Advocacy on behalf of the profession is a priority for PNZ. We know this is important to members and are committed to raising the profile of physiotherapy as well as the visibility of our advocacy work.
As of 12 September 2022 the Government has removed the COVID-19 Protection Framework and most COVID-19 rules have ended in New Zealand. Read more our COVID-19 webpage.
Once again our thanks to members working through COVID-19. Please be aware of work done by the Cardio-Respiratory Special Interest Group including guidance on PPE, noting that public health guidance for staff will override any messages from PNZ.
We also continue to advocate for physiotherapy access to aged residential care, where even a short term change can be irreversible and facilities have had stricter conditions than the general community.
PNZ meets regularly with ACC to question policy and processes, and link members to relevant information. They also feature in Physio Matters, send their own ACC Provider Updates and are present at PNZ events including Physiotherapy Conference 2022 where their CEO will present in September. Adrian Pretorius is our PNZ contact at ACC.
Cost of Treatment Regulations (CoTR)
The Ministry of Business, Innovation and Employment (MBIE) opened their Consultation on ACC Regulated Payments for Treatment in late September 2022, including a proposed 9.36% increase in treatment rates for physiotherapists. With this biennial consultation open until 18 October, PNZ will be making a submission and welcome feedback from members on the proposal. We also encourage all PNZ members working on Cost of Treatment Regulations to make individual submissions.
ACC Innovation Fund
From 2022 ACC have a fund supporting health sector innovation that will help people recover from injury faster. There is a wide scope to the Innovation Fund and initiatives may focus on service design, systems, technology, equity, or improvements to a current process or clinical pathway. Read more at acc.co.nz.
ACC are on track to launch their new online ProviderHub in 2022, with business owners being contacted to clarify who will be authorised to work in the platform on behalf of their business. Read more in a message from ACC or visit the ACC website which includes a video on working with ProviderHub.
Allied Health Contract
The ACC Allied Health Contract covering physiotherapy went live in November 2021 and is a focus for ACC Procurement. Available to apply for through the Government Electronic Tender Service (GETS) ACC have indicated the contract is working well, acknowledging some issues with providers being able to use the contract forms which are being resolved with Gensolve and communicated to contract holders.
Through our united advocacy telehealth rates for initial consultations and follow up visits remain through the COVID-19 Protection Framework, which match in person consultation.
PNZ has also advocated for an increased rate that covers the average co-payment for Community Service Card holders to address access issues for Māori, Pacific and low income people. ACC response to this is that there is the ability for providers to seek increased reimbursement on a case by case basis. We require examples of where such requests for funding are being declined so we have some evidence for the need for a review of contract pricing.
We've further called for a review of off-site rates especially for venues such as marae and schools where services might address equity issues. This has not been accepted by ACC and the current practice of offsite clinics funded at sideline rates remain. Again providing us of examples of where access to services is impacted for Maori and Pacific people because of the requirement to have off site venues audited would be helpful for future advocacy in this area. Please send any specific examples (de-identified) to email@example.com, with "ACC Advocacy" in the subject line.
Physiotherapists can ask ACC for assistance with co-payments for clients that are unable to afford them, and this is therefore a barrier to a client receiving physiotherapy treatment. ACC receives requests for co-payment funding assistance via MyACC, client phone calls / emails and provider phone calls / emails (essentially ACC is able to take requests from anyone via any route, assessing each on a case by case basis).
Proof of PNZ Membership for ACC Allied Health Contract application
Since May 2020 one of the requirements of the ACC Physiotherapy Contract is all staff working on the contract are members of PNZ. In their call for applications for the new Allied Health Contract, this is the first time ACC have asked for evidence of membership.
ACC Assisted Recovery
We are escalating member concerns and continue to meet with senior ACC staff about ACC’s Next Generation Case Management. These issues have been raised now since 2020 and despite a short–lived improvement early in 2021 the situation has not resolved. Specific examples of this are the most useful tool in our ongoing advocacy so please send these to firstname.lastname@example.org.
PNZ met with ACC's Manager Assisted Recovery Service and other managers in August 2021 to express ongoing frustration from members with the lack of progress on issues previously raised, including timeliness and responsiveness to client and provider treatment and rehabilitation requests. ACC again acknowledged the lack of progress and explained they are putting further short and long term measures in place, including processes, technology and more staff. ACC also acknowledged that changes to the vocational rehabilitation contract have caused frustration and impacted on Assisted Recovery responsiveness.
To raise this further, PNZ issued a media statement and was in the news in August 2021 highlighting frustrations with Assisted Recovery. Our PNZ Chief Executive subsequently met with the ACC Acting Chief Executive in August 2021, discussing Assisted Recovery as well as other topics including vocational rehabilitation. Through this ACC have reiterated that they are bringing on new staff and reviewing systems and delegations to make improvements.
Assisted Recovery was again discussed with the new ACC Chief Executive in January 2022 and an ACC Next Generation Case Management Post Implementation Review published in May 2022. PNZ were again subsequently in the media commenting that ACC case management needs more work and we continue to raise this with our ACC contacts.
Maternal Birth Injuries
PNZ and the Pelvic, Women’s and Men’s Health SIG submitted a response to the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill in February 2022. As of June 2022 the Select Committee report has been released with some of the recommendations made in our PNZ submission further recommended by the Select Committee, including extending the range of injuries covered. While we would prefer there was no list, we're pleased to see the recommendation that the list at least gets reviewed. The expectation is that this is going to be in place for 1 October, noting any delays in the Parliamentary process will delay implementation. The legislation can be tracked here.
ACC is preparing for implementation of the legislation, and the subsequent claims management of birth injuries. This includes the formation of an expert reference group, with a PNZ representative on the group and a representative from Tae Ora Tinana invited. PNZ understand that ACC will be contacting members about the claims management process and we look forward to providing further updates on this when available.
We have questioned ACC about delays in their payments following concern from members. ACC response is that they are meeting contractual obligations and paying by the 20th of month following but not always within the 7 days that was their practice. ACC have also informed us they are affected by staff shortages due to illness. We will continue to raise this with them and welcome feedback on improvements.
We have been working with the Physiotherapy in Mental Health SIG raising the concerns about funding of physiotherapy in sensitive claims and this is an ongoing area of advocacy. Similarly we have also been working with members from some rural areas of the country around ACC access to services and the interface between DHB and ACC services.
Concerns have been fed back on the tone and intention of outlier letters sent to a cohort of physiotherapists, whose billing is identified as dissimilar to others in the profession. ACC is rewriting these letters to help address this issue, also raised in previous years.
ACC is also restarting work that was commenced late in 2020 to look at physiotherapy treatment and an injury prevention approach for school children injuries. They have asked for PNZ input to follow up from work started in 2021 to develop guidelines for physiotherapists managing children with musculoskeletal injuries, which will include injury prevention and injury management guidance.
We have been advised that the Training for Independence contract is being reviewed. One significant change is the removal of physiotherapy as a single treatment option under this contract. The ACC view is this contract is to target clients with complex needs and will involve a multi-disciplinary team.
ACC is a currently undertaking a pricing review of the Pain Services Contract and they are talking with suppliers about service delivery costs. A review of claims triage to access specialist pain physicians has found easier access with prior approval.
Some Vocational Services issues have also been identified with a gap in funding resulting in return to work services stopping and impacting on timeliness of return to work. ACC are currently working to address this.
New Health and Disability System
PNZ Chief Executive Sandra Kirby and Professional Advisor Chris Bloomfield were in attendance when the Minister of Health Hon Andrew Little and Deputy Health Ministers Hon Peeni Henare (Māori Health), Hon Dr Ayesha Verrall (Public Health) and Hon Aupito William Sio (Pacific Peoples) announced the new health and disability system at Parliament on Wednesday 21 April 2021.
With changes generally going beyond recommendations from the Health and Disability System Review, we continue to actively work with the Transition Unit senior staff for PNZ and on behalf of Allied Health Aotearoa New Zealand (AHANZ). In June 2021 Sandra Kirby presented to the Federation of Primary Health and Health Transition Unit staff on the role of allied health in the new system, and in July 2021 met with Health Transition Unit senior staff to continue this advocacy.
PNZ also contributed to the June 2021 Hidden in Plain Sight report. This report was commissioned by AHANZ to demonstrate the value of allied health in community level care. Our message remains that the redesign of the health system provides the perfect opportunity to unlock the potential of physiotherapy, and other allied health, to improve the health and wellbeing of New Zealanders. This is an evidence based and cost effective solution to the growing pressure on health services.
Our Chief Executive again met with some of the Health Transition Unit and roadshow information sessions were run across the South Island in October 2021. A copy of the presentation is available at futureofhealth.govt.nz. With physiotherapists in primary care settings mentioned regularly, this includes allied health services in the context of both primary and community care and Mauri Ora. The Health Transition Unit is scheduling North Island sessions for November 2021.
Read more here including opportunities for physiotherapy and how our work with NZIER on Better Outcomes through Increased Access to Physiotherapy provides evidence to continue positioning primary care physiotherapy for long term conditions as the best health funding option.
In December 2021 PNZ made submission on the Pae Ora (Healthy Futures) Bill which provides for a new structure and new accountability arrangements for the publicly-funded health system, in order to protect, promote, and improve the health of all New Zealanders.
Ministry of Health
PNZ meets regularly with MoH, including with Chief Allied Health Professions Officer Dr Martin Chadwick. Current advocacy with MoH includes advocating for representation on the taskforce of medical professionals for planned-care and for physiotherapy to be added to the government’s immigration Green List.
Following collective advocacy with the PNZ Cardio-Respiratory Special Interest Group (CRSIG), we're pleased that CRSIG Chair Jen Mepham has been appointed to the MoH Long COVID Expert Advisory Group tasked with assessing the evidence about Long COVID and applying it to the New Zealand context.
We also continue to push for better access to evidence based physiotherapy care for long term conditions such as osteoarthritis, chronic pain, cardiac rehabilitation and pulmonary conditions.
With New Zealand’s Immigration Rebalance taking effect in July 2022, PNZ continues to advocate on behalf of the profession for improved access to overseas trained physiotherapists. We attended a meeting with Ruth Isaac (MBIE Deputy Chief Executive Immigration and Employment), where a presentation outlined the rebalance. Key messages include:
- There are overseas trained health professionals with 2021 Resident Visa Eligibility. This was identified as the simplest pathway to residence, with applications required by 31 July 2022. Any physiotherapists who qualify for this visa are encouraged to get their application in by this date.
- The new pathway for most of allied health, including physiotherapy, is the Accredited Employer Work Visa Programme (AEWV). This process is intended to be straightforward for any profession earning more than the median wage of $27.76 per hour ($58k per annum) – noting some exceptions to median wage criteria, such as for aged care workers. Timelines for the AEWV are:
- Employer accreditation | 10 working days
- Job check process: proof that the role has been advertised in New Zealand (note for employers seeking multiple people job checks can be bundled) | 10 working days
- Ticket for job: the employer provides the candidate with the job reference (this is added to the candidate’s application to immigration and matched against the job check) | 20 working days
- There are two alternative pathways to residence, summarised below. With neither of the pathways featuring physiotherapy we’ve raised this with MBIE and the Ministry of Health and been told these will be reviewed in 2023.
- The Green List of 85 professions which provides immediate residency. The only allied health professions on the Green List are psychologists, orthoptists, and Medical Lab scientists.
- The Work to Residence pathway which has a two-year period before people can apply for permanent residence – this includes Podiatrists, Audiologists, Med Lab Technicians and OTs.
- Other visa categories, such as student and tourism, open from 31 July and our borders are considered to be open from 1 August.
We remain concerned that the new settings have created negative consequences for physiotherapists and that the AEWV programme will not rectify the current shortage. While we’re encouraged by government signals that physiotherapists are valued in the new health and disability system, frustration is growing as the actions of government do not match the words.
PNZ has written to the new Minister of Immigration highlighting improved access to overseas trained professionals and our desire for physiotherapy to be included on the immigration Green List. We also encourage you to document your experiences with the AEWV programme and are in contact with MBIE about running an immigration webinar for members.
Physiotherapy for New Zealand
Commenced in 2019, PNZ has worked with the New Zealand Institute of Economic Research (NZIER) to identify the value of physiotherapy. In their report Better Outcomes through Increased Access to Physiotherapy NZIER found that greater use of physiotherapy can contribute to New Zealand healthcare’s Triple Aim Framework by:
- Reducing the overall cost of health system interventions through addressing lifestyle risk factors such as obesity.
- Empowering individuals to manage chronic long term conditions and risk factors.
- Contributing to the reduction in health system pressures associated with the burden of non-communicable diseases.
- Offering opportunities for advice and treatment that does not need to be funnelled via GP referrals.
Overall the report shows good returns from increased physiotherapy in three key areas and is a useful support in our advocacy work, demonstrating the cost effectiveness of targeted investment in physiotherapy treatments.
With COVID-19 impacting the work of physiotherapists, the report informed PNZ’s positioning statement written for Government on the essential value of Physiotherapy for New Zealand. This advocates for increased funding of physiotherapy through and beyond COVID-19 and was sent to decision makers and media in June 2020.
We believe that improving funding for physiotherapy in primary care will help improve health outcomes for New Zealanders living with non communicable diseases such as osteoarthritis where national and international evidence shows physiotherapy led treatments are effective and efficient use of health funds. Such funding must include targeted funding to help address Māori health outcomes.
Using the findings of the NZIER report, PNZ continues to advocate for increased funding of physiotherapy in primary care through MoH, Primary Health Organisations and Treasury.
As a direct result of the NZIER work, PNZ and Arthritis New Zealand were asked to present to an internal MoH group in February 2021 on effective models of primary care intervention for osteoarthritis. The MoH Chief Allied Health Professions Officer facilitated the session which included people from the Policy, Service Performance and Improvement, and Primary Care teams in the Ministry.
We have also worked with NZIER on a report on funding models for allied health services in primary care with the wider Allied Health Aotearoa New Zealand group (AHANZ).
Page updated September 2022