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On 21 June 2011 the Health Practitioners Disciplinary Tribunal considered three charges laid by a Professional Conduct Committee appointed by the Optometrists and Dispensing Opticians Board against Mr Forum Patel.
The first two charges related to Mr Patel practising as an optometrist without holding a current practising certificate and the third charge related to Mr Patel making an incorrect and careless declaration on an application for an annual practising certificate (APC).
Mr Patel did not dispute the first two charges and the Tribunal found that the charges were established and warranted a finding under section 100(1)(d) of the Health Practitioners Competence Assurance Act 2003.
Mr Patel accepted the established facts of the third charge but disputed that they were sufficiently serious to warrant disciplinary sanction. The Tribunal, however, considered that Mr Patel had a responsibility to ensure the information given was correct considering the importance of the document and the considerable lengths the Board had gone in reminding practitioners including Mr Patel, of the obligation to maintain a current APC. The Tribunal found the charge established as one of professional misconduct, bringing discredit to the profession.
Mr Patel was censured and ordered to pay a fine of $6,250, and an award of costs totalling $8,000. The Tribunal also directed that a copy of the decision or summary of it be published on the Tribunal's website and on the website of the Optometrists and Dispensing Opticians Board.
The full decision of the Tribunal can be viewed here.
In its June newsletter, the Board sought comments from practitioners on the question of the future of current optometry scopes of practice. We thank all who provided comment, and note that there was a range of views on what optometry will look like in the coming years, and on how the Board should approach the issue.
At its meeting on 29 July 2011, the Board considered the matter, including all submissions received by the due date. The Board also reviewed other relevant information, including Health Workforce New Zealand's Eye Health Workforce Service Review, which outlines the government's expectations of eye health service providers between now and 2020. You can access a copy of that review here. Among other things, this report envisages an increased role for optometrists in primary care, particularly in managing glaucoma, diabetes and age related macular degeneration. Moves are already in place to amend legislation around prescribing rights so that optometrists are able to prescribe more independently.
Based on the information available at this time, it appears to the Board that the optometry profession may be in a transitional phase to a new minimum standard of practice. The Board is comfortable that the current standard of care for safe optometry practice is, at this time, the standard of care required for practice in the Optometrist scope of practice. Following the completion of the DPA recertification programme in March 2010, all currently practising optometrists have the appropriate training to competently practise the profession as it is currently described. Nonetheless it appears that with a rapidly evolving health workforce, that description may be changing and in the future, optometrists who are unable to prescribe medicines may not be able to provide the level of primary care expected by the government and needed by the public. The Board acknowledges that it will be a challenge for it to identify solutions to this problem that are legal, fair and achievable, while ensuring that public health and safety continues to be protected.
The Board has not yet formed a view on how it will proceed with this piece of work, noting that it is a highly complex issue. As a first step it will be discussing this issue with the NZAO, and will undertake some research to assist in identifying possible solutions. The matter will be discussed again at the next Board meeting on 21 October 2011, and the Board hopes to be able to consult with the profession on the situation, and on any possible options to address that situation, late this year.
The Ministry of Health has advised the Board that it will be making changes to the Medicines Act which will allow optometrists to become authorised prescribers instead of designated prescribers. Instead of being limited to a list of approved medicines as is currently the case for TPA optometrists, an authorised prescriber is able to prescribe the medicine best suited to the patient and his/her condition, in line with the practitioner's scope of practice. These changes will take some time to be passed into legislation (currently estimated to take effect late 2012). Over the next year the Board will be working with the Ministry of Health and other relevant parties to ensure that optometrists with a TPA endorsement are ready for the change in their prescribing status. Practitioners will be notified when the changes take effect.
Changes to the Medicines Regulations have also been announced, some of which affect TPA endorsed optometrists. There have been amendments to Regulation 41 which governs the form of a prescription. Changes come into effect on 1 December 2011 and include:
If your prescription data is electronically prepared for printing, you may need to check whether amendments to software systems are needed to ensure compliance with the new Regulation. If you handwrite your prescriptions you will need to take note of the changes required from 1 December.
On 1 September 2011, the Minister of Health gazetted changes to the Board's membership. Although four positions had been advertised, only one appointment was made while the remaining three positions were left vacant. While delighted that Andrew Black has been reappointed for a further three year term, the Board is sad to say goodbye to John McLennan and Caryl Blomkvist. The fourth position was an already vacant dispensing optician position.
John McLennan has served six years on the Board, two of these as Chair. He has led the Board through a major shift in its governance and policy systems which has greatly improved effectiveness and cost efficiency. His strong clinical skills, his political acumen and his calm and measured approach will be greatly missed by the Board.
Caryl Blomkvist has served on the Board as a lay member for three years. With a background in nursing and law, Caryl brought a well informed consumer view to the Board table, asking insightful questions that greatly assisted the Board in clarifying its thinking and reviewing its options. She has served on the Board's Competence Review Committee, Legislation Committee, Registration Committee and Administration Committee.
The Minister's decision has meant that the Board's membership has been reduced from 11 to 8 members, effective from 10 September. The new composition is 4 optometrists, 2 dispensing opticians and 2 lay members (a reduction of one of each member type). This change obviously has implications for the way the Board currently does its work, and we will be discussing this at a strategic planning session in October. Some policy changes may result from these discussions, and we will consult and advise accordingly.
The Board had been aware that some other regulatory authorities were being reduced in size by one or perhaps two members, but it had not been aware that such a significant change was to be made to its composition. We do not expect further reductions in the future as our size is now consistent with most other regulatory authorities. We thank those who submitted applications for membership and strongly encourage those who applied for positions that were not filled to reapply again when vacancies come up next year.
As a result of recent meetings with the Optometry Board of Australia (OBA) and with the Optometry Council of Australia and New Zealand (OCANZ) which runs registration examinations and accredits optometry training institutions on behalf of this Board and the OBA, the Board has identified a technical issue with the current wording for two currently prescribed qualifications for registration in an optometry scope of practice.
The Board proposes to amend the wording of these two qualifications to more clearly reflect the true position with regard to OCANZ's role as an advisory body to the Board, and the Board's role as the decision maker on the prescribing or otherwise of qualifications. When OCANZ conducts an accreditation or reaccreditation of a training institution, it provides a report to the Board with recommendations on whether the qualification should be accredited (or reaccredited). The Board reviews the report, and decides whether to accept OCANZ's recommendation.
Under the current wording of the prescribed qualifications this process is not clearly reflected, and implies that a qualification can be prescribed through OCANZ without the Board's endorsement. Click here to see the proposed revisions to address this issue.
Under section 14 of the HPCAA, the Board must consult on any amendment it makes to prescribed qualifications. Submissions on the proposed changes are invited. The due date for any submission is 5pm on 11 October 2011.
In recent self audits, some practitioners have advised the Board that they are unable to provide a copy of a patient record from their database for audit purposes because their database does not print records in this form. On occasion, the Board receives a printed page with handwritten additions explaining what information has not printed out.
While this is an issue for the Board in conducting its audit processes, it is also an indicator that the practitioner is unable to comply with the requirements of the Privacy Act with regard to release of an individual's personal information to them, upon request. If you are asked by a patient to provide them with a copy of some or all of their record with you, you are legally required to comply with the full extent of their request, and in a timely manner. Failure to do so is a breach of the Privacy Act.
The Board urges all optometrists and dispensing opticians to check their software systems and ensure that their system allows for a complete printout of a patient record. Please also review the Board's Statement on Release and Receipt of Patient Information to ensure you are complying with your legal obligations.
Every quarter, the Ministry of Health provides the Board with information on all dispensed subsidised medicines prescribed by optometrists. The Board analyses this information to assure itself that optometrists with TPA endorsement are prescribing appropriately. Where anomalous practice is identified, the Board will write to the practitioner seeking their explanation. For example, where an individual has prescribed 20 percent of all prescriptions for a given medicine, the Board seeks information on particulars of their practice or areas of eye care they focus on which may explain such prescribing practices.
The Board is generally impressed with the thoroughness and professionalism of the responses it receives from such practitioners, which indicate that those who are prescribing medicines take this responsibility seriously, and are interested to receive information about their individual prescribing practice.