Advocacy

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.


COVID-19

COVID-19 advocacy continues to be a focus for PNZ. Key work has been:

Physiotherapy in Alert Level 3

PNZ continues to advocate for in-person physiotherapy treatments during COVID-19 Alert Level 3. 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 definition of urgent care. Our position remains that physiotherapists can make the clinical decision regarding urgency of care and take measures required to meet safety precautions.

Following a PNZ submission to MoH, a letter to the Minister of Health Hon Andrew Little, press release and meetings between the PNZ Chief Executive, Minister Little and Chief Allied Health Professions Officer Dr Martin Chadwick, PNZ was part of a MoH Working Across Alert Levels group and MoH updated their urgent care definition in mid-2021. 

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.

3-Step Approach for Auckland

With the Government introducing a 3-step approach to ease Alert Level 3 restrictions in Auckland we’re working to understand the impact on how physiotherapists can operate and advocating that physiotherapists should be able to see patients in person from Alert Level 3 Step 2.

While MoH has still not yet updated advice for community allied health, scientific and technical providers in Alert Level 3, our Chief Executive has met with the MoH Chief Allied Health Professions Officer to clearly state our position. To further reiterate that physiotherpists should be able to see patients in person in Level 3, we have sent a letter with the Physiotherapy Board to the Minister of Health raising concerns with the current situation and the lack of timely direction for Auckland non-DHB physiotherapists.

Our Chief Executive has also been in the media alongside Auckland-based member Yousif Mansour highlighting how physiotherapists and patients are suffering by being unable to operate during Alert Level 3 and, with other allied health professions supporting our message, we look forward to MoH updating their guidelines.

Vaccinations

Vaccines are being run through DHBs and Public Health Units. The path to become vaccinators is also delegated to DHBs and therefore variable around the country. Please check your DHB website for more information.


ACC

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. 

Over the past year there has been much change within the clinical partnerships team at ACC and we now have new relationship managers in place. Anthea Clements is the PNZ contact in the team managed by Fraser Wilkins.

ProviderHub

ACC are currently implementing a ProviderHub to make engagement with them easier. This will replace their existing online platforms (such as eBusiness Gateway), locating ACC's online tools for providers in one place with more functionality and security. More about the ACC ProviderHub, including a preview, is available at acc.co.nz.

The Physiotherapy Contract ends on 31 October and the Allied Health Contract commences 1 November

The current ACC Physiotherapy Contract (which was formerly known as EPN) is due to expire on 31 October 2021. ACC have confirmed that the new contract will cover all existing allied health contracts – physiotherapy, physiotherapy specialists, hand therapy and podiatry. There were some late changes to the contract specifications, particularly for Physiotherapy Specialists as a result of advocacy from PNZ and the Specialists. Any businesses currently working on the Physiotherapy Contract should have applied for the new Allied Health Contract.

This new contract replaces the existing separate contracts for Physiotherapy, Hand Therapy and Orthotics. The purpose of combining the three existing contracts under a single Allied Health Contract is to ensure consistent quality service measures are in place across the allied health providers, and the potential for future commissioning across allied health providers. The term of the new contract is two years from 1 November 2021 with a two year right of renewal.

Timelines for the new contract:

  • 8 July 2021 applications closed for the new contract
  • Mid-September 2021 ACC contracts will be sent
  • 31 October 2021 existing Physiotherapy Contract end
  • 1 November 2021 new contract commences

The indications are that any provider who meets all the requirements from ACC will be offered a contract. This is not a limited vendor model.

We continue to raise matters relating to this contract with ACC and hope to see some clarification for areas of concern in the Operational Guidelines due before the contract commences. We expect one of these areas will be around the use of student physiotherapists, particularly 4th year students.

This will be an open contract from 1 November 2021.

Telehealth rates for initial consultations and follow up visits will remain at the current rates which now match in person consultation. This is a great achievement. Unfortunately there are no other increases in rates proposed.

PNZ 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. To support our advocacy please send any specific examples to pnz@physiotherapy.org.nz, with "ACC Advocacy" in the subject line.

We have also 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 pnz@physiotherapy.org.nz, with "ACC Advocacy" in the subject line.

Physiotherapists can also 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.

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).

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. The biennial review of these Regulations is due this year and PNZ will contribute to this. Any feedback from members is welcome.

ACC Assisted Recovery

We are aware of ongoing concerns about ACC’s Next Generation case management and continue to hear from members who are distressed by the impact this is having on their clients whose treatment and rehabilitation is being stalled. Specific examples of this are the most useful tool in our ongoing advocacy so please send these to pnz@physiotherapy.org.nz.

We are escalating member concerns and continue to meet with senior ACC staff to seek better outcomes from this process. These issues have been raised now since 2020 and despite a short–lived improvement early in 2021 the situation has not resolved.

ACC acknowledges concerns and that efforts to fix the problems have not worked to date. They have now redirected all calls to their Customer Contact Centre, freeing up the ACC Assisted Recovery team to focus on providing proactive information.

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 a lot of frustration and impacted on Assisted Recovery responsiveness.

While not committing to a timeframe for improvements, ACC noted that the aim for Assisted Recovery is to work more proactively. They also reiterated the option for the judicious use of “URGENT” in the email subject line to Assisted Recovery Co-coordinators when physiotherapists require a quick response to a service request.

To raise this further PNZ issued a media statement in August 2021 highlighting frustrations with Assisted Recovery and was in the news noting that physiotherapy patients are waiting 'weeks, if not months' for ACC cover with members telling us that “the new system is less flexible, less patient centric and that means it takes longer to deliver treatment."

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 now bringing on new staff and reviewing systems and delegations to make improvements.

Other

We have been working with the Physiotherapy in Mental Health (PiMH) SIG for some months 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.

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.


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). On 30 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 on 8 July 2021 met with Health Transition Unit senior staff to continue this advocacy.

PNZ 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.

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.


Ministry of Health

In July 2021 PNZ Chief Executive Sandra Kirby and Professional Advisor Chris Bloomfield met with Dr Martin Chadwick, Chief Allied Health Professions Officer, and Becky George, Principal Advisor. PNZ shared the work we are doing on outcomes and on the health system changes. Other topics raised included:

  • Vaccinations for physiotherapists. We remain concerned that physiotherapists in Counties-Manukau DHB appear to have difficulty accessing vaccination.
  • Long Covid – the Ministry are developing some work on managing long Covid. We stressed the vital role for cardio-respiratory physiotherapy. We expect the CRSIG will be included in any project development.
  • The role for physiotherapy in long term conditions such as osteoarthritis, chronic pain, cardiac rehabilitation and pulmonary conditions. We continue to push for better access to evidence based physiotherapy care while we wait for health system changes.

Osteoarthritis Models of Care

PNZ President Ben Hinchcliff, Sandra Kirby and Chris Bloomfield represented PNZ at the Taupuni Hao Huatau Kaikōiwi: Osteoarthritis Basecamp on 10 July 2021. This was focused on improving the management and treatment of osteoarthritis in NZ. New Zealand and international experts came together to shape recommendations to be put to government ministers, health funders and policy makers in November 2021. Physiotherapy had a great presence and is critical to addressing this issue.


Minister Meetings

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.


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 were 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 facilitated the session which included people from the Policy, Service Performance & 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). This is a true collaboration for funding with 17 groups contributing.


    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 followed 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 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 understand 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 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. PNZ members have been actively supporting the Physiotherapy Board and PNZ has made submissions in the development of these scopes.

    Page updated October 2021