APWP Final Report April 08 08-05-08

8/14/2019 APWP Final Report April 08 08-05-08

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Acknowledgements

The lead authors of this document are:

Janice Mueller MBA (Distinction), ADP (Paediatrics), MNZCP

Director of Allied Health, ADHB

Lynne Taylor MBA, MSc, MNZCP

Senior Lecturer, AUT University

Janet Copeland BA, MHealSc (Rehabilitation), MNZCP

Research and Professional Development, NZSP

Jonathan Warren Dip MT, PGD Sports Med, MHSc, MNZCP

Private Practitioner, President NZSP

G. David Baxter TD, BSc (Hons), DPhil, MBA, MCSP

Dean, School of Physiotherapy, University of Otago

Steve White MHSc (Hons), Dip Public Health; MNZCP

Senior Lecturer, AUT University

The working party gratefully acknowledges financial support for this work from the

New Zealand Society of Physiotherapists and the New Zealand College of

Physiotherapy

Contact details

Janice Mueller & Lynne Taylor

New Zealand College of PhysiotherapyPO Box 27 386

Wellington

E-mail:[email protected]

Published in 2008

by the New Zealand Society of Physiotherapists & New Zealand College of Physiotherapy

Advanced Practitioner Working Party.

This document is available on the NZSP website

http://www.physiotherapy.org.nz

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http://www.physiotherapy.org.nz/http://www.physiotherapy.org.nz/http://www.physiotherapy.org.nz/


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Introduction

The Advanced Practitioner Working Party is a joint project between the New Zealand

College of Physiotherapy Inc. (NZCP) and the New Zealand Society of

Physiotherapists Inc. (NZSP), which arose from a request from the profession to

consider how it could enhance future physiotherapy services in light of current and

future healthcare requirements.

The Working Party was asked to:

Examine both the scope and recognition of the role of Advanced

Practitioner within the physiotherapy profession in New Zealand and

develop a set of recommendations for consultation with the profession and

key stakeholders.

To answer this question, the Working Party developed a Consultation Document

which was sent to health provider groups in November 2007 for comment. The

overwhelming majority of submissions supported the proposal for recognition of

physiotherapy specialisation, though there were a range of suggestions regarding

the title, qualifications and experience required for such a role. These suggestions

and comments have been incorporated into the recommendations detailed in this

report.

In considering a role for physiotherapy specialisation, it is important that any title and

definition of physiotherapy specialisation is relevant and meaningful to New Zealand

consumers, employers and purchasers of physiotherapy services.

It is also important that any recommendations are placed in the context of the current

New Zealand health environment and the role physiotherapists already play.

Physiotherapists act as independent practitioners, as well as members of health service

provider teams. The majority of physiotherapists (51%) work in either private

practice as primary healthcare providers or as members of health provider teams,within the provider arm services of District Health Boards (30%)New Zealand Health

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Information Service, 2007). New Zealand physiotherapists are recognised as first

contact practitioners, meaning patients may seek their services directly without

referral from another health professional.

There is currently no statutory or formal recognition of physiotherapists with

additional qualifications and experience, although the potential for physiotherapists to

expand and enhance the role they play within the health and disability sectors is

evident in the literature. In particular a recent independent review of physiotherapy

services in New Zealand led by David Goddard QC endorsed the concept of

specialisation, and stated it had the potential to provide significant advantages to

claimants, to reduce administrative costs for ACC, and to encourage the retention and

motivation of senior highly qualified members of the profession (Review of the Way

in Which Physiotherapy Services are Funded by ACC, 2007). It is anticipated that this

new role will provide substantial benefits to the health and well being of the New

Zealand public who will be able to identify Physiotherapy Specialists within defined

fields of healthcare.

Given the positive response to the consultation, and the potential benefits to

healthcare in New Zealand, the Working Party is committed to seeing action on this

critical issue for the profession.

Process

The initial business of the Working Party was primarily completed over a period of

eight months through four one-day meetings hosted at the Societys offices,

supplemented with regular communication between members of the Working Party.

As part of its deliberations, the group considered and reviewed a range of documents

including:

a. The New Zealand College of Physiotherapys current advanced practitionerframework;

b. Preliminary results from the Societys Membership Survey;c. Relevant published Strategies relating to New Zealand healthcare;

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d. Reports and strategy documents available nationally and internationally, includingthe most recent consensus statement from the World Confederation for Physical

Therapy; and,

e. Published literature relating to physiotherapy advanced practice.

Following this a Consultation Document outlining the Working Partys main

proposals was sent to all members of the NZSP, and other interested stakeholders

including other professional organisations and regulatory bodies, the Accident

Compensation Corporation, the Ministry of Health, and Government Ministers with

health-related portfolios.

The Consultation Document briefly reviewed the recent history of physiotherapy

specialisation and the evidence to support this within a national and international

context, and then detailed the individual elements of the Working Partys proposal to

the profession.

These included:

1. The proposed title for this role;2. Defining the scope of a Physiotherapy Specialist;3. Requirements for physiotherapy specialisation;4. Considering who would have the responsibility for recognition and monitoring

of the Physiotherapy Specialist process;

5. Defining specialty areas of physiotherapy practice; and6. Defining extended scopes of practice for physiotherapists.

The rationale for each recommendation was outlined and questions were asked to

prompt feedback from interested parties. There were one hundred and nineteen

responses to the consultation document; the following report is based on the analysis

of these results.

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Results

1. Title

The initial proposal was:

The Working Party proposes that the title for this new role be Specialist

Physiotherapist.

The majority of respondents agreed with this title with the proviso that the area of

specialisation was also included, although there was a strong argument put forward by

some respondents for the title to be Physiotherapy Specialist. The rationale behind

this suggestion was that it was more in line with titles given to other health

professionals who held additional qualifications (e.g. cardiac surgeon) and was

therefore more likely to be relevant to the public. The need to promote the profession

first and foremost as physiotherapy was discussed; in particular it was recognised

that consumers were more likely to look for our services and identify with a title

beginning with Physiotherapy rather than Specialist.

The Working Party is cognisant of the proposed Career Framework developed jointly

by the Ministry of Health (MoH) and District Health Boards New Zealand (DHBNZ).

Although this framework has the scope for advanced practitioner the Working Party

note that this is a position created within an organisation. In contrast, the proposed

role of Physiotherapy Specialist is directly related to the individual not a career

framework, and is therefore transferable across different employment environments. It

was also noted that 51% of physiotherapists are in private practice and the proposed

Physiotherapy Specialisation could form a component of a quality assurance

mechanism for this group of practitioners. From information currently available it is

thought that up to 10% of the profession would currently be eligible to apply to

become a Physiotherapy Specialist.

Recommendation: The Working Party recommends the title for the new role be

Physiotherapy Specialist (nominated area of expertise).

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2. Scope of Practice

In the Consultation Document the Working Party proposed the following description

for the physiotherapy specialist scope of practice.

A Specialist Physiotherapist is a physiotherapist who has formally demonstrated an

ability to apply advanced clinical competence in a defined clinical area, within the

scope of practice recognised as physiotherapy. A Specialist Physiotherapist will work

primarily in a specific area of clinical and /or teaching practice, but would be

expected to also be involved in research and evaluation and practice/service

development relevant to their practice setting.

The main concern with this proposed scope of practice related to the need for

involvement in research. Respondents highlighted the difficulties of participating in

research for the sole practitioner, especially in rural settings, and that the requirement

for involvement in research shifted the emphasis to academic activities rather than

clinical expertise. The Working Party reconsidered the rationale for inclusion of

research involvement within the scope of practice. We regard it as a method of

demonstrating an active contribution to the profession, but also acknowledge that

evaluation of practice, for example through clinical audits and practice/ service

development are also methods of professional contribution. However, the Working

Party remains of the view that Physiotherapy Specialists need to be critical

consumers of research, to enhance their clinical practice.

The focus of the proposed role was on clinical practice with the explicit aim of adding

value to the consumer. To better reflect this intent, the wording on scope of practice

has been altered accordingly.

Recommendation: The Physiotherapy Specialist is a physiotherapist who has

formally demonstrated an ability to apply advanced clinical competence in a

defined clinical area, within the scope of practice recognised as physiotherapy.

The Physiotherapy Specialist will work primarily in a specific area of clinical

practice, but would also be expected to contribute to the profession through

leadership, research and/or evaluation and/or practice/service development

relevant to their practice setting.

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Qualifications: There are currently a wide range of undergraduate and postgraduate

physiotherapy programmes available world-wide. The Working Party emphasise the

need for the required qualification for the Physiotherapy Specialist be a postgraduate

Masters, and not an entry level programme. For the Masters programme to be

acceptable it also requires a demonstrable component of research skills training. This

offers assurance that proposed Physiotherapy Specialists have expertise in critical

analysis of current research.

The NZ College of Physiotherapy recognises that they currently have members with

Advanced Practitioner status who would meet all the requirements for Physiotherapy

Specialist, while there are others who hold postgraduate qualifications but not a

Masters degree. The inclusion of the words Masters degree orapproved equivalent

accommodates the possibility of a grand parenting clause for clinicians who would

otherwise meet the criteria of a Specialist Physiotherapist and can demonstrate

postgraduate learning equivalent in content to current Masters degrees. It is

anticipated this approved equivalent will be for a limited time frame.

There was also concern regarding the time and cost of supervision and training of the

Physiotherapy Specialist. The Working Party acknowledges there is a cost attached to

any postgraduate education, whether that cost is borne by the individual or subsidised

by an employer. This has been the case for all physiotherapists who have chosen to

undertake postgraduate education in the past, and we do not believe physiotherapy

specialisation will increase this cost.

Recommendation: Qualifications

Physiotherapists applying for the Physiotherapy Specialist role should hold a

current Annual Practicing Certificate with a general scope of practice and a

postgraduate Masters qualification that demonstrates relevance to the area in

which the individual is seeking specialisation.

Experience: Despite some respondents suggesting the need for an increased amount

of clinical practice in the designated area the Working Party feels that four years full-

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Annual practising certificate with the Physiotherapy Board of NewZealand

Evidence of continued clinical practice within their nominated specialtyarea

Bi-annual peer review Continued professional development as required by the Physiotherapy

Board of New Zealand recertification criteria, with the majority of

activity (>50%) in their nominated specialty area and

Membership of a relevant professional association

The majority of respondents agreed with these requirements. There was discussion

regarding the requirements for evidence of continued clinical practice and whether

this should be replaced with the term professional practice. The Working Party

agreed the proposed specialist role is to support and develop a career pathway for

clinicians who have attained further postgraduate qualifications and clinical skills

within a specialised area, and have therefore retained the phrase: evidence of

continued clinical practice.

Bi-annual peer review was considered excessive and is replaced with biennial peer

review. It is anticipated that the format for peer review would follow the format

already developed by the NZ College of Physiotherapy for use by its members.

The Working Party considers that a minimum of 50% of a persons continuing

professional development in a designated area is sufficient to demonstrate continued

competence in that area. While an individual may choose to do more than 50% of

their continuing professional development in their nominated area, the Working Party

also recognises an increasingly holistic approach to healthcare and the need for

clinicians to access knowledge and learning activities across a range of clinical

practice areas. Therefore, the proposed continuing professional development

requirements provide clinicians with the flexibility to choose to devote a substantial

proportion of their professional development in professional activities outside of their

specialty area.

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Recommendations

- Annual practising certificate with the Physiotherapy Board of New Zealand

- Evidence of continued clinical practice within their nominated specialty area- Biennial peer review

- Continued professional development as required by the Physiotherapy Board

of New Zealand recertification criteria, with the majority of activity (>50%) in

their nominated specialty area and

- Membership of a relevant professional association

6. Recognition, implementation and monitoring of

Physiotherapy Specialist scope of practice

Three options that could be used to progress the model for the profession were put

forward for discussion:

The New Zealand College of Physiotherapy implements and monitors theprocess, taking full responsibility as an independent body;

The Physiotherapy Board of New Zealand recognises SpecialistPhysiotherapist as a specific scope of practice and monitors the process,

taking full responsibility as per the HPCAA; or

The Physiotherapy Board of New Zealand recognises SpecialistPhysiotherapist as a specific scope of practice and works collaboratively

with New Zealand College of Physiotherapy to assess applicants for the

new scope of practice.

There was widespread support for the Physiotherapy Board taking a leadership role in

this process and this is supported by the Board who acknowledged:

that the principle of recognition of specialist physiotherapists be endorsed as

desirable and in the public interest.

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Equally there was support for the NZ College of Physiotherapy continuing and

expanding the role they currently hold, utilising the structures and processes they

already established for recognition of specialisation. It was acknowledged that:

a working relationship be established with the College (and the Board) to determine

how this recognition can best be given.

Recommendation: The Working Party establish a working relationship with the

Physiotherapy Board to determine how this recognition can best be conferred

and monitored.

7. Nominated speciality areas of practice

The following models were put forward for discussion:

The New Zealand College of Physiotherapy currently endorses ten speciality

areas for their advanced practitioners, limiting it to those areas supported by a

clinical special interest group of the NZSP. These are: older adults, paediatrics,

womens health, occupational health, neurology, cardiothoracic, manipulative

physiotherapy, acupuncture, hand therapy and sports & orthopaedics.

These can be grouped into the following categories:

a population service group (i.e. older adults, paediatrics, womens health,occupational health) or

a recognised area of medical practice (i.e. neurology, cardiothoracic, handtherapy) or

a specific rehabilitation intervention (i.e. manipulative physiotherapy,acupuncture) or

a combination of both population and area of medical practice (i.e. sports& orthopaedics)

While the majority of respondents agreed with the current categories, there were

suggestions for both consolidation and expansion of specialisation categories. Some

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suggested consolidating the interventions such as manipulative physiotherapy and

acupuncture into an area of practice, for example musculoskeletal physiotherapy or

hand therapy. On the other hand, numerous suggestions were put forward for

expanding speciality areas, including pain, palliative care and health promotion.

In summary, the Working Party considers it is very important that any nominated

specialisation areas put forward are relevant and meaningful to the New Zealand

public.

Recommendation: Before proceeding further it was agreed to discuss the

suggested specialisation categories with consumer groups.

8. Extended Scope of Practice

The proposal in the Consultation Document was:

The Working Partys recommendation on extended scopes of practice is that:

Extended scopes of practice, within a recognised specialty area of practice will be

recognised when underpinned by:

Relevant postgraduate education from a recognised tertiary institute

This shall include relevant theoretical background and the assessment ofrisk and indications for use of the relevant practice

Relevant clinical practice

Supervised where considered appropriate

There was some confusion regarding the difference between physiotherapy

specialisation which was the focus of the Working Partys Consultation Document,

and Extended Scope of Practice. This led to concerns that the Working Party was

advocating for physiotherapists to undertake roles outside of their general scope of

practice, such as injection therapy or limited prescribing rights, for which they do not

have the requisite knowledge or skill levels.

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To clarify, the Working Party sees the role of the Physiotherapy Specialist sitting

within the current New Zealand scope of practice for physiotherapy. Extended scopes

of practice e.g. limited prescribing rights or injection therapy, are seen as sitting

outside of the current New Zealand scope of physiotherapy practice, and therefore

require specific additional education, and relevant supervised clinical practice.

Therefore, the Working Party takes the prudent approach that physiotherapists should

achieve the status of Physiotherapy Specialists prior to applying for any proposed

extended scopes of practice. These expanded roles would be congruent with their area

of specialisation and increased level of skills.

The Working Party is aware of the work that has already been done by the NZSP

Limited Prescribing Rights Working Party on an extended scope of practice and the

need for the two groups to continue to work closely together on this issue.

Recommendation: The Working Party recommends that a physiotherapist needs

to reach specialist status as defined in this document prior to applying for any

extended scope of practice. An application for extended scope of practice would

need to be supported by the relevant postgraduate education.

Summary

The feedback received on the Consultation Document was overwhelmingly in support

of the concept of physiotherapy specialisation; the Working Party therefore

recommends the establishment of the role of Physiotherapy Specialist. Further

consultation will now take place with the Physiotherapy Board and other key

stakeholders such as ACC and DHBNZ to determine how this position can best be

established and monitored.

It is also important that any new role, such as a Physiotherapy Specialist is evaluated

to ensure the original objectives of the position have been met. Consequently the

Working Party anticipates development of an independent pilot study to evaluate the

role in terms of its benefits to the consumers, employers and purchasers of these

physiotherapy services.

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The Working Party would like to thank all the physiotherapists and interested parties

who have taken the time to respond to the Consultation Document. The support given

for the proposed physiotherapy specialisation role has endorsed the Working Partys

findings and allowed a way forward to establish recognition of this role.

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Appendix 1- List of Individuals and Organisations who

submitted responses to the Consultation Document,

December 2007- March 2008

One hundred and nineteen responses to the Consultation Document were received

from the following individuals and organisations.

Haxby Abbott

Don Allomes

Margo Angland

Rebecca Armstrong

Jane Ashby

Hamish Ashton

Jo Ayers

Barbara Barbara

Lyndsey Bargy

Jennifer Baty Myles

Ruth Baxter

Storm Baynes

Karen Blakey, ACC (Rehabilitation Service Development)

Julie Bradley

Tanya Browne, Sports Physio

Miranda Buhler

Jackie Chiplin , NZ Association of Hand Therapists

NZ College of General Practitioners

College of Optometry

Jenny Collett

Jenny Conroy

Caroline Cross

Jill Cutfield

Margaret Davidson , ADHB Child Development Team

Jan Davies

Bridget Dickson

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Barry Donaldson

Hilary Exon

Emma Ferris

John Forest

Lesley Frederikson, NZ Association of Optometrists

Christine Gillespie, Kowhai Health Trust

Jeanie Glasgow

Heather Gordon

Carol Green

Catherine Grey

Philippa Grimes

Stephen Gunn, Te Korowai Hauora O Hauraki

Leigh Hale

Daniel Harvey

Hawkes Bay DHB Physiotherapy

Marilyn Head, NZ Nurses Organisation

Cheryl Hefford

Anne Hewetson, Gisborne Occupational Health & Physiotherapy Services

Graham Hill

Richard Hoskin

Jill Howard

Maree Hutchinson , Waitemata DHB Physiotherapists

Julianne Jackman

Julianne Jackson, Podiatrists Board

Gill Johnson, University of Otago, School of Physiotherapy

Andrew Jones

Jacqui Kerins

Deborah Kerry

Susan Kohut

Peter Larmer

Mark Laslett

Craig Leong

William Levack

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Robert Lindsay

Jenny Lucy

Anne Luty

Greg Lynch

Claire Matheson

Jill McDowell

Cameron McIvor (CEO), the NZ Medical Association

Anna McRae

Marion Meates

Jennine Mitchell

Margaret Moom

Sarah Mooney

Sarah Mooney

Suzie Mudge

Hilda Mulligan

Kara Mulvein

Fiona Murdoch

Ann Newsom

Kristine Nicol, ADHB Physiotherapy Clinical Supervisors

Nicky Nunn

NZ College of Midwives

Anne O'Donnell

Julianne O'Donnell, Mid Central DHB Physiotherapists

John Olsen

Sharon Peck

Physiotherapy Board of New Zealand

Liz Pollitt

Duncan Reid, NZ Academy of Sport (North Island)

Ineke Riley-Stol

Carole Rogers

Gabrielle Scott

Andrew Scott

Karen Setz

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Allison Shipton

Mark Shirley

Mark Silvester

Margot Skinner

Gisela Sole

Diane Sorrell

Jane Stone

Nikki Tse

Steve Tumulty

Colin Tutchen, Focus Health Physiotherapy

Leonie van den Bergh

Kathryn Vickers

Waikato DHB Physiotherapy

WairarapaDHB Clinical Board

Stella Ward, Counties Manukau DHB Physiotherapy

Rochelle Wardle

John Wellingham

Wellington School of Medicine Physiotherapy

Chris Whatman

Graeme White

Carlene Wilkie

Janice Wilson ( Deputy Director General) Ministry of Health- (Population Health)

Winifred Wing Ho

Nancy Wright, Occupational Therapists

Fiona Young

Nola Younger, Bay of Plenty DHB Physiotherapists

APWP Final Report April 08 08-05-08

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