Advocacy on behalf of members has been and continues to be 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.
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, the first opportunity to raise the profile of physiotherapy came immediately after the announcement when Sandra attended a sector briefing with the Minister of Health and Transition Unit senior staff on behalf of Allied Health Aotearoa New Zealand (AHANZ).
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.
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 in COVID-19 Alert Level 3, aged residential care in all alert levels and the role of physiotherapists in administering COVID-19 vaccines.
Advocacy regarding COVID-19 continues to be a focus for PNZ. Key work has been a May 2020 submission to the COVID-19 Epidemic Response Committee highlighting the impact on physiotherapy businesses and the importance of our profession within primary healthcare, August 2020 CRSIG Respiratory physiotherapy guidelines for managing patients with COVID19 infection (available here) and our collective PNZ submission to the October 2020 MoH discussion paper seeking feedback on their continued approach to Allied Health services through COVID-19.
Physiotherapy in Alert Level 3
PNZ continues to advocate for in-person physiotherapy treatments during COVID-19 Alert Level 3, with our united voice having an impact. The MoH position has been that health services should deliver telehealth as the first option in Alert level 3 unless the appointment is under a restricted definition of urgent care.
Following our collective PNZ submission to MoH on their approach to Allied Health services through COVID-19, a letter to the Minister of Health Hon Andrew Little and press release, the PNZ Chief Executive met with Minister Little and Chief Allied Health Professions Officer Dr Martin Chadwick.
MoH has now committed to reviewing their urgent care definitions under Alert Level 3 and PNZ is now joining a Working Across Alert Levels workshop in May 2021. Our position remains that physiotherapists can make the clinical decision regarding urgency of care and take measures required to meet safety precautions.
We also continue to advocate for physiotherapy access to aged residential care in all COVID-19 alert levels, where even a short term change can be irreversible and facilities have had stricter conditions than the general community.
The vaccination situation is as yet still uncertain. The covid.govt.nz website does have an online tool including a definition of front line health worker that covers most physiotherapists and staff of physiotherapy clinics in the health sector, but not education.
Vaccines are being run through DHBs and Public Health Units and our experience to date is there is much regional variation in this interpretation. We are continuing to advocate for certainty in this space. Please do let us know if you are finding blocks to access, and also if you have access.
The path to become vaccinators is also delegated to DHBs and therefore variable around the country. We know some of our members have completed the training and are now able to vaccinate. Please check your DHB website for more information.
As a key stakeholder for the profession PNZ is in ongoing contact with ACC. This includes meeting regularly to discuss their activity, questioning policy and processes relating to physiotherapy, recommending policy and process changes, linking ACC to members and sharing information from their team.
ACC provide regularly updates in our member magazine Physio Matters and have been sponsors of key events including Physiotherapy Conference and the PNZ Business Symposium. This provides further opportunity for members to hear from and engage with their team.
From March 2020 PNZ advocated strongly to ACC for increased physiotherapy Telehealth rates through the COVID-19 alert levels. ACC subsequently increased Telehealth rates for approved allied health providers in Alert Level 4 and then for most services at all alert levels.
The Physiotherapy Contract renewal is underway, as part of the Allied Health contract and we are scheduled to meet with ACC in April 2021 for the next steps. If you currently work under the contract, or are thinking about it, do register on GETS for updates as this is the ACC communication channel.
For those members working under Cost of Treatment Regulations the biennial review is due to commence in April 2021. We will be responding and urge providers to respond to the survey when you receive it. Because this is managed through separate legislation there is a very long process to make changes.
ACC Assisted Recovery
We are aware of concerns about the national roll out of ACC’s Next Generation case management and have heard from members who are becoming increasing distressed by the impact this is having on their clients whose treatment and rehabilitation is being stalled.
We have been raising this through regular liaison with ACC and have had the issues acknowledged. We've also been told by ACC that response times for Assisted Recovery improved over Summer 2020/21 from an increased resource within their team.
One proposed change from ACC is to channel all calls to their Customer Contact Centre, freeing up the ACC Assisted Recovery team to focus on providing proactive information. Please let us know of any examples where ACC Assisted Recovery can be improved so we can continue to advocate for this.
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 the COVID-19 alert levels and was sent to decision makers along with a public media release 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 the Ministry of Health (MoH), Primary Health Organisations and Treasury.
PNZ and Arthritis New Zealand have been asked to present to an internal MoH group in February 2021 on effective models of primary care intervention for osteoarthritis. This is a direct result of the NZIER work. The Chief Allied Health Professions Officer Martin Chadwick is facilitating the session which includes people from the Policy, Service Performance & Improvement and Primary Care teams in the Ministry. In our dreams the result of this one meeting will be a lightbulb moment across MoH that results in immediate funding for physiotherapy led interventions in primary care. In reality we might inch a little closer to this.
We are also working 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). This is a true collaboration for funding with 17 groups contributing. We plan to feed this report into the review of Health and Disability funding.
The current ACC Physiotherapy Contract is due for renewal in November 2021. ACC have indicated their intention to include a number of contracts under an umbrella allied health contract. This includes the current Physiotherapy contract, Physiotherapy Specialist Services, Hand Therapy, Podiatry and Orthotics. There is a notice on GETS announcing this contract review. At present the Physiotherapy contract is an open contract meaning any business can join at any stage. While ACC intends to keep the contract as an open contract there are likely to be some restrictions for new providers during the review process, from May to November 2021.
The intention from ACC is that the current terms and conditions of the Physiotherapy, Hand Therapy and Specialists contract will remain largely unchanged. At this stage they have signaled their desire to include a Maori cultural safety standard as the only change. Our position is that there are a number of concerns raised during the review of the contract 2017-2020 that remain. This includes equity of access for Māori, Pacific and low income families due to cost barriers, rates for telehealth (which were addressed during higher COVID-19 alert levels but we would like to be permanent) and full reimbursement for the costs associated with compliance.
Live Stronger For Longer
PNZ met with ACC’s Live Stronger For Longer programme lead in November 2020 and were pleased to be informed that ACC intend to continue funding the programme. This follows a meeting earlier in the year with the Hutt Valley District Health Board Allied Health Leadership Team, where the possibility of ACC ceasing to fund various DHB In-Home Strength and Balance programmes was raised.
PNZ took a lead in coordinating a meeting with ACC Manager Targeted Investment Paul Kennedy and representatives from Age Concern, Bone Health NZ and Arthritis NZ, to strongly advocate for ACC’s ongoing funding of this programme given an ageing population as well as the need to prevent falls and fractures and the resulting poor health outcomes for the elderly.
Please read the ACC announcement that "following consultation with Live Stronger for Longer (LSFL) stakeholders, ACC is pleased to confirm it will continue to invest in the LSFL programme." Thank you to everyone across the profession who has helped advocate for this.
The Physiotherapy Workforce
We need to ensure that we have enough physiotherapists in the country and in the right places. PNZ members have been concerned about recruitment and retention in the workforce. PNZ contracted independent researchers BERL to fully understanding potential workforce issues and how they can be addressed. You can read the reports and recommendations here.
The workforce issues that we are currently progressing include:
- Remuneration: we are tracking remuneration through our annual survey.
- The makeup of our workforce: Māori and Pacific people are under-represented in the physiotherapy workforce. While the overall workforce is young, there is a high degree of reported burnout and concerns over retention and attrition.
- The career pathway: PNZ, and in former years the College of Physiotherapy, had been working for some years towards a career pathway that included Advanced practitioner and Specialists scopes. Because physiotherapists work under the HPCA Act these scopes of practice are the responsibility of the Physiotherapy Board of New Zealand (PBNZ). PNZ members have been actively supporting PBNZ in the development of these scopes and PNZ has made submissions to PBNZ on scopes. We are delighted to see that PBNZ has recently approved the development of an Advanced Physiotherapy Practitioner scope of practice. We will continue to work with PBNZ on the development and implementation.
Page updated April 2021