes, while NZPS argued that the vocational scopes were unnecessary, created confusion, and fostered elitism and patch protection.

Outcome

After considering the large volume of submissions received, on 21 August 2009 the Board decided to retain the scopes of practice as then currently gazetted.