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.
COVID-19 advocacy continues for PNZ, as physiotherapists operate through the COVID-19 Protection Framework and Omicron. With all of New Zealand in the COVID-19 Protection Framework we're in ongoing contact with the Ministry of Health (MoH) to provide clear guidance for physiotherapists on this and the MoH phased approach to Omicron.
There is a public health order regarding the COVID-19 Protection Framework and a MoH guidance statement notes that “health services can continue to operate and are still required to meet certain requirements, including requirements to display QR codes, maintain contact tracing records.” Read more our COVID-19 webpage.
Once again our thanks to members working in DHBs through COVID-19. Please be aware of work done by the Cardio-Respiratory SIG including guidance on PPE, noting that DHB 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 where their CEO will present in September. Anthea Clements is our PNZ contact at ACC.
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 thier 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 firstname.lastname@example.org, 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.
Cost of Treatment Regulations
For those members working under Cost of Treatment Regulations from 1 May 2021 there was a 2.05% increase in the rates ACC pays providers to treat client injuries under the Cost of Treatment Regulations. There is a biennial review of these regulations, and any feedback from members is welcome.
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 email@example.com.
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.
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, with PNZ representation also included in the ACC internal group to prepare for subsequent claims management of birth injuries.
ACC attended a Select Committee hearing on draft amendments to the Accident Compensation Act 2001. Feedback to PNZ is that consequential injuries do not need to be included in the primary list of seven injuries proposed for Schedule 3A. PNZ voiced concerns that if the consequential injuries are not listed this may result in current issues with Cover and Entitlements. ACC is pulling together an expert reference group to develop a list of consideration factors.
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 the outlier letters recently sent to a cohort of physiotherapists. ACC is considering it’s next steps to 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.
With COVID-19 impacting service delivery, ACC has suspended the need for specified treatment providers working under Cost of Treatment Regulations to submit ACC32 forms for treatment extension requests. This ACC32 change will remain until 30 June 2022. For any queries about this please email firstname.lastname@example.org.
Health and Disability System Review
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.
Osteoarthritis Models of Care
PNZ President Ben Hinchcliff and Chief Executive Sandra Kirby were at the Taupuni Hao Huatau Kaikōiwi: Osteoarthritis Basecamp in July 2021. This was focused on improving the management and treatment of osteoarthritis in Aotearoa, with New Zealand and international experts coming together to shape recommendations for government ministers, health funders and policy makers.
PNZ Chief Executive Sandra Kirby met with Deputy Prime Minister Hon Grant Robertson and Minister of Health Hon Andrew Little in March 2021, highlighting that allied health including physiotherapy needs to have an elevated role in prevention, early intervention and wellness.
The meeting with Minister Little also included Laura Seary (Health Private Secretary) and Dr Martin Chadwick (MoH Chief Allied Health Professions Officer). Among other topics these meetings raised physiotherapy treatment through COVID-19, aged residential care and the role of physiotherapists in administering COVID-19 vaccines.
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 June 2022