Today’s correspondent is

… a paramedic and nurse practitioner in Tasmania. We have developed a model of care utilising a paramedic as a care provider in a Nurse practitioner led clinic. I am lobbying hard to find rewarding work for paramedics outside ambulance. I would like to press for limited prescribing for paramedics and wonder how to perpetuate this?  I see that the Tas Poisons Act 25.1(2) refers to “authorised endorsed health professionals” so theoretically I need to work out a way to add endorsement?

My questions

1) Are there any legal restrictions to prevent paramedics working in primary care/ private practice?

And

2) How do we start on the endorsed prescribing that is similar to ECP or remote area nurses? 

Question 1

There is no legislated limit on what paramedics can and cannot do. The Health Practitioner Regulation National Law works via title protection; it does not define scope of practice.  Apart from performing restricted dental acts (s 121), giving anaesthesia in dentistry (s 121A), prescribing optical appliances (s 122) or performing spinal manipulation (s 123) a paramedic can do anything that he or she is competent to do provided it complies with the Code of Conduct issued by the Paramedicine Board.  The Code of Conduct (June 2022) says (p. 6) ‘Practitioners have a responsibility to recognise and work within the limits of their skills and competence’ (see also [1.1](d)].  Paragraph 1.2 says:

Good practice includes that you:

a. ensure you maintain adequate knowledge and skills to provide safe and effective care9

b. ensure that, when moving into a new area of practice, you have sufficient training and/or qualifications to achieve competency in that new area.

Conclusion question 1

There are no legal restrictions to prevent paramedics working in primary care/ private practice provided they work ‘within their skills and competence’.

Question 2

The issue here is a right to prescribe, rather than possess, supply or administer a drug.

The Poisons Act 1971 (Tas) s 25C(2) says:

An authorised health professional, who is endorsed to prescribe scheduled substances by an authorised body may only, for the purposes of his or her profession, possess, sell, supply or  prescribe  the scheduled substances specified in that endorsement.

An ‘authorised body’ is the organisation declared to be the body that can authorise particular health professionals. For example, the Optometry Board and the Podiatry Board can endorse the registration of optometrists and podiatrists respectively, to ‘prescribe a scheduled substance … in accordance with an endorsement on his or her registration’ (Poisons Regulation 2018 (Tas) r 7).

Conclusion question 2

Fundamentally for a paramedic to prescribe a narcotic or restricted substance they must be endorsed to do so (rr 20 and 45). To do that it would be necessary to persuade the Minister for Health that this would be of community benefit. The Minister could then prepare a regulation to appoint an authorised body (presumably the Paramedicine Board) that could then authorise Tasmanian paramedics with appropriate skills and qualification to prescribe relevant drugs.  How you ‘start on the endorsed prescribing that is similar to ECP or remote area nurses’ is not a legal question, it is a question on government relations and how best to present a relevant case to the minister.  That is an issue my friend Ray Bange, the Paramedic Observer, is better placed to answer.

This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.