Advocacy

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.


Election Briefing

In the approach to the 2023 General Election and forming of the new government, PNZ prepared a political briefing to identify what needs to change to support physiotherapists in leading improved health outcomes for Aotearoa. This includes a call to act on evidence and fund physiotherapy in primary health, and for ACC to meet the real cost of treatment and ensure a sustainable workforce.

With Ministers sworn in during late November, we’re continuing our advocacy with the government including Minister of Health Dr Shane Reti and Minister for ACC Matt Doocey, to ensure these and other Ministers are aware of and support the critical role of physiotherapists. As part of this work a public message to the incoming Minister of Health highlighted that physiotherapists can and should be part of the solution in easing the chronic pain and pressure on our health system. This was followed by briefings for incoming ministers sent in December from PNZ President Kirsten Davie.

Thank you to all members for your advocacy support. Please feel free to use these messages in any conversations you have with Ministers and government agencies. Matt Doocey is also an Associate Minister of Health, along with David Seymour and Casey Costello. Melissa Lee is the Associate Minister for ACC.


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, PNZ has worked actively with the Future of Health Transition Unit on behalf of the physiotherapy profession. Read about opportunities for physiotherapy in the new system and how our work with NZIER on Better Outcomes through Increased Access to Physiotherapy provides evidence to position primary care physiotherapy for long term conditions as the best health funding option.

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 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.

In December 2021 PNZ made submission on the Pae Ora (Healthy Futures) Bill which provides for the structure and accountability arrangements for the publicly-funded health system, in order to protect, promote, and improve the health of all New Zealanders.

Previous PNZ President Mark Quinn and Chief Executive Sandra Kirby met with Minister of Health Hon Dr Ayesha Verrall in April 2023, with a focus on discussing physiotherapy in the new health and disability system. The Minister spoke about the role for physiotherapists within the implementation of the Pae Ora (Healthy Futures) Act, with the meeting also covering other topics including models of health delivery, funding primary care providers, and immigration. We know the critical role of physiotherapists is in the Pae Ora plans and we have the evidence. Action is next step, and we’ll be continuing to engage with Ministers to achieve this.

Further work with Te Whatu Ora and Manatū Hauora (Ministry of Health), advoacting for physiotherapy in the new health and disability system, is outlined below.


ACC

PNZ meets regularly with ACC to convey member concerns, request further information and identify barriers to service delivery whilst promoting positive solutions. ACC feature in Physio Matters, send their own ACC Provider Updates, and are present at national PNZ events. Hon Matt Doocey is the Minister of ACC and Kate Jerram is our  Health Partner, primary contact.

The PNZ Executive welcomed ACC Chief Executive Megan Main and Deputy Chief of Partnerships and Prevention Tane Cassidy to the June 2023 Executive meeting, where ACC presented their new 10-year strategy Huakina Te Rā.

Following our ongoing call for an independent pricing review of the Allied Health Contract, the terms of reference for this are now agreed upon. The review is limited to physiotherapy funding under the Allied Health Contract including physiotherapy specialists. ACC and PNZ have agreed to proceed with the review and are keen to have this completed in the first half of 2024. Results will be shared with PNZ members.

Pay Equity For Healthcare Workers

When the pay equity settlement for Te Whatu Ora Allied, Scientific, and Technical employees was announced in October 2023, PNZ challenged ACC to review and update the rates within their contracts. Read our communications and their responses here.

In December 2023, ACC undertook an analysis of the impact of the public pay equity settlement and presented it to their Board. As a result of this ACC issued contract variations that included a 4.2% uplift  to the direct costs component of the allied health contract rates, outside of the annual pricing review.  PNZ sought clarity on ACC's calculations to better understand them. ACC provided comprehensive information on how the figure was determined ACC Allied Health Pay Equity Update. Here members will find valuable information on how pricing for the Allied Health contract is constructed.

PNZ President and Chief Executive met with ACC twice during the week of contract dissemination to ensure ACC are aware of the financial pressures on business viability in light of the gap between the contract variation and the reality of salary increases. PNZ impressed on ACC that the actual cost change in salaries is in the order of 20%. PNZ have shared your feedback that the issues of staff recruitment and retention are at crisis point. 

ACC asked that PNZ members feedback any questions on their proposed percentage variation in response to the pay equity settlement to health.procurement@acc.co.nz. We encourage you to take the time to share your questions and feedback through this mechanism. 

Rehabilitation Improvement Group

The ACC Rehabilitation Improvement Group (RIG) has spent time with providers and employers across the country, and alongside their frontline teams, to understand what clients need and want from the rehabilitation system, how the system meets that need, what works well, and what doesn’t. This work is now in its design phase, and PNZ has representation within the RIG from one of our Executive members. Read more about ACC Rehabilitation Improvement Group at acc.co.nz and see their RIG presentation from PNZ Business Symposium 2023.

Cost of Treatment Regulations (CoTR): Ministry of Business, Employment and Innovation (MBIE)

Cost of Treatment Regulations is managed through MBIE and administered by ACC. 

Ministry of Business, Employment and Innovation (MBIE) announced a 9.36% increase for payments to physiotherapists who bill under the CoTR, effective from 1 April 2023. This was followed by a request for submissions in May 2023 on another CoTR consultation document. Our full submission to the October 2022 consultation is available here. Main points include:

  • 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.

PNZ expressed their concern regarding the delay in implementation given that the 2022 CoTR consultation process has been completed and is still awaiting formal approval. .

In summary the 2023 PNZ submission supported our belief that the current system lacks the flexibility, quality measures and processes to reduce inequitable access to quality evidence informed services that are inherent in the ACC policy drivers.

PNZ is therefore calling for a full review of the Cost of Treatment Regulation Model.

Thank you to all members who contributed to these submissions. For any questions on CoTR please contact ACC at cotr@acc.co.nz.

Integrated Care Pathways Musculoskeletal (ICPMSK)

This is ACC’s provider-led service, replacing their former Escalated Care Pathway. The integrated care pathway is for moderate to high injury and non-injury complexity claims.

A tender process for the ACC Integrated Care Pathways Musculoskeletal (ICPMSK) service opened on 30 August 2023. The first round of procurement is now complete with all applicants informed of their outcome. A second round of applications opened on 15 January 2024; a continuous series of procurement rounds will be available throughout 2024.

More information on ICPMSK is available at acc.co.nz with tenders made through the Government Electronic Tender Service. Please also refer to the ACC website for how to apply for the ICPMSK service contract.

Physiotherapists signing medical certificates

As per ACC’s current legislation, only GPs, Nurse Practitioners and Medical Specialists can issue ACC medical certificates. PNZ is advocating for a change to this legislation to enable physiotherapists to also sign medical certificates for patients under ACC, which will align with the certification practices for non-ACC related conditions. This motion is supported by the Royal New Zealand College of General Practitioners (RNZCGP). We propose that such a change would alleviate health system pressures, particularly in rural areas where access to GPs is limited. For information on the current scope of practice please refer to the PNZ webpage on can I sign medical certificates.

      Payments

      PNZ has  long advocated for an increased payment rate that would cover the average co-payment for Community Service Card holders. This would facilitate access for Māori, Pacific and low income people. The ACC pilot scheme in South Auckland testing the use of Community Service Cards is ongoing. PNZ are waiting for the pilot results with interest.

      Physiotherapists can ask ACC for assistance with co-payments for clients that are unable to afford them, where co-payments are 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 to reinforce our call for a review of contract pricing.

      PNZ have 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 pnz@physiotherapy.org.nz.

      Proof of PNZ Membership for ACC Allied Health Contract application

      One requirement of the Allied Health Contract is for all staff working on the contract to be members of PNZ. 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 pnz@physiotherapy.org.nz.

      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:

      • 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

      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 continues to raise concerns around Assisted Recovery, including in our briefing to the incoming ACC Minister and when meeting with ACC Deputy Chief of Partnerships and Prevention Tane Cassidy in November 2023. This item is one of our priorities in all communications with ACC, due to its impact on members.

      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, and in June 2022 a Select Committee report was 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. An ACC Maternal Birth Injuries webinar held in February 2023 is also available, providing a useful guide for members working in this area.

      Invoicing

      PNZ questioned ACC throughout 2022 about delays in their payments following concern from members and the impact on physiotherapy businesses. We have been told by ACC that this is now resolved, and as of early 2023 thier team is no longer reporting invoicing backlogs. However, we continue to welcome feedback from members if you are experiencing invoicing delays.

      Home and Community Support Services

      The Integrated Home and Community Support (IHCS) contract is coming to the end of its term in March 2024, which ACC will be replacing with two new services: 

      • Home & Community Support – Return to Independence: For clients who need support temporarily
      • Home & Community Support – Maximise Independence: For those with long-term or lifelong needs

      Read more about these new services at acc.co.nz including a 10 August 2023 webinar.

      Other

      ACC is considering restarting work that was commenced late in 2020 to look at physiotherapy treatment and an injury prevention approach for injurie in school children. They have indicated that they will be seeking PNZ input during 2024 to develop guidelines for physiotherapists managing children with musculoskeletal injuries, which will include injury prevention and injury management guidance.


      Health New Zealand/ Te Whatu Ora

      The Pae Ora (Healthy Futures) Act became law on 1 July 2022 radically restructuring our public health system. The new health system is to be nationally planned, regionally empowered and locally tailored. 
      • National teams are to reduce duplication and improve consistency.
      • Local teams will support a place-based approach to decision-making within communities.
      • Regional teams weave together the national system with local aspirations.

      The new centralized structure is balanced by the development of localities to ensure that despite central control, priorities are set by locals for local-led solutions. The establishment of localities is a fundamental part of the health reform. Localities do not commission services directly but plan and make recommendations to Te Whatu Ora. They must
      provide a minimum and consistent range of core services to meet local needs. Physiotherapists, practice-based pharmacists, paramedics and kaiāwhina are the named professions stated as a minimum requirement for extended care. 

      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; this was flagged through the Government 2022 Budget announcements.

      2023: As regional Te Whatu Ora structures and borders developed in consultation with Iwi, PNZ consulted with Te Aka Whai Ora and Te Whetu Ora highlighting the value of physiotherapy. PNZ continued to develop connections with active localities and encouraged members to connect within their locality.  

      2024: Meetings are planned with Health New Zealand's National Commissioning team's Director of Living Well Martin Hefford to talk about the role of Physiotherapy in primary care and how members might best engage with funding models as they are revealed. 

      PNZ has met with the Regional Wayfinders to directly advocate for the commissioning of physiotherapy within primary care. Four Regional Wayfinders have recently been appointed and are currently commissioning their teams:

      Northern -Danny Wu, Te Manawa Taki -Nicola Ehau, Central -Tricia Keelan, Te Waipounamu -Chiquita Hansen. 
      PNZ is advocating directly to the Regional Wayfinders for funding models of primary care that include physiotherapy. 

      From time to time, we're being asked for physiotherapists who are interested in providing input into this work, including local contacts. If you'd like to be involved please contact Sandra Kirby. if you have concerns or queries please direct them to the PNZ office staff so that we can speak to them on your behalf or direct you appropriately.

      Te Whatu Ora released their Planned Care Taskforce Reset and Restore Plan in October 2022. The Allied Health Advanced Clinical Practice Capability Framework was finalised in November 2023 after having undergone several endorsement processes. This prototype is part of a musculoskeletal pathway development that will be used for the national rollout of the Orthopaedic Triage programme between now and June 2024. PNZ supports the role of physiotherapists in reducing orthopaedic wait times.  


      Manatū Hauora: Ministry of Health (MoH)

      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.

      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 an overarching New Zealand health strategy and strategies for Hauora Māori, 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.

      Manatū Hauora continue to work on the six health strategies for all New Zealanders, with a focus on including voice of the customer feedback such as that provided by PNZ on the Women’s Health Strategy.


      Immigration

      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:
      1. Employer accreditation | 10 working days
      2. 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
      3. 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.
      1. The Green List of professions which provides immediate residency.
      2. 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.

      Immigration Green List

      In April 2023 physiotherapists were added to the Immigration Green List Straight to Residence pathway. Having been previously excluded from this list, PNZ strongly advocated for the inclusion of physiotherapists and thank all members who have supported this work. Please read more here including the announcement from Immigration Minister Michael Wood and Health Minister Dr Ayesha Verrall. As noted in the statement from parliament, eligible people are able to apply from 29 May 2023.


      Therapeutic Products Bill

      PNZ and our Māori partner Tae Ora Tinana both made March 2023 submissions on the Therapeutic Products Bill. The Bill was intended to replace the Medicines Act 1981 and the Dietary Supplements Regulations 1985 to provide for the regulation of therapeutic products.

      Read the PNZ submission, and the Tae Ora Tinana submission including our concerns regarding physiotherapists administering medicines, and the insufficient consultation that occurred with groups representative of a wide range of Māori practitioners. The new coalition government has included the redaction of the bill in its 100-day plan.


      COVID-19

      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 on 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 funneled 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, Te Whetu Ora, Localities 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). This report is available at alliedhealth.org.nz.


          Page updated March 2024