Physiotherapy NZ wants the government to amend ACC legislation to allow physios to certify work capacity. Photo: 123RF
- Physiotherapists say patients are waiting too long to be allowed to return to work due to long GP wait times
- Their professional body is calling on the government to amend the law to give physiotherapists the power to issue medical certificates
- GPs say medical oversight will still be needed to certify clients as unfit to work
- ACC says extending the professions that could complete return-to-work certification is "a challenging issue"
* Clarification: This story has been updated to make clear it is nurse practitioners that can certify work capacity.
Wait times for GP appointments to get medical certificates signed off is costing ACC millions of dollars a year in needless compensation payouts, according to Physiotherapy NZ.
The organisation is calling on the government to amend ACC legislation to allow physios to certify work capacity (both off work and to return to work), claiming it would get injured people back to work safely and quickly, and cut ACC's weekly compensation bill.
Gisborne nurse Robyn* is one ACC client who found herself in a legislative limbo.
Six weeks after breaking her foot, she was keen to return to work, starting with light admin duties under her physio's "return to work" plan.
All she needed was a medical certificate from her GP - but there were no appointments available for another three weeks.
Meanwhile, since her current medical certificate had expired, her ACC compensation stopped.
"This was really frustrating - I was facing weeks without income sitting around at home because I couldn't get to see a GP," she said.
Fortunately, her physiotherapist intervened, phoning the GP clinic to explain the urgency.
"It shouldn't take a call from my physio to make this happen. And we have a real shortage of nurses here so having a nurse out of action for longer than necessary just puts more pressure on the hospital when it doesn't need to be that way."
Under current ACC legislation only nurse practitioners and medical practitioners can certify work capacity.
Delays to see GP costing taxpayers
Physiotherapy New Zealand president Kirsten Davie said the shortage of GP appointments was "a real bottleneck" in the system.
"These are people we are currently working with, we're in discussions with their employers, we might have gone out and visited their workplace, we've put a return-to-work plan together. But we're needing to wait for that medical certificate sign-off for people to return to work."
This was costing patients and taxpayers, she said.
A Physiotherapy New Zealand survey of 454 members last year found at least 4400 "days of delay" for patients getting a return-to-work certificate in one month alone.
Based on the minimum rate of weekly compensation, $740 for a 40-hour week, that equated to about half a million dollars in weekly compensation every month, just for that group of patients.
The organisation has more than 4000 members, many of whom work with ACC clients, so the potential savings were significantly higher.
"The NZ taxpayer really can't afford to paying for people to be off work when they could get back to work - and it's not just about the money side of things. People returning to work is so positive for their mental health," Davie said.
A legislative change would also mean if people were not safe to return to work, physiotherapists would be able to sign them off, she said.
"These are people that we are working with and rehabilitating back to be able to return to work. It means they can get a timely sign off and access to the rehabilitation support they need.
"Our focus is to put together a safe, graduated return-to-work plan which suits the employee and the business.
"So a medical certificate will have graduated hours and duties, i.e. [the employee] can return to work four hours, three days per week, cannot lift over 15kg etc.
"Then when they are fully fit to return to work the medical certificate will state the person is fully fit to return to normal days and hours of work."
It was already within physiotherapists' scope of practice to issue return-to-work certificates. In fact, they already do it for non-ACC clients, under the Holidays Act, she said.
"It just seems like a complete no brainer really - it's a simple legislation change.
"We could even look at an operational regulation change in the interim because we do know that changing legislation can be quite cumbersome.
"But we do need that buy-in from ACC as well."
The proposal has the support of the Physiotherapy Board of New Zealand, physiotherapy training institutions and the New Zealand Institute of Safety Management.
Construction Health and Safety NZ chief executive Chris Alderson also backs a "tweak" to the law.
Construction Health and Safety NZ chief executive Chris Alderson. Photo: RNZ / Phil Pennington
Many of the injuries construction workers suffered were musculoskeletal related, which physios were "well placed to help", he said.
"Our view is, more options and better support can't be a bad thing at the end of the day.
"We're very keen to make sure that our construction people have as many avenues as possible - safe avenues - to make sure if they can go back to work, or go back to work under certain conditions, that it can be done as soon as possible."
Doctors say medical oversight still needed
However, GPs warn that giving non-doctors and nurses the power to decide whether someone was "unfit to work" could create other problems.
The Royal NZ College of General Practitioners medical director, Dr Luke Bradford, said those patients needed ongoing medical supervision.
"Our position is that occupational physiotherapists who design return to work plans should have the ability to certify when a patient can restart work, but that certification when a patient is unfit for work has multiple factors and should remain with the medical teams over seeing care."
Royal NZ College of General Practitioners medical director Dr Luke Bradford. Photo: supplied
In a written statement, ACC deputy chief executive system commissioning and performance Chris Ash acknowledged the work and the expertise of occupational health physiotherapists.
"ACC also recognises the significant role the wider primary healthcare workforce can play in helping people return to work following injury, and is working with the sector to understand how we might better enable that."
However, extending the professions that could complete return-to-work certification was "a challenging issue as any changes would require legislative change".
He said ACC did not have "specific data" on delayed GP appointments affecting weekly compensation costs.
"However, ACC is actively engaging with general practice to identify how we can improve recovery outcomes for New Zealanders."
The Ministry of Business, Innovation and Employment is responsible for advising the ACC Minister on the legislation and regulations governing the scheme.
MBIE accident compensation policy manager Bridget Duley said when determining whether a claimant was incapacitated, the legislation required this assessment to be carried out by medical or nurse practitioners, although ACC could also seek advice from other experts.
"Given these decisions have a significant impact on how long claimants are off work due to their injury, expanding the groups of professions able to assess a claimant as incapacitated would need to be carefully considered and managed.
"The aim is for people to be off work for only as long as they need to be to recover from their injury."
There was no requirement in the legislation for claimants to receive a return-to-work certificate before returning to work, she said.
"Therefore there is no work being done or considered to amend the legislation in this context."
Physiotherapy NZ responds
But Kirsten Davie said while it may not be a legal requirement for an injured employee to be certified to return to work, ACC had made it an "operational requirement".
"ACC asks for confirmation that a fully fit certificate has been received as part of the vocational rehabilitation completion report, once the employee is at the stage to return [to] full hours.
"The majority of employers ask for a 'fully fit' medical certificate, so they can be confident the employee can now safely return to work their full hours and duties."
In response to further questions from RNZ, ACC's Chris Ash confirmed the agency does ask if a clearance to return to work has been given at the completion of a vocational rehabilitation programme, "but this is not a requirement".
"If a client can safely recover at work, they will be certified as 'fit for selected work'. This means there are some things they can still do safely while recovering from injury.
"This certificate will specify any restrictions or modifications required. For example, this could be limited hours, or the type of work they can undertake."
*name changed for privacy reasons
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