PROFESSIONAL GOVERNANCE

AND MIDWIFERY

Dr Belinda MaierClinical Associate Professor,

Australian Catholic University

Maier.Belinda@yahoo.com.auPresented 2011/12

“I would like to respectfully acknowledge the Traditional Custodians of the land on which we meet today and Elders both past andpresent.”

National Registration Authority Scheme - NRAS

Australian Health Practitioners Registration Authority - AHPRA

Nurses and Midwives Board Australia - NMBA

Australian Nursing and Midwifery Accreditation Council - ANMAC

AMENDED/ ENABLED ACTS TO ENABLE ACCESS:

The Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009

Health Insurance Act 1973 for MBS access

National Health Act 1953 for PBS access National Health (Pharmaceutical

Benefits) Regulations 1960 Health Insurance (midwife and nurse

practitioner) Determination 2010 Queensland Legislation - Health (Drugs

and Poisons) Regulation 1996. Collaborative arrangements for

MBS/PBS: National Health (Collaborative

arrangements for nurse practitioners) Determination 2010.

National Health (Collaborative arrangements for eligible midwives) Determination 2010.

MATERNITY REFORM – STATEWIDE AND NATIONAL March 2005 Re-Birthing: Report of the

Review of Maternity Services in Queensland. Cherrell Hirst AO

2009 National Maternity Services review: Improving Maternity Services in Australia: The Report of the Maternity Services Review

Health Practitioner Regulation National Law 2009

Health legislation Amendment (Midwives and Nurse Practitioners) Bill 2009.

Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009

Care is safe and feels safe Care is open and honest Care is local and feels local Care is integrated Care belongs to consumers Carers work together and

communicate

Office of the Chief Nursing OfficerMidwifery

BackgroundFollowing Re-Birthing the review of Maternity

Services in Queensland 2005, the position of Midwifery Advisor was created in the Office of the Chief Nursing Officer.

NATIONAL REGISTRATION AUTHORITY SCHEME

NRAS

HEALTH PRACTITIONER REGULATION NATIONAL LAW 2009 National Registration and accreditation for

Chiropractic, Dental, medicine, Nursing and Midwifery, Optometry, Osteopathy, Pharmacy, Physiotherapy, Podiatry, Psychology and from 2012; Aboriginal and Torres Strait Islander Health Practice,

Chinese medicine and Medical radiation Practice. Mandatory reporting of registrants Demonstration of continuing practice development

and recency of practice National boards with the power to delegate all board

decisions Criminal history and identity checks Simplified complaints arrangements for the public Student registration Handling of complaints

The intent of NRAS is national registration aligning all professional bodies with particular professional requirements

Statutes are also known as ‘Acts’ of Parliament.

A ‘Bill’ is drafted and introduced into Parliament. Then it is ‘read’ 3 times, amended as necessary, before being passed by both houses of Parliament

(In QLD there is only one house) It then becomes known as the Act.

Health legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009.

PLUS’ One registration fee professional development mandated Australian registration Standardisation of professional

competencies across Australia Mandatory criminal checks and

reporting - better for us better for our clients/patients

MINUS’ Indemnity Insurance for midwives –

excludes birth at home Collaboration requirements – written

requirements with a medical practitioner or kind or kinds…

Eligibility criteria for Midwives and Nurse Practitioners to access MBS PBS

HEALTH LEGISLATION AMENDMENT (MIDWIVES AND NURSE PRACTITIONERS) BILL 2009

To enable midwives to have access to MBS and PBS

Must be eligible – therefore must meet registration criteria, show collaborative arrangements and have or be exempt from Private Indemnity Insurance

MIDWIFE PROFESSIONAL INDEMNITY (COMMONWEALTH CONTRIBUTION) SCHEME BILL 2009

Purpose of the Bill is to allow the Government to provide for Indemnity Insurance to eligible private practice midwives.

NATIONAL REPORT

The Report makes a series of recommendations in

the key areas of:1. Safety and Quality

2. Access to a Range of Models of Care3. Inequality of Outcomes and Access

4. Information and Support for Women andtheir Families

5. The Maternity Workforce6. Financing Arrangements.

THE NATIONAL MATERNITY SERVICES PLAN

THE PLAN Strategic national framework to guide

policy and programme development across Australia over the next five years

Focus is Primary Services not specialist services

FIVE YEAR VISION Woman centered

Evidence based Continuity of care

Culturally competent “Closing the gap”

PRIORITIESAccess

Service deliveryworkforce

infrastructure

Click icon to add picture

REGISTRATION REQUIREMENTS FOR REGISTERED MIDWIVES

Continuing professional development (CPD)Recency of practiceProfessional Indemnity Insurance (PII)Criminal historyEnglish language skills

REQUIRMENTS FOR ENDORSEMENT AS AN ELIGIBLE MIDWIFECurrent general registration as a midwife in Australia with no restrictions on practice;Midwifery experience that constitutes the equivalent of 3 years full time post initial registration as a midwife;Current competence to provide pregnancy, labour, birth and post natal care to women and their infants;Successful completion of an approved professional practice review program for midwives working across the continuum of midwifery care;20 additional hours per year of continuing professional development relating to the continuum of midwifery care;Formal undertaking to complete within 18 months of recognition as an eligible midwife; or the successful completion of:

i. an accredited and approved program of study determined by the Board to develop midwives’ knowledge andskills in prescribing, orii. a program that is substantially equivalent to such an approved program of study.

Under section 129 (1) of the Health Practitioner Regulation National Law, a health practitioner must not practise the health profession in which the practitioner is registered unless appropriate professional indemnity insurance arrangements are in place. 

OPTIONSMIGAMEDIPROTECT MIGA requires: written collaboration with a named medical

officer OR If collaborative arrangements are unable to

be secured, then a MIGA care plan must be submitted to a maternity facility, by the self employed (private practice) midwife.

that the hospital acknowledge receipt of the care plan.

HOMEBIRTH Exemptions in law until 2013 No insurance available for birth at home Homebirth in itself is not regulated but the

risk is that homebirth attendants are not a registered professional

(3) Schedule 1, item 70, page 22 (line 2), at the end of the definition of authorised midwife, add

“, so far as the eligible midwife provides midwifery treatment in a collaborative arrangement or collaborative arrangements of a kind or kinds specified in a legislative instrument made by the Minister for the purposes of this definition, with one or more medical practitioners of a kind or kinds specified in the legislative instrument”.

[collaborative arrangements]

COLLABORATIVE ARRANGEMENTS …ARE NOT A DIRTY WORD???

NHMRC COLLABORATIVE GUIDANCE

MisconceptionsSupervisory roleLegally responsible for the actions of the midwifeSupport homebirthExtra workExtra on callRealityProfessionalismCollegialityHealthy women and babiesTimely and appropriate access to medical careEffective and timely use of resources

MIDWIFERY ADVISOR PORTFOLIO; NURSING AND MIDWIFERY OFFICE QUEENSLAND

Rural Maternity Initiative

Collaborative Arrangements for Private Practice Midwives

Drug Therapy Protocol - Midwifery

Continuity Models of Care Implementation Guide

Credentialing for midwives

Policy - Breastfeeding Policy - Transfer of a woman and

or infant from a planned home birth to a Qld Health Service

Policy - Clinical Governance for Midwifery Models of Care Policy - Normal Birth

Policy – water immersion in labour Policy – admitting rights for

midwives

DELIVERING CONTINUITY OF MIDWIFERY CARE TO QUEENSLAND WOMEN: A GUIDE TO IMPLEMENTATION

DRUG THERAPY PROTOCOL In 2007 the Health (Drugs

and Poisons) Regulation 1996 was amended to authorise Midwives to:

“the extent necessary to practice midwifery: to obtain, possess, administer or supply a controlled or restricted drug, under a drug therapy protocol.”

The HMP Midwifery is a set of clinical guidelines that outline the situations and conditions under which an registered midwife can administer and supply medications listed in Appendix One of the DTP.

DTP: MIDWIFERY IS DIFFERENT TO PBS FOR ELIGIBLE MIDWIVES DTP Midwifery is a resource for Registered

Midwives employed within Queensland Health.

PBS is different to a DTP and is for Eligible Midwives.

MIDWIFERY MODELS OF CARE Private Public hybrid

FUTURE Greater access to visiting rights,

indemnity insurance, credentialing… Negotiated contracts…. More public models… More rural and remote models that

utilise midwives to full scope of practice….

Rural/remote midwives with maternal child health, sexual health and immunisation qualifications….

• THE CHALLENGE NOW IS TO PRACTICE POLITICS AS THE ART OF MAKING WHAT APPEARS TO BE IMPOSSIBLE, POSSIBLE.HILARY RODHAM

WOMEN