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.
Like many organisations a core challenge is to use limited resources to effectively advocate for the profession. To do this our advocacy focuses on a few key areas and uses our unified structure to provide a single advocacy voice.
Our areas of advocacy are shaped by member feedback through channels such as PNZ’s annual surveys, research projects and leadership days. We also adjust for environmental factors, like COVID-19 and Government changes, as demonstrated in our current advocacy work below.
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.
Briefing for the Incoming Minister
With the 2020 General Election in October, we have worked with NZIER on a Briefing for the Incoming Minister (BIM). Government departments provide a BIM for the new Minister after an election and many organisations such as PNZ write one to highlight key issues. This is important in positioning physiotherapy as a key stakeholder for the incoming Ministers of Health and 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. Our advocacy work with ACC includes the following.
- 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.
- Through 2020 we have also asked ACC to review their updated provider engagement structure, following member feedback that ACC is less contactable within the new structure. ACC have indicated that they are not looking to change and we continue to advocate for this. See below for more information on Assisted Recovery.
- Payment processes from ACC remain an ongoing discussion. PNZ works directly with ACC on matters related to physiotherapy contracts – both the primary care contracts including the physiotherapy contract (formerly known as the EPN) and secondary care contracts such as the Vocational Rehabilitation contracts.
- We also work with the Ministry of Business Innovation and Employment (MBIE) who are responsible for the Cost of Treatment Regulation (COTR sometimes known as Regs). Changes to COTR are dictated by Government and affect all the professions working for ACC.
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.
ACC Assisted Recovery
Concerns about the national roll out of ACC’s Next Generation case management have now been bubbling for more than 12 months. While simple cases can be managed by the client seamlessly, the ongoing issues relate to the lack of timely responses or at worst no response from ACC’s Assisted Recovery team. We 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.
As you know the Assisted Recovery team manages clients with the complex needs requiring co-ordinated rehabilitation programmes to help them return to work, get back to work or to their lives. This does not just affect physios but all primary care practitioners for ACC. Complaints are coming from all professions and from clients. We have been raising this through our regular liaison, and have had the issues acknowledged. We are now raising the issues with ACC leadership to escalate the concerns and will keep you updated.
ACC informed PNZ in January 2021 that the response rate for emails has dropped to two working days (down from over 10) and the average wait time on phone calls is now under 20 minutes. While it is good that ACC have managed to reduce the backlog over the quiet holiday period, the test will be if this can be maintained with the return to normal service as people return from holidays.
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.
Advocacy regarding COVID-19 has been a key area this year and with modelling suggesting that COVID-19 management will be ongoing into 2021 we need to be prepared that Aotearoa may again be in higher alert levels at short notice.
In May 2020 PNZ made a submission to the COVID-19 Epidemic Response Committee highlighting the impact on physiotherapy businesses and reminding MPs about the importance of our profession within primary healthcare.
More recently together with the Physiotherapy Board of New Zealand we have asked the Ministry of Health (MoH) to broaden the conditions in which physiotherapists can operate at higher alert levels. In September 2020 PNZ met with Chief Allied Health Professions Officer Martin Chadwick to propose that in-person physiotherapy treatments be permitted in Alert Level 3. However this was not agreed and MoH guidance is that physiotherapists provide treatment via telehealth. Our position remains that the work of physiotherapists justifies being open in Alert Level 3 and will continue to revisit this with MoH.
In August 2020 the CRSIG, supported by PNZ successfully negotiated with MoH and the Infection Technical Advisory Group to develop and publish the Respiratory physiotherapy guidelines for managing patients with COVID19 infection here.
In October 2020 MoH released a discussion paper seeking feedback on their continued approach to Allied Health services through COVID-19. With this partly a result of our advocacy work asking the Ministry to review their COVID response, PNZ sought member feedback on the paper and made a submission. Thank you to all the individuals and groups across PNZ that provided input into this, allowing us to offer a united submission to MoH. MoH have noted that the outcome of this consultation will be a set of principles that help balance the trade-off between Protection & Prevention on one side and Health & Wellbeing on the other.
In addition, we’re advocating to MoH and the Aged Care Association for physiotherapists to have increased access to patients in aged residential care during alert levels. This is a challenging balance between protecting the frail elderly from infection and ensuring that this vulnerable population are able to maintain existing levels of mobility and maintain health. While the aged care sector are currently erring on the side of preventing infection this is not being consistently applied. It is another ongoing conversation.
Physiotherapy in Alert Level 3
While the results of the MoH consultation and PNZ submission on their approach to Allied Health services through COVID-19 are yet to be released, Chief Allied Health Professions Officer Martin Chadwick confirmed at a meeting in February 2021 that there are no changes planned for the list of essential service providers or service delivery at Alert level 3.
MoH accept there is an impact on wellness for many people and Dr Chadwick stressed that all health services, including GPs, are expected to deliver telehealth as the first option in Alert level 3. Physiotherapists and all other community based allied health providers can provide urgent care, with the definitions of urgent set out here. The Government response on early, short lockdowns in part recognises that longer lockdowns have the greater impact on wellness.
PNZ will continue to advocate on this issue, and for physiotherapy access to aged residential care at all alert levels. In aged residential care even a short term change can be irreversible and facilities have had stricter conditions than the general community.
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 February 2021