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.
Our overall approach to advocacy is based on building positive relationships with key stakeholders to achieve our goals, working collaboratively with other groups and organisations where our goals and values are aligned.
Te Anamata O Te Oranga: Future of Health (New Health and Disability System)
With the new health and disability system announced at Parliament in April 2021, and changes generally going beyond recommendations from the Health and Disability System Review, we continue to actively work with the Future of Health Transition Unit on behalf of the physiotherapy profession.
In June 2021 PNZ Chief Executive 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 Allied Health Aotearoa New Zealand (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.
Further work with Te Whatu Ora (Health New Zealand) and Manatū Hauora (Ministry of Health), advoacting for physiotherapy in the new health and disability system, is outlined below.
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. Codie Bedford is our PNZ contact at ACC.
ACC are on track to launch their new online ProviderHub in 2023, 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.
PNZ members in private practice who are funded by ACC are likely to be paid either under Cost of Treatment Regulations or under the Allied Health Contract. Cost of Treatment Regulations is managed through the Ministry of Business, Employment and Innovation (MBIE). ACC manages and runs the Allied Health Contract.
Cost of Treatment Regulations (CoTR)
PNZ responded to the most recent Consultation on ACC Regulated Payments for Treatment run by MBIE in 2022. The full submission is available here, with the main points below.
- The 9.3% proposed increase for physiotherapists based on the Multi Employer Collective Agreement (MECA) uplift is welcome, but does not address the longstanding funding gap.
- Introducing a Community Service Card rate for low income clients would improve health equity.
- Including liaison with other health professionals within the definition of “direct treatment” would improve health outcomes.
- The Cost of Treatment Regulations pricing and associated proportion of the fee paid by ACC requires review, given the proportion of fee paid by ACC has been falling.
Allied Health Contract
The ACC Allied Health Contract covering physiotherapy commenced in November 2021, replacing the ACC Physiotherpay Contract. It is an open contract available through the Government Electronic Tender Service (GETS). ACC reviewed the contract rate in June 2022, and increased the contract rate by 1.95%. PNZ has advocated strongly, including directly to the ACC CEO, that this increase is an insult to physiotherapy providers.
While ACC has indicated a second uplift to address the changes in the MECA is expected this year, we continue to advocate for a more comprehensive review of the pricing assumptions made as part of the Allied Health Contract. ACC say they are funding 60% of the cost of treatment; we believe it is less than 50% and the fundamental costing premise is now either outdated or flawed. We'll continue to advocate strongly for this into 2023.
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. This year ACC have implemented a pilot scheme in South Auckland testing the use of Community Service Cards. We continue to advocate for this and will be watching the pilot results with interest.
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). If PNZ members have feedback on this, we require examples of where such requests for funding are being declined so we have some evidence for needing 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.
Proof of PNZ Membership for ACC Allied Health Contract application
Since May 2020 one of the requirements for the ACC Physiotherapy Contract, and now the Allied Health Contract, is all staff working on the contract are members of PNZ. For providers who are required to show evidence of membership, PNZ members can download their personal receipt through pnz.org.nz and provide this as evidence of membership (by going to their My Account section and selecting the relevant SalesOrder Id).
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 and we continue to raise this with our ACC contacts.
ACC Manager Assisted Recovery Leon Tsui provided an October 2022 update, identifying main areas of focus as staff upskilling, staff working to areas of strength and interest, and the implementation of an “off-track” team dedicated to early identification of clients whose rehabilitation is off track and putting in place actions to address this. There is a 30% increase in the number of Stay At Work (SAW) referrals, which is significant as one of the concerns from our members was that referrals to secondary care had dropped by more than 20%. ACC staff have caught up on seven months of delayed work and the current aim is to get to real-time check ins with clients.
In November 2022 the ACC Manager Assisted Recovery provided the following points on progress with improvements to the Assisted Recovery service.
What ACC have achieved so far:
- Successfully implemented capability streaming in Assisted Recovery where we assigned skillsets for our people based on their strength and preferences and allocated work based on those capabilities. Our new capabilities will include:
- Successful deployment of our new workforce and workload management technology which will give us the ability to forecast our workload, optimise our capacity and provide great insights into performance
- Building capability through targeted training for all of our people in the Assisted Recovery team
ACC improvement in service:
- Improvement in timeliness of response in wait times and emails
- Our welcome conversations with client and employer are completed within 2 working days
- Increase in number of return to work outcomes for our clients and employers
- Increase usage vocational rehabilitation service e.g. referral to SAW has increased by 30%
- Increase our connection through 2 ½ times more proactive contact with clients and employers
As of January 2023, work continues internally at ACC to address the performance issues impacting providers and patient outcomes. Despite improvements previously reported, member feedback suggests that for more complex clients being managed by the Assisted Recovery team delays in decision making and contact continue to impact workloads. PNZ has asked to meet again with Leon Tsui Manager Assisted Recovery to continue pressing for improvements.
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.
ACC personal injury cover now includes maternal birth injuries (MBI) as accidents for injuries that occur on or after 1 October 2022. Information about the maternal birth injuries that ACC covers, injuries that can be lodged by a pelvic health physiotherapist, and birth related musculoskeletal injuries that can be lodged by a physiotherapist with musculoskeletal skills can be found in the ACC Maternal Birth Injury Quick Guide.
The claims management processes for maternal birth injuries are now in place and being transitioned to business as usual management within ACC. Comprehensive information about the management of these injuries is avaiable at acc.co.nz.
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.
As of October 2022 there are two week delays with automated invoices and one month for manual invoices. With ACC not providing a time frame for when this will improve, we have further raised member concerns and business impacts due to this delay.
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.
Te Whatu Ora: Health New Zealand
In October 2022, PNZ Chief Executive Sandra Kirby and Professional Advisor Chris Bloomfield met with a representative of the Primary and Community Care team within the Te Whatu Ora Localities Team, which was flagged through the Government 2022 Budget announcements.
Physiotherapists, practice-based pharmacists and kaiāwhina have been identified to be part of new location based primary and community care teams, with issues being worked through including the practicalities of getting physiotherapy services into these teams and consideration of effective models of care that will address equity issues.
Te Whatu Ora released thier Planned Care Taskforce Reset and Restore Plan in October 2022, including recomnedations that (page 38):
- In the immediate phase, the Taskforce supports implementation of a nationally consistent care pathway that incorporates allied health professionals to ensure timely, evidence-based interventions before and/or instead of orthopaedic surgery, noting the Taskforce’s support for rollout to all patients is contingent on establishing clarity of the benefits to Māori and Pacific patients, including access to the pathway or if more appropriate, access directly to orthopaedic review all within equitable timeframes.
- The role of orthopaedic physiotherapy in assessment should be considered as national programme. Collaboration between physiotherapists, orthopaedic specialists, and the Physiotherapy Board is necessary.
In December 2022 we met with members of the Te Whatu Ora Primary, Community, and Rural Early Actions Team, focused on implementation of the comprehensive primary care teams that are part of Te Pae Tata (the interim New Zealand Health Plan). Physiotherapy, pharmacy, and kaiāwhina are the named professions as a minimum requirement for extended care.
Manatū Hauora: 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.
As part of new health system the Pae Ora Act was passed earlier in 2022. One of the changes in the legislation is a new requirement for a Women’s Health Strategy (alongside strategies for NZ Health, Pacific Health, Health of Disabled People and Rural Health). Chris Bloomfield, PNZ Professional Advisor Policy and Practice and Dr Melissa Davidson, Specialist in Pelvic Health Physiotherapist, joined a discussion with member of the Manatū Hauora Policy Team to discuss opportunities for physiotherapists to be involved in developing and delivering services.
Whilst in the early stages of shaping the strategy, the team is taking a broad view and life curve approach. Potential areas of interest that could involve physiotherapy include: chronic pain, building on the recently published model of care; long COVID work; age related issues including menopause, osteoporosis, falls prevention; equity for people on lower incomes; mental health; all areas with a strong Rangitahi lens.
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.
- 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 professions which provides immediate residency.
- The Work to Residence pathway which has a two-year period before people can apply for permanent residence.
- 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 Minister of Immigration highlighting improved access to overseas trained professionals and our desire for physiotherapy to be included on the immigration Green List. While the list was updated in December 2022, physiotherapists were left off again - to which PNZ President Mark Quinn commented "we know that physiotherapy can keep New Zealanders healthier and more active which plays a significant part in reducing the need for more acute care and hospital admissions. It makes no sense to us that the government doesn’t recognise these benefits and open the way for overseas professionals to work here."
As of 12 September 2022 the Government removed the COVID-19 Protection Framework and most COVID-19 rules. Once again, our continued thanks to members for your support 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 will override any messages from PNZ. Read more our COVID-19 webpage.
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 February 2023