After almost four years as General Manager of Policy and Government Relations, I am moving on to a different challenge.

However, I want to share some reflections about the APA, the physiotherapy profession and future prospects.

When I started at the APA, I was struck by the parallels between competitive cycling and the race for funding, power and influence that physiotherapy and the other health disciplines find themselves in. 

Like the Tour de France, the health system is a long, difficult, multi-staged race with many smaller classification contests, such as sprints, mountain climbs and time trials. 

There are designated leaders and winners—for example, the Australian Medical Association, the Royal Australian College of General Practitioners and influential medical colleges representing anaesthetists, surgeons and specialists—and a peloton that includes participants in the central group.

Physiotherapy sits in that central group. 

We are classified as allied health, a grouping that I feel hinders physiotherapy at times. 

To belabour the race analogy, we are part of a team that is not all the same—and certainly not all equal in skills, training and service delivery.

The APA has managed to position physiotherapy at the front of the pack, a very significant achievement. 

While life-saving medical specialists and hospitals are the principal focus of health funding and health sector reform, we are a leading health discipline within our designated grouping. 

Through National President Scott Willis and his predecessors, the APA has engaged with government ministers, opposition spokespeople and the active crossbench. 

We have built a good relationship with the Department of Health and Aged Care and the Department of Veterans’ Affairs. 

Scott sits on the Strengthening Medicare implementation oversight committee and has been a vocal and persuasive advocate throughout the Scope of Practice Review process.

The success of this advocacy was evident in April this year when Professor Mark Cormack released Unleashing the Potential of our Health Workforce—Scope of Practice Review—Issues Paper 2, which specifically recommended physiotherapy direct referrals and other measures that the APA has promoted in submissions, in stakeholder consultations and through Scott’s direct advocacy.

The issues paper noted, ‘The Review heard widespread practical examples of where referral to another health professional, or for imaging or pathology falls within a profession’s scope of practice, but is limited by MBS funding rules. 

For example, it is within the competency and training of a physiotherapist to refer a consumer to an orthopaedic surgeon, but the consumer is currently required to access this referral via a GP. 

This may result in unnecessary duplicative service delivery and limits the extent to which a health professional can exercise their professional judgment, that is, work to their full scope of practice.’

It went further, citing a scenario in which a patient ‘experiencing pain associated with an acute musculoskeletal injury visits their physiotherapist for assessment. 

The physiotherapist is enabled to refer the patient for diagnostic imaging and to an orthopaedic surgeon for their opinion on treatment options. 

This streamlined referral pathway includes digital notification of the consumer’s home GP where available, but reduces the requirement to visit to the GP to obtain referrals. 

The result is a more efficient process and an improved consumer experience resulting from unnecessary GP visits and quicker access to required treatment.’

It may be a while before a federal government implements these recommendations. 

However, the ‘win’ for the APA is having our advocacy recognised and incorporated in the most significant review of scope of practice ever undertaken.

I was told by an allied health colleague that the APA is seen as ‘throwing its weight around’. 

I took this as a compliment, a badge of honour, not the criticism they intended. 

We should—and do— exert influence and seek to position physiotherapy as the leading discipline. 

To counter this barb, a former Australian Medical Association colleague said to me, ‘Physio is everywhere!’ 

He noted that we always produce high-quality submissions, engage in clinical and social issues, and are seen as constructive and as adding value to health reform.

Whether our growing influence and credibility will lead to the reforms the APA outlined in its federal pre-Budget submission for 2024–2025, Strengthening Medicare: funding what matters, and in Future of Physiotherapy in Australia: a 10-year vision policy white paper is not yet known. 

Much will depend on the outcome of the next federal election. 

Governments work to a two-term agenda—there hasn’t been a one-term federal government since the 1930s. 

If Labor is returned, I expect they will begin to implement reforms in primary care, including the reforms proposed by the APA. 

But I doubt the government will say too much before the next election because they do not want a fight with the medical associations.

What I am confident of is the importance and influence of the work the APA has done on the Scope of Practice Review, on referral pathways, through its valuing skills assets, through research partnerships, in rural health, in aged care and with the National Disability Insurance Scheme and the Department of Veterans’ Affairs.

The APA has achieved a lot so far through its policy work and its advocacy. 

As I take my own next steps, I look forward to seeing what happens now.