2023: Psychologists Board’s roadshows

FAQs document

In around mid 2023, the Psychologists Board held a series of roadshows around the country, on a number of topics, including scopes of practice.

During the roadshows, the Board began making comments that stirred alarm in practising psychologists, including those with the ‘Psychologist’ scope of practice. The Board released a document called “FAQs for Psychologists Board roadshow – What is it all about”. Among other things, that document states:

“We will seek changes in the training and structuring of the psychology workforce so that psychology need is met by an appropriate range of competent psychological services.”

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7. What is happening with the scopes of practice?

The scopes of practice have not been substantially reviewed since the Health Practitioners Competence Assurance Act 2003 came into force in September 2004. In addition to the consultation on the new provisional psychologist scope of practice, the Board has begun considering the wording of the existing scopes of practice to ensure they are fit for purpose.

Before we develop this mahi further, we want to hear from the profession about issues with scopes of practice – what needs fixing, clarifying or changing? See Appendix 1 for more background on the issues we see with scopes of practice.

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In Appendix 1 of the document, after setting out relevant parts of the sections 3, 8 and 11 of the Act, the Board stated:

What this means …

Psychologists must only provide psychology services that are included in the scope of practice they are registered in. If there are tasks, services or activities defined in another scope of practice, they must not do those things.

While the intention of scopes of practice is to protect the public by making it clear to practitioners the limits of their practice, the current wording for psychology scopes is broad and with much overlap. The intention of the Act is that scopes are described in such a way that it is clear to the practitioner what they are permitted to do (and therefore what they are not permitted to do).

Problems with these statements

For some psychologists, it was these statements, together with assertions made by Board staff during the roadshow sessions themselves, that got the alarm bells ringing.

There are at least two problems with these statements. First, it incorrect to say the scopes of practice have not been substantially reviewed since September 2004. The Board reviewed the scopes in 2008. In its August 2008 newsletter, the Board said: “There has been an excellent response to the consultation with stakeholders to review the Board’s use of scopes of practice. Approximately 220 submissions have been received, including some from groups and organisations. Although most of the submissions have been from psychologists, there has also been interest from other stakeholders who may potentially be affected by any changes, such as DHBs, Government Departments and also GPs in PHOs.”

Second, and importantly, the statement – “If there are tasks, services or activities defined in another scope of practice, they must not do those things” – is, given the way the psychology scopes were developed and applied, incorrect. The statement assumes:

• that the scopes of practice are siloed, in the sense that reference to an activity in one scope (usually a vocational scope) prevents psychologists with another scope (whether general or another vocational scope) from undertaking the same activity, regardless of competence; and/or
• there is no overlap between scopes; and/or
• once an activity becomes the subject of a vocational scope, practitioners with other pre-existing scopes (whether general or another vocational scope) are prevented from undertaking the same activity, regardless of competence.

For the following reasons, these assumptions are incorrect:

• Given the way that the general scope of practice was both described in the notice in the Gazette (which all psychologists have or are deemed to have), and clearly intended to apply, psychologists with the general scope of practice can undertake an activity within a vocational scope, and a psychologist with one vocational scope (e.g., clinical or educational) can undertake work described in another vocational scope (e.g., neuropsych or clinical) but only if they are competent to do so. What psychologists who are not registered in a particular vocational scope cannot do, is use the title of that vocational scope because that title is reserved for psychologists registered with that scope, and the purpose of that is to enable people to know that the psychologist’s university training has prepared them for that activity (whereas other psychologists may need to undertake additional training or have further supervised experience). For over 15 years, the Board had been abundantly clear about this.
• Given the Board’s approach to describing the scopes, it is undeniable that there is overlap between the scopes. Indeed, the Board itself has already recognised this expressly. For example, in the Roadshow FAQs document, the Board noted that “the current wording for psychology scopes is broad and with much overlap”.
• It is not the case that, once an activity becomes the subject of a vocational scope, practitioners with other pre-existing scopes (whether general or another vocational scope) are prevented from undertaking the same activity, regardless of competence. The New Zealand College of Clinical Psychologists considered and addressed this issue fairly recently upon the gazetting of the Neuropsychology scope of practice. Its then President, Malcolm Stewart, wrote in the Spring 2019 edition of the College’s ShrinkRAP newsletter:

The Neuropsychologist SOP is designed for people who are practising neuropsychology at a high level, as evidenced by the requirements which include high level qualifications specifically in neuropsychology and/or extensive recent experience specifically in neuropsychological practice. There are also extensive additional core competencies that have been defined for the Neuropsychological SOP that go well beyond what a clinical psychologist would generally obtain in the course of their pre-qualification training, and would only acquire later if neuropsychology was a large part of their practice. Many of the people in New Zealand who are functioning at this level are clinical psychologists, but the majority of clinical psychologists are not functioning at this level.

But what does this mean for clinical psychologists who do some cognitive and neuropsychological assessment but not to the level of obtaining the Neuropsychologist SOP? Are they unable to undertake cognitive or neuropsychological assessments if they don’t have the Neuropsychologist SOP. The short answer is they are still able to undertake neuropsychological assessments as long as they are working within their competencies.

You will remember that the areas in which we can ethically practise are primarily determined by what we are competent to do and have maintained competence in.

• Note also that, when the Board was consulting on the neuropsychologist scope in 2016, it said this in its second stage consultation paper:

1. Should a scope of practice for Neuropsychology be established?

After carefully considering this question and the very thoughtful input received in the first round of consultation, the Board has decided that a scope for neuropsychology will be established as it would serve to better protect the public. A clear majority (71%) of those who made submissions on this question supported its establishment. Many of those who thought the scope should not be established were concerned that the scope would stop competent practitioners from practising in neuropsychology and reduce the public’s access to such services. It is important to remember, however, that:

“A vocational scope of practice does not “fence off” any area of practice. It only protects use of the scope’s title. A psychologist can perform any activity within the all-encompassing (“Psychologist”) scope of practice, as long as they are demonstrably competent to do so, or are doing so under appropriate supervision (for example when training in a new area of practice). Holding a vocational scope simply provides the practitioner with the additional right to use that scope’s title, and thereby clearly and simply signals to the public (or an employer) their competence in that scope. In short, practice is not restricted by scope, but by competence. Only title use is restricted by scope. All psychologists are ethically and legally bound to practise only within the bounds of their competence.”

The key to understanding

The key to understanding why the statements and their assumptions are incorrect is to understand that the general scope is “all-encompassing” (a term the Board itself has used many times of the years), and that all fully registered psychologists have or are deemed to have the general scope. For further details, see Why we believe the Board is incorrect.