In accordance with the authority established in section 24 of the Health Professions Act, the Health Professions Council is hereby directed to review the scope of practice and the legislative framework for all recognized health professions and to consider the following matters in accordance with the Criteria and Guidelines (Schedule A).

1. How should the existing scope of practice for the health profession be legislatively defined in order to reflect fairly and accurately the current state of practice in that field of health care and reflect the public interest in the practice of the profession?

2. Should any of the tasks or services performed by the health profession be considered "reserved acts" exclusive to that health profession (or jointly with other related professions) because of the risk of harm involved to the health, safety or well-being of the public?

2.1 Which of the reserved acts, or aspects of the reserved acts, may be performed by persons supervised by practitioners, and under what terms and conditions?

3. Do the titles reserved exclusively for the health profession adequately serve the public?

4. Would designation of the health profession under the Health Professions Act be in the public interest or are there unique features of the health profession, or other relevant factors, that justify a continuing need for a separate Act?

5. What amendments, if any, are required to the current Act, rules, regulations and bylaws for each profession to adequately provide for the regulation of the profession in the public interest and to ensure they contain the core principles of professional regulation reflected in the Health Professions Act and discussed in Schedule B?

The statutes to be examined are listed in Schedule C together with specific directions about priority reviews.

SCHEDULE A - CRITERIA AND GUIDELINES

1. How should the existing scope of practice for the health profession be legislatively defined in order to reflect fairly and accurately the current state of practice in that field of health care and reflect the public interest in the practice of the profession?

• The current definition may require expansion and updating to reflect academic/scientific advancements in the practice of the profession and in related professions.

• A concise legislative definition of the tasks and services appropriately delivered by registrants is required. This should include any limits on the scope of practice that may be necessary for public protection and may involve limits on a class or classes of registrants who have different skills and abilities than other registrants.

• An aspect of scope of practice may be shared between two or more discrete health professions.

2. Should any of the tasks or services performed by the health profession be considered "reserved acts" exclusive to that health profession (or jointly with other related professions), because of the risk of harm involved to the health, safety or well-being of the public?

• Where a reserved act is presently conferred on a health profession, the Council will determine if it is necessary to continue that exclusivity for reasons of public protection, in view of the desirability of maximizing consumer choice and limiting cost of health care services.

• Only those tasks and services involving a significant risk of harm should be reserved exclusively for members of that health profession.

• A reserved act may be conferred on more than one profession where the Health Professions Council is satisfied that it is an appropriate aspect of the scope of practice of each profession.

• Although reserved acts may only be performed by certain professions, it may be appropriate for other persons to perform them, or aspects of them, under the supervision of members of those professions.

• Where the Council is satisfied that a reserved act, or an aspect of it, may be performed by another person under the supervision of a practitioner, it will recommend the terms and conditions under which it may be performed, including but not limited to,

• whether it should only be performed by a person having certain training or qualifications,

• whether its performance should be limited to specific locations such as a hospital, or

• the degree of direct or indirect supervision which should be exercised.

3. Do the titles reserved exclusively for the health profession adequately serve the public?

• The reserved title must adequately serve the public in describing the practitioner and the services which are being provided.

• The title must adequately distinguish professional members from others performing similar services outside the jurisdiction of the college.

4. Would designation of the health profession under the Health Professions Act be in the public interest or are there unique features of the health profession, or other relevant factors, that justify a continuing need for a separate Act?

• Where the profession favours designation, and designation would be in the public interest, the Council may -- following its review of scope of practice -- forego the legislative review and recommend the form of a regulation for designation of the profession under the Health Professions Act.

• Where a profession expresses a preference for retention of a statute, the Council should consider these factors:

• Does the degree of complexity in operating the existing college make it difficult to convert to the regulatory scheme established under the Health Professions Act?

• Is more than one health profession regulated by the same college? If so, would separation of the regulatory responsibilities be desirable because of the difficulties experienced with the existing scheme?

• Is the current Act so flawed that it needs to be repealed and replaced or are only minor amendments required?

• Is it likely that a new Act for the health profession would closely resemble the Health Professions Act?

• A high degree of consistency between statutes is essential to reflect the minimum regulatory requirements that apply equally to all health professions.

• It would be desirable to minimize the number of statutes that apply to the governance of health professions in order to facilitate statutory amendments as required from time to time.

5. What amendments, if any, are required to the current Act, rules, regulations, and bylaws to adequately provide for the regulation of the profession in the public interest and ensure they contain the core principles of professional regulation reflected in the Health Professions Act and discussed in Schedule B?

• The Health Professions Act embodies those core principles of professional regulation which the Ministry considers are desirable or essential, for a profession to be effectively regulated in the public interest.

• The Health Professions Act should be considered the standard or template of professional legislation -- it sets out the relevant matters which should be included in a professions statute and provides appropriate bylaw-making authority for those which should be contained in ancillary legislation. Where membership in a professional association is compulsory, the bylaws of that association should also be considered.

• Each health profession's legislation should be compared with the Health Professions Act, with a view to identifying those provisions which are inadequate, incomplete or missing -- as well as those which do not serve the public interest.

• Regulation of Emergency Medical Assistants under the Health Emergency Act should be reviewed with particular regard to the role of the Emergency Health Services Commission and to the terms of the collective agreement.

• The review will require close scrutiny of the five essential core principles of effective professional regulation set out in Schedule B.

Review Process

• It is anticipated that the scope of practice / legislative review will include a consultation process with affected stakeholders.

• The Terms of Reference and information regarding the progress of the review will be circulated in the Health Professions Bulletin of the Legislation and Professional Regulation Division of the Ministry.

• The Council has been requested to deal with the following three statutes first for the reasons noted:
  • Optometrists Act -- the profession has been asking for an expansion of its scope of practice for some time.

  • Naturopaths Act-- the profession has been seeking approval of a pharmacopoeia for some time and the Act requires updating.

  • Dentists Act -- there is a need to examine issues respecting the appropriate governance structure for the College of Dental Surgeons.

SCHEDULE B - CORE PRINCIPLES

Mandate of the regulatory body

• The mandate for health professions has been defined in section 15.1 of the Health Professions Act (and has been replicated in each of the other profession statutes).

• Legislative provisions -- including provisions found in regulations, rules and bylaws -- which are outside of those enumerated duties and objects should serve the public interest.

• Barriers to inter-disciplinary practice are not generally in the public interest. The public interest is best served when all related health professions work together collaboratively to maximize the quality and choice of services for the consumer in any field of health care.

• Activities of a regulatory body to promote the economic, political, and professional interests of its members must not compromise the ability of the regulatory body to regulate the profession in the public interest.

Registration requirements for entry into the profession

• Principles of administrative law, including natural justice and fairness, must be reflected in the admissions criteria and application process for both new graduates of accredited educational programs and foreign-trained practitioners.

• There must be objective requirements for registration and for accreditation of education programs.

• Applicants should have appropriate rights of appeal of decisions affecting their ability to register.

• There should be effective mechanisms for monitoring the continuing competency of practitioners, including the ability to set mandatory continuing education requirements.

• A committee of the board should be responsible for reviewing the standards of practice and code of ethics and circulating new practice guidelines and bulletins to members.

Complaint and disciplinary processes

• The principles of administrative law, including natural justice and fairness, should be respected within the regulatory scheme for the handling and disposition of complaints.

• Penalties should be adequate to protect the public.

• Rights of appeal -- whether internal or to the courts -- of decisions following a hearing and decisions not to proceed to a hearing must be available to the complainant and the practitioner.

There should be a requirement for Government approval of rules or bylaws.

SCHEDULE C - HEALTH PROFESSIONS STATUTES

* Scope of practice review only. Pharmacists, Pharmacy Operations and Drug Scheduling Act was only recently enacted (1993) and reflects the unique features of the practice of pharmacy. The Physiotherapists Act has been repealed in favour of the designations of physical therapy and massage therapy under the Health Professions Act. The Nurses (Licensed Practical) Act is also to be repealed in favour of the designation of licensed practical nursing under the Health Professions Act.

The Dental Technicians and Denturists Act and the Hearing Aid Act are not included because of applications submitted to the Health Professions Council by practitioners regulated under these Acts.