RACS has opposed the introduction of the PA scope of practice in Aotearoa New Zealand. Given the government’s decision to regulate PAs and allocation of responsibility to MCNZ, we contributed to design of the draft regulatory framework alongside doctors, physician associates, unions, consumers, and other health sector organisations. Our submission from the Chair of the AoNZ National Committee supported the overall framework of the proposed provisional and general scopes of practice, the qualifications and registration pathways, supervision requirements, and expectations around cultural safety and equity in healthcare delivery.
However, we expressed concern at the possibility of scope creep which would put patient safety at risk and could displace vocational trainees from essential training opportunities. We recommended a more prescribed scope for PAs, with explicit inclusion and exclusion of activities delivered by PAs across the framework. We would like to see tighter supervision requirements so the supervising vocationally registered doctor can prioritise the supervision of trainees in their own vocational scope over supervision of PAs; ensuring the supervision of PAs does not place unsafe workloads on already overstretched doctors; and under no circumstances is supervision of PAs assigned or transferred to doctors in training. We recommended taking the step up from provisional to general scope should be dependent on demonstrating competence, skills, knowledge, and expertise in all areas of practice, not be time-based.
Culturally safe practice is essential for patient trust, equity, and quality of care. Given all PAs initially practising in Aotearoa New Zealand will have trained overseas, we recommended greater emphasis on training in cultural safety and hauora Māori and demonstrated cultural competence. Cultural safety must be recognised as a system responsibility, not an informal training burden to be shifted onto other members of the medical workforce.
RACS prefers the professional title Clinical Assistant, prioritising patient safety and understanding over the preferences of the small current PA workforce.
We collaborated in and endorsed a submission from the New Zealand Council of Medical Colleges.