Professional Documents
Culture Documents
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
Wairarapa DHB 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
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Acknowledgements
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
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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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.
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
3
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.
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 Society’s 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 Physiotherapy’s current advanced practitioner
framework;
b. Preliminary results from the Society’s Membership Survey;
c. Relevant published Strategies relating to New Zealand healthcare;
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d. Reports and strategy documents available nationally and internationally, including
the most recent consensus statement from the World Confederation for Physical
Therapy; and,
e. Published literature relating to physiotherapy advanced practice.
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; and
6. 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.
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.
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3. Requirements for attaining Specialisation
The appropriate body (to be confirmed) will recognise New Zealand registered
physiotherapists as Physiotherapy Specialists who meet the following requirements:
Qualifications
− A current annual practising certificate
− A relevant postgraduate Master’s degree (from an approved tertiary institution)
or an approved equivalent
Experience
− The equivalent of four years’ full time clinical experience in the nominated
speciality area
Continuing professional development
− Evidence of a minimum of 120 hours of continuing professional development in
the relevant or nominated speciality area over the last 3 years, including peer
review
In addition, each applicant must:
− Submit their professional portfolio of evidence
− Complete an application form / statutory declaration
− Pay the prescribed fee
Although the majority of respondents agreed with these criteria there were some
concerns expressed in respect of the requirement for a Master’s qualification, the term
‘approved equivalent’ and the amount of clinical experience required. In general,
respondents who had concerns considered a Master’s degree too much and the clinical
experience of 4 years too little. Respondents also requested further detail on the
expectations of the peer review and the purpose of the prescribed fee.
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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
Master’s, and not an entry level programme. For the Master’s 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
Master’s degree. The inclusion of the words ‘Master’s degree or approved 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 Master’s 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 Master’s 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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time equivalent within the designated specialty area of practice is appropriate. This is
based on other models that have been developed and keeps our framework broadly in
line with the Australian College of Physiotherapy which recommends three years of
clinical practice with the addition of a practical exam.
Recommendation: Experience
The equivalent of four years’ full time clinical experience in the nominated
speciality area
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− Annual practising certificate with the Physiotherapy Board of New
Zealand
− Evidence of continued clinical practice within their nominated specialty
area
− 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.
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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
Three options that could be used to progress the model for the profession were put
forward for discussion:
There was widespread support for the Physiotherapy Board taking a leadership role in
this process and this is supported by the Board who acknowledged:
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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.”
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.
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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.
Summary
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 Party’s
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
Wairarapa DHB 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
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