Update on the regulatory framework for PAs in Aotearoa 
Te Kaunihera Rata o Aotearoa | Medical Council of New Zealand (MCNZ) has approved the scope of practice, pathways to registration, and supervision framework for Physician Assistants (PAs). 

Responsibility for providing a professional title for PAs sits with the Minister of Health. The minister has confirmed the title as physician associate(s). In response, the Chair of the AoNZ National Committee wrote to the minister saying we consider this title creates a risk to patients who may wrongly understand and trust they are being treated by a doctor. We suggested the title Clinical Assistant would avoid confusion for patients and make it as clear as possible these practitioners are not physicians, nurses or doctors. At a minimum the title should include Assistant, not Associate. This would prioritise patient safety and understanding over the preferences of the small current Physician Associate workforce. We recommended the minister reverse the decision and adopt the title Clinical Assistant before MCNZ begins registration of this healthcare profession in October 2026.

MCNZ is now consulting on the draft professional standards for PAs. These propose the principles and values of good PA practice and the professional standards expected of PAs working in Aotearoa. 

Our RACS submission said we are pleased to see the emphasis on supervision in the PA scopes of practice. These state a PA may only work under the ‘employer-approved supervision of a doctor registered in a vocational scope of practice that is relevant to the practice setting and the [PA’s] role’ with requirements regarding credentialling. We would like to see these more explicitly and robustly reflected in the professional standards. We know PAs are currently working in Aotearoa without onsite supervision, so the requirement for onsite supervision will be a significant change for those PAs and their current supervisors. 

We noted situations will arise where there is a risk to patient safety either because a supervising doctor does not meet their responsibilities, or where a PA acts outside of supervision requirements. The standards need to be clear where accountabilities lie in these situations, also what a PA must do when the relationship between the supervisor and the PA breaks down, or where the PA feels unsafe with the supervision being provided. Because the PA profession is relatively new to Aotearoa New Zealand, we believe strong emphasis needs to be put onto communication with colleagues and safe handover and transfer of patient care. The strong guidance on these in Good Medical Practice should be duplicated in the standards for PAs. At least initially, all PAs working in New Zealand will be overseas-trained, which requires a high degree of emphasis on ensuring they can establish relationships of trust with Aotearoa New Zealand patients. This includes being aware of cultural diversity and safety, and an expectation they function effectively and respectfully when working with and treating people of different cultural backgrounds. Again, Good Medical Practice contains some excellent guidance for doctors and should be mirrored in the standards for PAs.

Updates on the regulatory framework | Medical Council

Legislation (Definitions of Woman and Man) Amendment Bill (Aotearoa)
RACS contributed to a submission by Te Kaunihera o Ngā Kāreti Rata o Aotearoa – the Council of Medical Colleges (CMC) strongly opposing the legislation (Definitions of Woman and Man) Amendment Bill. We opposed the Bill on the grounds it fails to reflect scientific complexity, will have a negative impact on specific groups of people, and will result in unintended consequences causing harm to patients.

The Bill does not meet its aim of reflecting ‘biological reality’. Biological sex is not a clean binary. It is a complex, multi-dimensional set of characteristics encompassing chromosomal, gonadal, hormonal, and anatomical variation. Intersex traits are a naturally occurring biological phenomenon, estimated at 1.7 per cent of the population. As written, the Bill would impose legal categories on people, which do not reflect their biological reality, identity or lived experience.

The increased rates of depression, anxiety, self-harm, and suicidality experienced by LGBTIQ+ people are explained in significant part by societal responses—by stigma, discrimination, and exclusion. This Bill will add to that stigma and cause further harm to this vulnerable group. 

LGBTIQ+ young people are at an elevated risk of developing a mental health condition and attempting suicide. Different cultures also often have a different view of gender. Concepts such as takatāpui, fa'afafine, and fakaleiti are long standing and culturally embedded. This Bill will further stigmatise and isolate groups jeopardising their ability to get health care in a way that is equitable. The Bill may also have a negative impact on doctors’ ability to provide appropriate care, as sex, gender identity, and lived experience may all be relevant variables that will impact on clinical decision-making. 

Imposing a universal statutory definition across all legislation will create numerous unintended consequences across the health system. The Bill defines 'woman' as 'an adult human biological female' but 'female' as simply 'a human biological female' with no age qualifier. Any legislation usings 'woman' rather than 'female' would exclude biological females below the adult threshold. A key example of where this will cause harm is in relation to the Contraception, Sterilisation and Abortion Act 2020, which uses the term 'woman' to describe who may access abortion services. Under the current Bill, biological females under the age of 20 will no longer be able to access these services. The Bill will prevent trans, and intersex people from being able to access abortion services for the same definitional reasons. 

Females under 20 may no longer be eligible to apply to the court for a declaration of paternity. The partner or spouse of a female under 20 may be unable to access parental leave, because the relevant legislation requires a certificate confirming a 'woman' is pregnant.

The majority of medical colleges in Aotearoa supported the CMC submission. RACS strongly opposes this Bill on the grounds that it fails to reflect scientific complexity, will have a negative impact on specific groups of people, and will result in unintended consequences that may cause harm to patients.

Read submission here

Healthy Futures (Pae Ora) Amendment Act 2026
The Healthy Futures (Pae Ora) Amendment Act 2026 came into effect 9 July 2026, making changes to the previous the Pae Ora (Healthy Futures) Act 2022. The Act’s Purpose is to provide for public funding and provision of services to:
• protect, promote, and improve the health of all New Zealanders
• achieve equity by reducing health disparities among New Zealand’s population groups, in particular for Māori
• build towards healthy futures (pae ora) for all New Zealanders
• ensure that patients get timely access to quality services.

The new Act introduces stronger strategic direction setting and accountability arrangements for Te Whatu Ora. A new Government Policy Statement on Health (GPS) including six health targets must be in place within 18 months. All health entities, including Te Whatu Ora, are required to give effect to health targets. New health strategies and the New Zealand Health Plan must be issued within 24 months. 

RACS and CMC submitted against the original bill. Changes were made to clarify that under the Public Sector Code of Conduct doctors, including those working for working for Te Whatu Ora, do have a right to comment publicly on policies and proposals in areas of their professional expertise. However, the Health Committee went ahead with amendments removing the Crown’s obligations to give effect to Te Tiriti o Waitangi, diminishing the role of Iwi-Māori Partnership Boards, changing the function of the Hauora Māori Advisory Committee, and repealing the health sector principles and the Health Charter.

Read more: 
Patients now the focus of the health system | Beehive.govt.nz
Healthy Futures (Pae Ora) Amendment Act 2026 | New Zealand Legislation

HPCAA Amendment Bill 
The Health Practitioners Competence Assurance Act Amendment Bill is still waiting for a first reading after being introduced to Parliament in May 2026. The Minister of Health has indicated the Bill will be referred to the Health Committee for consideration. The bill makes significant changes to regulation of health professionals, such as:
• making regulators such as Te Kaunihera Rata o Aotearoa |  Medical Council of New Zealand (MCNZ) subject to direction from the Minister of Health on policies, administrative processes, or procedures, although directives cannot be about a particular person or qualification
• creating a new ministerial committee, which can review a decision by MCNZ to refuse a doctor’s registration and certain decisions about scope of practice. 

A ministerial directive could include for example a requirement for MCNZ to accelerate registration of international medical graduates to meet workforce shortages, but not about whether to register an individual doctor or require recognition of a particular qualification. 

We submitted against these changes as foreshadowed in early 2025. The Minister of Health said in September 2026, “The planned amendments to legislation will allow overseas trained health professionals to be registered more quickly and make regulators more accountable.” RACS will make a submission.

Health Practitioners Competence Assurance Act | Ministry of Health NZ