A brief summary of some of the activities NZPPA has been involved with over the years
Reciprocal registration with the Chartered Society of Physiotherapists in England was cancelled in 1970 and accordingly the advantage of its low cost premium and cover was lost. With approximately 14 Acts under which a physiotherapist may be prosecuted, insurance is a necessity.
With 60 members the Association instituted its own scheme in 1972 with the General Accident Insurance Co, for which the NZPPA was the agent. All insurance (fire, household, all risks) could be purchased through the Association and gave the NZPPA a commission from those sales.
The NZPPA changed its insurer to the Medical Protection Society in July 1992 thus establishing a legal protection system which was new to New Zealand Physiotherapy and proved of value.
NZSP later adopted a scheme from a competing company Minet Insurance. Because two schemes were being offered the issue of professional insurance was a divisive one for a number of years. The NZPPA commissioned a report from an Auckland barrister and solicitor, Marguerite Brien, in 1995 to examine both the MPS and PNZ’s Insurance Policies in the hope that a balanced and objective opinion may help resolve the problems. This report was published in their Newsletter.
The NZPPA has run a locum and employment agency since the early 1980s and these were an important function of the early Association, continuing to a much lesser extent in 1999.
The Association deliberately did not run courses on clinical skills because they felt other clinical SIGs catered for this need. Instead the Association ran numerous courses on management skills to give members an awareness of the real meaning of running a small business.
Two geriatric courses run in 1987 were an attempt by Barbara Hetherington to persuade the physiotherapists working long hours in rest homes to charge realistic fees and join the Association. Part time subscriptions were introduced to cater for this group of practitioners, a policy later adopted by PNZ.
A computer group (now defunct) was established in 1993, providing information about the ever changing computer market.
A patient profile to assist in forward planning and marketing was called “One day in September”. This entailed coding all patients seen by members of the Association in New Zealand on one day in September 1989. Details about disease/accident, age, sex, conditions etc were recorded. The NZPPA conducted a back care survey in 1984 to provide further information about treatment and outcomes in back patients.
The Inter Practice Comparison (IPCs) surveys were sent to members annually (about October) and returned to the financial advisors Peat Marwick who computed the financial results of each practice and returned the results to individual members. These results showed the economic viability of the practice in relation to other practices about the same size in the district and against the National average and were discontinued in 1994.
The NZPPA employed two firms in 1989 to establish a marketing strategy, with the aim of increasing public awareness of physiotherapy. Brochures with an identifiable logo were developed, published and distributed by NZPPA in 1990.
A marketing strategist was contracted in 1996 and their work showed the importance of General Practitioner referrals. As a result of this the Association compiled the Physiotherapy Referral Handbook (originally named the National Physiotherapy Handbook) with a copy being supplied free to every General Practitioner in the country. Peter Melvin and Jenny Stuart did much of the work on this. Membership of the NZPPA showed a marked but temporary increase in 1997 as a result of physiotherapists’ desire to be included in the handbook.
Another important distribution in 1997 was the NZPPA Practice Manual which provided advice and information on the setting up and running of a private practice. This had originally been produced in the early 1980s but was updated and given a new format in 1997.
The NZPPA concern about quality in 1983 led them to suggest changes to the Code of Practice. They committed to accreditation in 1988 and began the accreditation scheme in 1989 initially as an internal standard. The New Zealand Physiotherapy Accreditation Scheme (NZPAS) has grown to be a major scheme for both the NZPPA and PNZ.
The Adverse Reaction Reporting Scheme was introduced by the NZPPA in 1994 and had a steady stream of reports. This is now run by PNZ and has developed into a useful database for physiotherapists who face claims under the ACC medical misadventure scheme.
Initially the NZPPA felt the NZSP were not active in assisting private practitioner members. When Michael Lamont became National President of PNZ in 1982 the two groups worked closely together continuing when Barbara Hetherington was elected to Executive.
Two meetings were held in 1987 with the Executive of the Hospital Physiotherapists Association resulting in better understanding between the groups. The Association also assisted physiotherapists working in units in special schools as well as physiotherapists employed in private practice.
There were some difficulties between the NZPPA and PNZ in 1994/1995. They were largely to do with insurance and two meetings between the two executives were held to resolve the differences, assisted by facilitator Judith Morland. Gillian Webb sat on both PNZ ACC Committee (1996/8) and was NZPPA President in 1995/7, and felt there were improving communications between the groups.
To assist private practitioners to adapt to further health reforms in 1996 the NZPPA and PNZ held a joint workshop to develop a closer and co-ordinated action within the profession. In 1997 the NZPPA supported the ACC Committee by providing financial assistance to Ian Carrick and Gillian Webb on the ACC Committee.
Gillian Webb was appointed President in 1995, to be succeeded by Ian Carrick in 1998.
Policies and plans established in 1993 gave clear direction to both Executive and members. In an effort to make Executive more available to members, in 1993 meetings were held in various centres and each executive member had responsibility for a Regional Health Authority (RHA) area.
Typically the office was busy in 1994 with submissions, meetings and reports to such diverse interests as Health Information Retention, ACC stakeholder, Immigration, Electrical Regulations, Medical Practitioner’s Bill, Privacy, to name but a few.
A postal survey sent to the 470 members in 1995 showed that many were young in business experience. The Executive Committee held a workshop in 1996 focussing on private practice and the future and endeavouring to see where physiotherapy private practice may be in 2006.
There was a major change in structure and focus in 1998 with the aim of providing the private practitioner with business skills and information to survive the ever changing health sector. New developments meant there was no longer the need for such a large executive and it was reduced to four. Key portfolios were devised - data base development, business development, marketing, membership, as well as health sector liaising. Because of the continuing evolution of the NZPPA, rules were revised in 1995 and 1999.
Postal ballots about incorporation were sent to members in 1996 and 1998 and the Association was finally incorporated in July 1999. Most work for the NZPPA in the late 1990s has been driven by the health reforms.
Changes to contracting with RHAs in 1992 caused problems for members; it was difficult for a central organisation to give members direction as the local scenes were so variable. An encouraging trend in 1992 was to see local groups get together to co-operate in new developments. Discussions between RHAs and physiotherapy providers continued in 1993. By 1994 the RHAs still had not moved effectively into contracting with physiotherapists, in part delayed by the ACC move to become a funder/provider.
The Association made continued submissions on the “Guidelines for Acute Low Back Pain” published by the ACC/NHC Committee. The need for research to validate physiotherapy was clear.
The Association focussed on development of the PINS (Physiotherapy Independent Network) concept in preparation for contracting. When Gillian Webb was Chairperson on the ACC Committee in 1997 she observed how the ACC funder/provider split would affect private practitioners. It was obvious the funders would have control over how and when health funds would be spent.
The Association’s accreditation scheme would become increasingly important.
Changes in the Accident Insurance Bill in 1999 with six more funders in the market meant the position of physiotherapy and what can be achieved needed to be continually enhanced. Ian Carrick and Gillian Webb with Peter Larmer made representations in this area, along with submissions by PNZ. The election of a new government in November 1999 meant that these changes could be reversed.
The need for accurate information for funders, led the NZPPA to develop a data base in 1998 with information about conditions treated, numbers of treatment, and-outcomes.
The use of tools which will become the cornerstone of benchmarking were advocated in the 1998 NZPPA Newsletter. Members were encouraged to use the ICD9 CM coding system and a range of functional outcome measurement questionnaires. Executive hoped groups of like minded physiotherapists would come together to discuss their strengths and weaknesses in practice.
Following the 1999 AGM a clinical audit pilot study was undertaken by six practices whereby a functional outcome form was completed prior to, and at the end of, a series of treatment. Collection of data was complete and ready for analysis in September 1999.
The direction of healthcare in New Zealand towards integration with other health professionals and integrated care models showed the need to position private physiotherapists as key players in the health sector. The NZPPA fostered this through discussions with medical insurance companies and other key players in the Health Sector such as management organisations.
NZPPA has conducted two-yearly remuneration surveys since 2004.
In 1999 the NZPPA office moved to Christchurch and Lisa Thomson took up the role as part-time Office Administrator. This is the year in which NZPPA established its website, and, following Lisa’s appointment, new services came on stream. They included NZPPA mousemats, individual employment agreement templates for permanent staff, contractors and locums, and the continuation of the directory of member practices for distribution to GPs nationally
In 2000 NZPPA adopted the slogan “The Business of Physiotherapy”.
In 2005, the Executive following a strategic planning exercise, decided to place the Association on a firm business footing, by employing a Business Manager. This would enable the Association to be professionally managed and developed allowing the Executive to move into a governance role. It was decided the office should be re-located to Wellington and that the part time administration role would also become fulltime.
Following incorporation the NZPPA Rules have been amended twice to align them with the Society’s rules and to ensure consistency and clear interpretation of the various clauses. The NZPPA financial year now runs April to March and the AGM is held by June each year.
In 2006, the bi-monthly newsletter was replaced with a quarterly magazine. Situations Vacant and locum advertising was dropped from the magazine as the website has become the preferred forum for advertising.
In more recent years, NZPPA has been involved in a range of advocacy activities. Executive members have represented NZPPA on:
NZPPA is a member of the ACC Physiotherapy Liaison Group.
Informal relationships are in place with the British and Australian counterpart associations - Physio First and Physiotherapy Business Australia respectively. These relationships include sharing of publications, magazines and website listings.
In 2006 and 2009, NZPPA surveyed members on the Patient Management Systems currently in use and published the results in Physio Focus magazine. The NZPPA website was also revamped and re-launched in 2006.
In 2000 and in 2006, NZPPA developed submissions for the review of Cost of Treatment Regulations.
In 2001, NZPPA contributed to the Injury Prevention and Rehabilitation Bill and Hip Fracture guidelines and in 2002-03 the HPCA bill.
In 2007, the Minister for ACC initiated an Independent Review of the way in which physiotherapy services are funded and accredited by ACC. The terms of reference for the review include such matters as:
Peter Brown, NZ First MP was alerted by lobby groups to “issues” in the sector. This review arose from the NZ First confidence and supply agreement with the Labour Government. NZPPA has made a written and an oral submission to the review to date.
NZPPA has been a member of the IPPA since 2000. Scott Thomson has been an Executive member of the Association and in 2007 was elected as Vice Chairman and 2011 elected as Chairman.
The EPN pilot was initiated by ACC in 2000 with the support of NZPPA. NZPPA held regular meetings with its members who were part of the pilot to monitor progress, provide support and hear issues. The EPN framework and contracts were rolled out from 2005 and now more than 70% of private practices are on EPN contracts.
The NZPAS scheme was finally wound up in October 2006. The history of the NZPAS and the relationship between the NZPPA and the NZPAS is summarised in Appendix 2.
The Executive currently comprises six members and meets up to four times a year. Appendix 3 lists the NZPPA and NZPAS Executive from 2000.
In 2010, NZPPA embraced PNZ’s new brand and changed its trading name to Physiotherapy NZ Business.
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