2003-2004: Development of original scopes of practice

Legislative introduction of scopes of practice

Prior to enactment of the Health Practitioners Competence Assurance Act 2003, health professions in New Zealand were not regulated by reference to legislatively required scopes of practice. This form of regulation was created by the Act.

When the Health Practitioners Competence Assurance Bill 2003 (230-2) was reported back to Parliament by the Health Committee, the Committee recorded the concern of submitters that scopes of practice would be narrow and prescriptive, but the Committee clarified that “the intention is that the scopes will be broad”.

Key legislative provisions in the Health Practitioners Competence Assurance Act 2003

The principal purpose of Act, as described in section 3(1), 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”.

Section 11 of the Act required each responsible authority, such as the Psychologists Board, to describe the contents of the profession in terms of 1 or more scopes of practice. These notices are secondary legislation, and needed to be published in the Gazette. Section 11(2) states that a scope of practice may be described in any way the authority thinks fit, including, without limitation, in any 1 or more of the following ways:

• by reference to a name or form of words that is commonly understood by persons who work in the health sector;
• by reference to an area of science or learning;
• by reference to tasks commonly performed; and
• by reference to illnesses or conditions to be diagnosed, treated, or managed.

The Board’s development of scopes of practice for psychology

Consultation – first round

When developing the first scopes of practice for psychologists, the Board consulted psychologists twice (in accordance with its consultation obligation in section 14(2) of the Act). The first consultation paper was released in or around July or August 2003. When releasing it, the Board noted on its website:

“The Board could adopt one general scope for all of Psychology, or could adopt multiple scopes to better define specialty practice. The scopes described in this paper are meant to stimulate thought and discussion about the options available to us.”

The consultation paper records that, initially, the Board had proposed to adopt scopes for:

• Industrial/Organisational;
• Educational and Child;
• Clinical;
• Counselling;
• Academic; and
• Community

The Board also recognised that the Act would require all psychologists registered under the previous Act to continue to be registered under the new Act. The Board said:

“Clarifying which scope(s) Psychologists shall belong to may require some detailed consideration of individual cases. It is therefore proposed that all Psychologists be given a “transitional” scope of practice for one year, and that approval to work within specified scopes of practice be completed in the first year of operation of the HPCA Act”.

It was proposed that:

• the transitional scope would encompass “any practice of Psychology, whether in Industrial/Organisational, Educational & Child, Clinical, Counselling, Academic, Community or any other field”;
• every psychologist registered under the Psychologists Act 1981 would be deemed to be registered with a transitional scope of practice; and
• those “psychologists with a transitional scope of practice, who have a proven track record of working competently within a particular scope but do not have the specified entry qualifications, may be eligible for registration under that scope”, with “mechanisms for determining proven competence [to] be developed before the Act is implemented”.

Consultation – second round

When releasing its second consultation document on proposed scopes in late December, the Board noted on its website that the “feedback to the first discussion paper was both overwhelming and enormously helpful”. It said (emphasis added):

“The Board, (through its Committees), has considered the hundreds of written submissions, the verbal feedback we received at conferences and small group meetings, and the continuing advice of the Psychology HPCA Working Party. We believe the model now being proposed is the best option in terms of its ability to protect the public, and still afford flexibility to ethical practitioners. It has strong similarities to the model used successfully in the medical profession for some years now. We have proposed a developmental approach to implementation, allowing the Board to ‘grow’ the model as time passes and experience is gained.”

In its second consultation paper, the Board said it can be argued that the public encounters the practice of psychology in three main contexts:

1. Practice directed at maintaining and enhancing health, well-being and development.
2. Practice directed at groups, organisations and communities.
3. Practice directed at advancing and communicating the knowledge base of the science.

The Board said there were varying degrees of risk to the public across these domains, and that (emphasis added):

“The challenge for the Board is to ensure that there is adequate room to include all areas of psychology with a degree of risk to the public, whilst also providing protection for the most vulnerable groups in the public.”

The Board continued (emphasis added):

“The Board proposes to implement two main types of scope of practice, a “general” scope and a “vocational” scope. Initially two vocational scopes will be specified. Scopes of practice can be changed easily, and it is expected that other vocational scopes may also be developed in future.

All psychologists will be registered within a general scope, and those working in defined branches of psychology may also hold also hold a relevant vocational scope of practice. Psychologists may have more than one vocational scope of practice, and may change their vocational scope if the Board assesses their qualifications and/or experience as being appropriate for the changed vocational scope. The Board also proposes to introduce a ‘limited” scope to enable it to register psychologists who are undertaking supervised practice for the purpose of achieving full registration.

The Act provides for protection of title. The descriptors “Psychologist”, “Educational and Developmental Psychologist”, and “Clinical Psychologist”, (and any other future vocational scope descriptors), will be able to be used only by those registered with an appropriate scope or practice. This will not preclude others from using related terminology (e.g. “Lecturer in Psychology” will not be affected by the Act).

The Board abandoned the notion of a ‘Transitional’ scope, and described the four scopes mentioned above, as follows:

Scopes of practice notified in the Gazette

The finalised scopes of practice were notified in the Gazette on 9 September 2004. The general ‘Psychologist’ scope, and the two vocational scopes, were described as follows:

It is worth pausing to focus on the actual words of the general scope: “… any psychological service involving the application of psychological knowledge, principles, methods and procedures of understanding, predicting ameliorating or influencing behaviour, affect or cognition“. This wording was intended to be all-encompassing.

Relevance of transitioning psychologists registered under the 1981 Act to the 2003 Act

Under the Psychologists Act 1981 Act, there were various educational pathways to become a psychologist, set out in the Schedule to the Act, but there were no defined scopes. As a registered psychologist, you could practice in any area, as long as you were competent. Competence and accountability requirements were set out in codes of ethics (such as the Psychological Society’s Code of Ethics of 1986 and, later, the Code of Ethics For Psychologists Working in Aotearoa/New Zealand (2002)), not the legislation. (For example, Principle 2.2 of the 2002 code, still in place today, states: ” Psychologists recognise the limits of their own competence and provide only those services for which they are competent, based on their education, training, supervised experience, or appropriate professional experience.”)

Under section 189 of the 2003 Act, persons registered under Psychologists Act 1981 were deemed to be registered under the new Act, and under section 190 of the new Act, the Psychologists Board was “deemed to have authorised the practitioner’s scope of practice”. That scope of practice was deemed to consist of:

• health services of the kind that the practitioner was permitted to perform by virtue of their registration under the 1981 Act; and
• any conditions that had been imposed by or under the 1981 Act on the practitioner’s registration or annual practising certificate or annual licence.

This is relevant because, in dealing with questions of transition from the 1981 Act to the 2003 Act, the Psychologists Board had to deal with the deemed scope of practice for pre-existing registered psychologists. In the absence of legislative scopes under the 1981 Act, it needed to have a scope in place that accommodated all pre-existing psychological services. The approach the Board ultimately took was to say that all psychologists registered under the 1981 Act were deemed to be registered in the ‘Psychologist’ scope of practice (as noted above, it had abandoned its earlier notion of a ‘Transitional’ scope of practice). As the Board noted in its August 2004 newsletter:

“On 18 September 2004, when the Act officially comes into effect, all psychologists registered under the Psychologists Act 1981 will be deemed to be registered under the general “Psychologist” scope of practice. You do not need to re-register under the new Act, or apply for a general scope of practice if you are currently registered.”

This clearly supports the position long explained by the Board, from 2004 to 2021.