Today’s correspondent comes from a large, private paramedic employer.  They say:

I am particularly interested in the ongoing necessity of maintaining an employer-issued “Authority to Practice” (AtoP) for paramedics – specifically privately employed paramedics, given that AHPRA registration now fundamentally confers the right to practice.

Background and Context

As you have noted in your commentary, a paramedic’s core authority now flows from their AHPRA registration, making employer-issued certificates essentially internal credentials rather than legal licenses.

While national registration establishes baseline competence, many state services still rely on the legacy AtoP mechanism, often tied to medication authority and specific clinical guidelines. The Paramedicine Board appears to deliberately leave scope flexible, driven by individual competence and employer protocols, similar to nursing.

This leads to the core question: Can the profession transition to a model where a paramedic’s scope of practice is primarily conferred by their AHPRA registration and competence, supplemented by organisational credentialing and policy (akin to the nursing model), rather than requiring a standalone AtoP document from each employer?

Key Questions

We are currently re-examining these legacy requirements as we look to expand our paramedic workforce into Critical Care, and Aeromedical Retrieval. I would greatly appreciate your general perspective on the following:

Legal Necessity & Redundancy: From a legal or regulatory standpoint, is there any current requirement that mandates an employer-issued AtoP for a registered paramedic, or is the national registration fully sufficient as the authority (excluding specific state drug authorities)? Would eliminating the formal AtoP conflict with any general legislation, or only with traditional practice?

Transition Risk: What are the key legal or clinical governance risks an organisation must mitigate if it chooses to phase out the formal AtoP certificate?

Practical Implementation (Governance & Drugs): If an organisation relies solely on clear job descriptions, competency assessments, and clinical practice guidelines, how can it best ensure compliance with state medicines and poisons legislation? Would this require explicitly listing individual paramedics on a state health department drug authority instrument, or is compliance primarily handled via organisational permits?

I recognise that the employer certificate has been necessary to define the scope of employment in the past. However, we are exploring whether that definition can be achieved entirely through HR documents and internal clinical governance policies, removing the bureaucratic layer of a separate “Authority to Practice” certificate. Essentially allowing us to credential our Paramedics in the same manner that we credential our Nurse and Doctor cohorts…

I reiterate that this is not the place for legal advice and an organisation will need to get local legal advice, from a solicitor in their state or territory, for specifics.

Speaking generally however I have discussed the concept of the authority to practice before – see What is a paramedic’s ‘authority to practice’? (August 19, 2014). 

The Health Practitioner Regulation National Law works via title protection. I do not need anyone’s authority to do what paramedics normally do if I am competent and obtain a patient’s consent.  What I need, and what registration provides, is authority to use the title ‘paramedic’.  Using the title paramedic tells any potential patient, employer or contractor that I have been assessed as a fit and proper person and I have obtained the qualifications necessary for that registration.

What an employer’s authority to practice does is say to the paramedic, ‘you have the employer’s authority to practice in the employer’s name and to represent the employer’.  With an ‘authority to practice’ a person who turns up in a jurisdictional ambulance service ambulance clearly represents and is performing as part of that ambulance service, and not on their own account.  

An authority to practice is also relevant to the use of drugs.  Where an employer has a general authority to authorise staff to use various drugs and where that employer has determined to have different categories of paramedics, then the authority to practice says to the paramedic ‘you can practice as a paramedic, or an extended care paramedic, or an intensive care paramedic (or any other title that the employer chooses to use) and with that you have our authority to carry and use the drugs we have determined can be used by paramedics of that classification’.    As my correspondent has noted these are ‘internal credentials rather than legal licenses’.  The concept of an authority to practice does not get a mention in the Health Practitioner National Law nor any other law that I am aware of.

So let me then turn to the questions:

Legal Necessity & Redundancy: From a legal or regulatory standpoint, is there any current requirement that mandates an employer-issued AtoP for a registered paramedic, or is the national registration fully sufficient as the authority (excluding specific state drug authorities)? Would eliminating the formal AtoP conflict with any general legislation, or only with traditional practice?

No, there is no current legal requirement for an employer issued authority to practice. Eliminating the formal authority to practice would not conflict with any general legislation.

Transition Risk: What are the key legal or clinical governance risks an organisation must mitigate if it chooses to phase out the formal AtoP certificate?

That would depend on what ‘key legal or clinical governance risks’ the employer thinks the authority to practice is mitigating. That would be a matter for each employer to consider in the context of the work they do. That is not a matter that can be addressed here; other than to say whatever you think the authority does, you would have to have an alternative to do the same job.

Practical Implementation (Governance & Drugs): If an organisation relies solely on clear job descriptions, competency assessments, and clinical practice guidelines, how can it best ensure compliance with state medicines and poisons legislation? Would this require explicitly listing individual paramedics on a state health department drug authority instrument, or is compliance primarily handled via organisational permits?

That would depend on the terms of the any authority granted and the provisions in each state and territory in which you work.  If we take the Poisons and Therapeutics Goods Regulations 2008 (NSW) and NSW Ambulance as an example, the regulation says (appendix C, cl 7):

A person–

(a) who is employed in the Ambulance Service of NSW as an ambulance officer or as an air ambulance flight nurse, and

(b) who is approved for the time being by the Secretary for the purposes of this clause,

is authorised to possess and use any Schedule 2, 3 or 4 substance that is approved by the Secretary for use by such persons in the carrying out of emergency medical treatment. Act 

What is required is the secretary’s authority. How that authority is expressed, whether it’s called an ‘authority to practice’ or is in a list of approved providers or the like, doesn’t really matter.  What is required is the Secretary’s authority and that should be recorded somewhere.

Whether an employer would be required to list ‘individual paramedics on a state health department drug authority instrument, or …  via organisational permits’ would depend entirely on the terms of any authority granted by the service but whether you call it an authority to practice or something else makes no difference.  

Conclusion

Can the [paramedic] profession transition to a model where a paramedic’s scope of practice is primarily conferred by their AHPRA registration and competence, supplemented by organisational credentialing and policy (akin to the nursing model), rather than requiring a standalone AtoP document from each employer?

Clearly yes.  Medical Practitioners, nurses and paramedics are all governed by the same law – the Health Practitioner Regulation National Law.  Whatever way an employer ‘credential … our Nurse and Doctor cohorts…’ could also be applied to paramedics.

This blog is a general discussion of legal principles only.  It is not legal advice. Do not rely on the information here to make decisions regarding your legal position or to make decisions that affect your legal rights or responsibilities. For advice on your particular circumstances always consult an admitted legal practitioner in your state or territory.