Healthcare Professionals Crossing Borders - Update .
Spring edition I Issue 44Crossing BordersUpdateWelcome to the 44th edition of the Healthcare Professional Crossing Borders(HPCB) Update. In this edition we reflect on the success of the recentHPCB conference – Mobile professionals, safe patients – that was held on4 February in Dublin. A big thank you to our wonderful speakers, attendeesand hosts - the Pharmaceutical Society of Ireland (PSI) and the Health andSocial Care Professionals Council (CORU). We have received really positivefeedback, with 100% of participants who completed feedback forms agreeingthat they would attend a future conference. If you attended the conferencebut have not yet provided feedback please do so via this survey.In this edition we hear from the Standing Committee of European Doctors ontheir Health Check 2019 for the forthcoming European elections, look at theEC’s first EEA market study on telemedicine, the UK Nursing and MidwiferyCouncil’s consultation launch on the future of midwifery and we provide anupdate on the EC tender on the mapping and assessment of developmentsfor nurses responsible for general care.HPCB conference – Mobile professionals, safe patientsWe held the Healthcare ProfessionalsCrossing Borders (HPCB) – Mobileprofessionals, safe patients conferenceon 4 February 2019 in Dublin. This was the11th HPCB conference to be held since thecreation of the network.Jointly hosted by the Pharmaceutical Societyof Ireland (PSI) and the Health and SocialCare Professionals Council (CORU), theconference brought together over120 representatives from Europeanhealthcare regulators, professional bodies,and national governments.In the historic setting of Dublin Castle,delegates discussed a range of topicsof relevance to competent authoritiesacross Europe.Mairead McGuinness MEP gave a speechon the impact of Brexit on professionalmobility, especially in the context of theIrish border. This was followed by a detailedpresentation by Paul Buckley of the UKGeneral Medical Council (GMC) whichoutlined the work that the GMC has beendoing to prepare for Brexit and gave detailsContinued on next page 1CONTENTSHPCB conference1EU INSTITUTIONAL DEVELOPMENTSHPCB edition caveat4CPME Health Check 20194EC telemedicine report5ePrescriptions in Estonia5Electronic health files5RPQ infringements6EC issues follow upinfringement notices6Austrian infringements oncross-border healthcare7Nursing tender7Enhancing healthcarecooperation conference7Brexit8CPME – Brexit press release8EUROPEAN PARLIAMENT QUESTIONSNational Action Plans9Impact of eHealth9NETWORKS UPDATEENMCA meetingPGEU 2030 vision paper1010EUROPEAN REGULATION UPDATESNMC consultation on futureof midwifery11GMC PMQ and nationalityreport 2017-201812Review of dental CPD12AROUND THE GLOBEWHO list threats in 2019WCPT physical therapy 2018 dataUS regulatory trends 2018Nursing Now! UpdateAustralia regulates paramedics1313131414Upcoming eventsNewsletters1515For further information please contact:Olivia Guthrie, HPCB,350 Euston Road, London NW1 3JNTel: 44 020 7189 5162Email: hpcb@gmc-uk.org
on the UK Government’s planning for registering EEAqualified doctors should the UK leave the EU without a deal.Konstantinos Tomaras from DG GROW in the EuropeanCommission presented on the future of the professionalqualifications framework and outlined plans to revise theminimum training requirements for nurses.The first panel then discussed the recognition ofprofessional qualifications (RPQ) in more detail.Representatives from the German Medical Association,the Dutch BIG Register and the Health and SocialCare Professionals Council (Ireland) spoke about theirexperiences with RPQ in practice and outlined ways inwhich they believe the recognition framework couldbe improved.From left: Ginny Hanrahan, CORU; Mairead McGuinness MEP;and Paul Buckley, GMC.After lunch, the conference focused on health workforceissues. Eszter Kovacs of Semmelweis University in Hungaryupdated on the EC-funded SEPEN Joint Tender which aimsto map the trends and expectations in healthcare mobility.Representatives of the Federation of European DentalCompetent Authorities and Regulators, the Pre-HospitalEmergency Care Council (Ireland) and the EU Network ofNurse Regulators then shared experiences of workforcechallenges and projects in their respective organisations.Feedback from conference delegates was overwhelminglypositive with 100% ‘strongly agreeing’ or ‘agreeing’ that theconference was very good and useful. Delegates welcomedthe opportunity to network with regulators from acrossEurope and to build relationships with counterparts inother organisations. All presentations and photographs areavailable on the HPCB website here. If you attended theconference and have not yet provided your feedback pleasedo by filling out this short survey.The final session of the day focused on eHealth. MariaFilina-Kossatsova of the Estonian Health Board gave anoverview of how eHealth has transformed the Estonianhealthcare system and how the country is leading theway in the cross-border recognition of ePrescriptions. Thefinal panel session saw representatives of the GeneralPharmaceutical Council (UK) and the World Federation ofPhysiotherapists outline how the growing prevalence ofcross-border eHealth is transforming their sectors.We hope to build on the success of the conference and toensure that the Healthcare Professionals Crossing Bordersnetwork continues to provide opportunities for competentauthorities to come together and discuss issues of sharedinterest. If your competent authority is interested in hostinga future HPCB event please get in touch with the secretariatvia HPCB@gmc-uk.org.From left: Alexander Jäkel, German Medical Association; Margaret Hynds O’Flanagan, CORU; SenizSicim-Sari, BIG Register; Damhnait Gaughan, PSI; and Konstantinos Tomaras, DG GROW EC2Eszter Kovacs, SEPEN Joint Tender, Semmelweis University
Mairead McGuinness, MEP; Paul Buckley, GMC; Niall Byrne, PSI; and GinnyHanrahan, CORUAttendees at the HPCB conferenceMaltese delegationNetworking3
EU institutional developmentsPlease note with European Parliament elections taking place in May and a new European Commission due to be appointed we havefound that updates to EU institutional developments are scare for this edition. 2019 is certainly going to be a year of change.European doctors towards theEuropean Elections 2019Miriam D’Ambrosio, Communication and Project Officer, StandingCommittee of European DoctorsThe Standing Committee of European Doctors (CPME) has launchedits Health Check 2019 ahead of the upcoming European elections.European doctors call on EU decision makers to: Put health high onthe EU agenda; support skilled doctors and safe conditions; enablehealthy living; invest in health security; foster trust in the sharing ofhealth data; and guarantee access to medicines.Future of healthThe CPME Health Check 2019 puts emphasis on the future of health.Although the need to respect budgetary restraints is recognised, itis equally important to assess the impact that any budgetary planmay have upon health policy. Health is an essential element of theEuropean social model and contributes to social cohesion, inclusivegrowth and nurtures a sound economic environment which is aprerequisite for investment.The future newly-elected European Parliament and EuropeanCommission will have the power to make concrete contributions to thecreation of a healthier European Union and to keep health policy onthe EU agenda. Therefore, CPME considers it essential that the politicalgroups within the European Parliament, national representatives in EUmember states and the new Commission commit to health priority ontheir working agenda.Skilled doctors, safe conditionsEnsuring the best possible conditions for doctors’ education andprofessional practice remains a priority of CPME. Therefore, theEuropean medical community asks that safe and attractive workingconditions for doctors be ensured across Europe, even more sowith Brexit changing the paradigm of medical migration andeducation and training. Brexit will bring many changes within the EUmembership and within EU institutions. For the European medicalprofession, the impact of Brexit on mobility is a great concern.Doctors’ mobility in fact takes many forms: students cross bordersto attend medical schools in other member states; junior doctorsseek specialist training in another country; and professionals take thechance to develop their capacities by accepting posts abroad, be ittemporary or long-term. European doctors will therefore continueto advocate for a solution which safeguards quality of care and acontinued knowledge transfer in the profession throughout Europe.CPME thanks you for your support of the Health Check 2019 and thework of CPME towards a safer and better Europe for all its citizens.4
EC market study on telemedicineThe European Commission has released its first EEA- widemarket study on telemedicine. The aim of the study isto examine the telemedicine market in Europe and tounderstand the factors that determine its development.The analysis maps telemedicine applications and solutions,and applicable technical standards and guidelines. It alsodescribes market dynamics and potential barriers limitingwider deployment and uptake of telemedicine solutions.The study also assesses the cost-effectiveness oflarger-scale deployment of telemedicine under currentand future market conditions, and aims to provideadvice to policy makers when considering deploymentof telemedicine.To read the full report, follow this link.Finnish citizens first to use ePrescriptions in another EU countryIn January 2019, the first EU patients were able to usedigital prescriptions issued by their home doctor whenvisiting a pharmacy in another EU country.The initiative between Finland and Estonia applies to allePrescriptions prescribed in Finland and to the Estonianpharmacies that have signed the agreement. The noveltyof this initiative is that the ePrescriptions are visibleelectronically to participating pharmacists in the receivingcountry via the new eHealth Digital Service Infrastructure,without the patient having to provide a writtenprescription.This is in line with the European Commission’s policy ondigital health and care, which aims to empower patients bygiving access to their health data and ensuring continuityof care.Maria Filina-Kossatšova, Estonian Department of Health Care Servicesacross borders. The Directive gives the possibility formember states to exchange health in a secure andefficient way.At the HPCB conference we were lucky enough to hearfirst-hand from Maria Filina-Kossatšova from the EstonianDepartment of Health Care Services on the new initiativeregarding ePrescriptions. To see her slides from theconference follow this link or more information can befound here.Twenty two member states are part of the eHealth DigitalService Infrastructure and are expected to exchangeePrescriptions and patients summaries by the end of 2021.Ten member states (Finland, Estonia, Czechia, Luxembourg,Portugal, Croatia, Malta, Cyprus, Greece and Belgium) maystart these exchanges as early as this year.In 2011, European institutions adopted Directive 2011/24which ensures continuity of care for European citizensEC Commission publishes view on the exchange of electronic health filesFollowing the launch of the Finnish and Estonian initiative, the European Commission has presented a set ofrecommendations proposing that member states extend the eHealth Digital Service Infrastructure from ePrescriptionsand patient summaries to three new areas of the health record, these are:1 laboratory tests2 medical discharge reports3 images and imaging reports.The Commission believes that access to complete and personal health records across the EU can offer immense benefitsto European citizens. For more information please follow this link.5
EC issues further infringement letters for therecognition of professional qualificationsIn January, the European Commission took infringementdecisions concerning 27 member states to ensure theproper implementation of EU rules on services andprofessional qualifications. Letters of formal notice weresent to all member states (except Denmark) for thenon-compliance of their legislation and legal practicewith EU rules on the recognition of professionalqualifications and the corresponding access to activities.Member states now have two months to reply to theCommission; otherwise they face further legal action.EC issues follow up infringement noticesThe EC has issued a further set of infringement noticesregarding non-compliance with the recognition ofprofessional qualifications Directive. The notices are afollow up to one issued last summer. Partial access: Austria, Belgium, Croatia, Denmark,Estonia, France, Germany, Hungary, Latvia, Malta,Poland, Slovakia, Slovenia and Sweden; Proportionality of language requirements:Reasoned opinions have been sent to 24 member states(Austria, Belgium, Bulgaria, Croatia, Cyprus, Denmark,Finland, France, Germany, Greece, Hungary, Ireland, Italy,Luxembourg, Malta, the Netherlands, Poland, Portugal,Romania, Slovakia, Slovenia, Spain, Sweden and the UnitedKingdom) and complementary letters of formal notice to2 member states (Estonia and Latvia). Reasoned opinionsrepresent the second stage in the infringement process.Belgium, Bulgaria, Croatia, Germany, Poland,Romania and Slovakia Setting up of assistance centres: France, Hungary,Italy and Portugal Transparency and proportionality of regulatoryobstacles: Austria, Belgium, Bulgaria, Croatia,Cyprus, Denmark, Finland, France, Germany, Greece,Hungary, Ireland, Italy, Latvia, Luxembourg, Malta,the Netherlands, Poland, Portugal, Romania, Slovakia,Slovenia, Spain, Sweden and the United Kingdom.We understand the reasoned opinions and supplementaryletters of formal notice cover the following issues: European professional card: Austria, Belgium, Bulgaria,All member states concerned have now two months torespond to the arguments put forward by the Commission.Without a satisfactory response, the Commission maydecide to address a reasoned opinion to Estonia and Latvia,and to refer the other 24 member states to the Court ofJustice of the EU.Croatia, Cyprus, Denmark, Finland, France, Hungary,Italy, Portugal, Romania, Slovakia, Slovenia and Sweden; Alert mechanism: Austria, Belgium, Croatia, Denmark,Estonia, France, Germany, Latvia, Malta, Portugal,Romania, Slovakia, Slovenia, Spain and Sweden;6
EC issues infringement letter to Austria on cross-border healthcareThe EC has sent a letter of formal notice to Austria requesting that it ensures that the costsofhealthcare received in another EU country under the EU cross-borderhealthcare Directive are reimbursed up to the level applicable whenhealthcare is receivedin Austria. The Directive grants patients the right to choose toreceive healthcare in another member state and to claimreimbursement from their home country.It states that this must be up to the level of the costs that wouldhave been assumed by the patient’s own member state if thehealthcare had been provided there, without exceeding the actual costs.Austria now has two months to respond to the arguments put forward by the Commission.Mapping and assessment of developments for nursesresponsible for general careThe European Commission DG for Internal Market, Industry,Entrepreneurship and SMEs has awarded the tender forthe mapping and assessment of developments for nursesresponsible forgeneral care (a profession under the Directive on theRecognition of Professional Qualifications) to Spark LegalNetwork EU BVBA.The study will provide the necessary data and analysisto assist the EC in taking an informed decision onwhether amendments to the recognition of professionalqualifications Directive with regard to minimumtraining requirements would be appropriate and if so,to what extent.While minimum training requirements for general carenurses have been harmonised at EU level, member statesretain the power to introduce additional requirements ifthey consider it necessary. Since the minimum trainingrequirements of the Directive were set out more than30 years ago, the Commission believes it is necessary toreview the current situation at national level with regardsto training requirements, with a particular focus onrequirements that go beyond the minimum required underthe Directive.Information on the awarded tender can be found here.Enhancing healthcare cooperation in cross-border regionsconference - 4 December 2018On 4 December 2018, the European Commission hosted aconference “Enhancing Healthcare Cooperation in Crossborder regions” to present the results of a mapping studyof successful cooperation projects and to share its toolkitfor practitioners interested in setting up cross-bordercooperation. The conference was an opportunity to closethe gap between scientific research and policy makers.More information on the conference can be found hereand a full video from the conference can be found here.7
Likely postponement of Brexit dateFollowing the failure of the UK Parliament to adopt theWithdrawal Agreement which was agreed between the UKand EU at the end of 2018, the UK has formally requestedto postpone the date of EU exit. If EU leaders agree,negotiators will have extra time in which to find agreementon the terms of the UK’s withdrawal from the EU. At thetime of publication, the extended date was not yet agreedof a ‘no deal’ Brexit. For the automatic professions, theprovisions would allow for the continued recognition ofcertain EEA qualifications as evidence of knowledge, skilland experience, regardless of the nationality of the holder.The qualifications covered by this new route would bethose qualifications that are included in Annex V of therecognition of professional qualifications Directive as ofexit day. The general system route to recognition would beremoved and replaced by the respective international routeto recognition in place for each profession.Earlier this month, the UK Parliament adopted legislationin the field of recognition of professional qualifications toensure that EEA healthcare professionals can continue tohave their qualifications recognised in the UK in the eventCPME Brexit press release - Impact of Brexit on healthcare servicesThe Standing Committee of European Doctors (CPME) has highlighted that European doctors are deeply concerned by thecontinuing uncertainty about the UK’s future relationship with the EU. According to the CPME’s press release, the lack of aclear guidance represents a threat to patients, medical workforce and health systems with the future of medical mobility ofspecial concern.8
European Parliament questions1National Action PlansNicola Caputo MEP has questioned the EC on the National Actions Plans (NAPs) thatmember states were due to submit by January 2016 under the terms of the revisedrecognition of professional qualifications Directive. He queried what measures the ECintends to take with regards to those member states who have submitted a plan but notyet initiated any reforms.In response, the EC stated that the Directive for a proportionality test and theCommunication on reform recommendations for regulation in professional services wereproposed as a direct result of the NAPs. The Proportionality Directive compels memberstates to thoroughly assess the proportionality of any new requirement before adoptingnew regulation or amending existing ones.2Impact of eHealth on older peopleDubravka Šuica MEP has questioned the EC on the impact of the increasing use of eHealthservices on older people who may not be computer literate and on populations withoutInternet access. In response the EC stated that, despite the delivery of health services andmedical care being the responsibility of the member states, it has taken an active interestin this area.The Communication published last year on ‘Enabling the digital transformation ofhealth and care in the Digital Single Market
The European Commission has released its first EEA- wide market study on telemedicine. The aim of the study is to examine the telemedicine market in Europe and to understand the factors that determine its development. The analysis maps telemedicine applications and solutions, and applicable technical standards and guidelines. It also
Introduction: crossing borders, changing times Madeleine Hurd, Hastings Donnan and Carolin Leutloff-Grandits . crossing borders results in variously bordered combinations of time as well as space, superimposed on, challenging and reinforcing one another in shifting patterns of spatio-temporal . progressive and orderly. It may be concurrent .
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California School Crossing Guard Field Assessment Tool Assessment Areas: 1. The Crossing Guard is wearing the appropriate uniform authorized by the Crossing Guard Local Program. 2. The Crossing Guard is utilizing the proper equipment (e.g., retroreflective vest, STOP paddle, whistle, gloves) as authorized by the Crossing Guard Local Program. 3.
County Police Academy have adopted the crossing guard training program developed by VTC for instructing some crossing guards in their regions. To learn more about the training's effectiveness, VTC led crossing guard training in September 2014 in Middletown Township (73 crossing guards) and the City of Newark (122 crossing guards).
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3.4.1. Impact on Border Crossing Points crossing time, security and complexity (TF5) 76 3.4.2. Impact on average border crossing time for TCNs and general impact on queues at entry and exit (TF 5.3 and TF 5.4) 85 3.4.3. Impact on the resources of Border Crossing Points (TF 5.5) 88 3.4.4. Impact in relation to Local Border Traffic (TF 4.4) 89 3.4.5.
at Nuweiba beach, which was still a territory under Egyptian control but out of Egypt proper. 3. The Bible says that after crossing the Red Sea they encountered the mountain of God or Mount Sinai; if the Nuweiba beach crossing is correct, that requires Mt Sinai to be inFile Size: 2MBPage Count: 31Explore furtherA ‘Land Bridge’ off Nuweiba? - Biblical Historical Contextbiblicalhistoricalcontext.comThe Exodus Route: Crossing the Red Sea - Biblewww.bible.caMaps - Red Sea Crossing Truth - Google Searchsites.google.comNuweiba Beach Red Sea crossing: Rejected, debunked, refutedwww.bible.caTHE EXODUS EXPLORED—Nuweiba Beach - YouTubewww.youtube.comRecommended to you based on what's popular Feedback
Crossing Guard Training Updated August 2018. Updated August 2018 Agenda Introduction Basic Crossing Procedures Basic Crossing Steps . Updated August 2018 Introduction Adult school crossing guards play several important roles in the community: They help children safely cross the street They remind drivers of the presence of .
