What happens after a notification to the Physiotherapy Board of New Zealand?

When the Physiotherapy Board of New Zealand receives a notification about you, it decides which route under the Health Practitioners Competence Assurance Act 2003 (the HPCA Act) the concern belongs on: competence, health or conduct. It writes to you with the concern, asks for your written response by a date, and then decides whether to close the matter, order a competence review, refer it to its health process or appoint a Professional Conduct Committee. While a matter is open it can suspend your practising certificate or place conditions on it. Call your indemnity insurer the same day, keep your clinical notes and appointment records as they stand, do not contact the patient, and reply before the date with a response written against the notes, the Physiotherapy Standards and the Code of Ethics and Professional Conduct.

Where a notification comes from

A notification about a physiotherapist can come from a patient or their whānau, a colleague, a clinic owner, an employer, ACC, a sports club, the Health and Disability Commissioner or another agency. Two routes are mandatory under the HPCA Act. An employer must notify the Board when a physiotherapist resigns or is dismissed for reasons relating to competence (section 34), and a practitioner or employer who believes a physiotherapist may be unable to practise safely because of a mental or physical condition must notify the Registrar (section 45). The guide to a mandatory employer notification covers how the employment and Board processes run side by side.

Write the concern in the Board's letter out in one sentence of your own. That is the sentence your response has to answer.

The three routes

Competence. If the concern is that your practice may not meet the required standard, the Board can order a competence review under section 36 of the HPCA Act. Reviewers look at your notes, assessment, clinical reasoning and treatment planning, can interview you and observe you with patients, and report to the Board. The guide to what happens in a competence review covers the review and the competence programme that can follow it.

Health. If the concern is that a mental or physical condition may affect your ability to practise, the Board's health process applies. The Board can require an examination, accept voluntary undertakings and set conditions. The guide to the health process under the HPCA Act explains it.

Conduct. If the concern is about behaviour, the Board can appoint a Professional Conduct Committee under Part 4 of the Act. The Committee investigates, hears from you, and recommends an outcome to the Board or lays a charge before the Health Practitioners Disciplinary Tribunal. The guide to how a Professional Conduct Committee process runs sets out each stage.

What the Board measures you against

The Board assesses practice against the Physiotherapy Standards and the Code of Ethics and Professional Conduct, and competence against the competencies for your scope of practice. The standards set the Board's expectations on matters that include informed consent, professional boundaries, cultural safety, records and the delegation of tasks to others. The Code of Health and Disability Services Consumers' Rights applies alongside them, including the right to be fully informed and the right to have a support person present. Find the standard the allegation engages before you write, and answer in its terms.

The concerns a physiotherapist can face

• Consent and another person in the room. An examination or treatment of a sensitive area without a clear explanation first, without agreement, or without the offer of a support person or another clinician in the room. The Board reads what you said, what you recorded, and how you protected the patient's privacy and dignity.
• Boundaries. A boundary with a patient or a colleague, including dual relationships with a patient who is a friend, a team member or a client of your business, personal messages, social media, gifts and a relationship after care ends. The guide to a professional boundaries concern covers how the Board and the Tribunal treat these.
• Over-treatment and ACC billing. Treatment beyond clinical need, appointments booked without a plan to discharge, or claims to ACC that the notes do not support. The guide to an honesty or probity concern explains why a claim for treatment not provided is treated as serious.
• Delegation. A task passed to an assistant, a student or another worker without checking their competence, giving clear instructions or arranging supervision.
• Records. Notes that are missing, written late, copied from earlier visits or that do not show assessment, reasoning and consent. The guide to a clinical records concern covers how a reviewer or Committee reads them.

What happens, step by step

1. The letter arrives. The Board sends you the concern, the material and a date. Call your indemnity insurer that day and gather your notes, appointment records, ACC claims, messages and any incident report.
2. You respond in writing. Facts from the notes with references, your reasoning at the time, what fell short, what you have done since with evidence, and what you have understood, in the terms of the standards and the Code. The guide to how to write a response to a Board notification gives the structure.
3. The Board decides the route. On your response, the records and any further enquiries, it decides whether to close the matter, write to you with advice, order a competence review, refer the matter to its health process or appoint a Professional Conduct Committee.
4. The review or investigation runs. Reviewers report to the Board on competence. A Professional Conduct Committee gathers documents, can interview you and witnesses, and puts its concerns to you before it decides.
5. You are heard before any order. Before the Board sets a programme, imposes conditions or makes an interim order, it tells you what it proposes and gives you the chance to respond.
6. The outcome is recorded. The Board tells you its decision, what it has told your employer and what appears on the register. A charge laid by a Committee goes to the Tribunal.

Interim suspension and conditions

While a Professional Conduct Committee investigation is open, section 69 of the HPCA Act lets the Board suspend your practising certificate or place conditions on it if it is satisfied that is needed to protect the public. You are entitled to be heard first. A physiotherapist who has arranged for another clinician to be present for sensitive examinations, accepted supervision from a named senior colleague, and set that out in writing gives the Board a reason to prefer conditions to suspension. The guide to interim suspension and conditions on practice covers the risk test.

What you can do now

• Get advice the same day. Your indemnity insurer, Physiotherapy New Zealand if you are a member, or a lawyer, before you put anything in writing to the Board, your employer or ACC.
• Keep the records as they stand. Notes, appointment and billing records, ACC claims, consent forms, messages, rosters and any incident report.
• Write against the notes and the standards. Facts with references, reasoning at the time, what fell short, what you have done since, what you have understood.
• Start remediation before you reply. A revised consent process for sensitive examinations, a records and billing audit with results, supervision, and courses completed with dated certificates. Completed steps are evidence; intended steps are promises.

The outcomes

After a competence review the Board can find the standard is met, set a competence programme or place conditions on your practising certificate, such as supervision or another clinician present for some examinations. On the health route it can accept undertakings or set conditions. A Professional Conduct Committee can recommend no further action, counselling, a competence review or conditions, or lay a charge before the Tribunal. The Tribunal can cancel or suspend registration (suspension for up to three years), impose conditions, censure, fine and award costs. The guide to a Health Practitioners Disciplinary Tribunal hearing describes what it weighs.

Where remediation fits

The part of a Board matter you control is what you have done since the concern was raised. Courses completed before your response goes, with dated certificates attached, are evidence that you have engaged with the standards. Ethics for Physiotherapists and Professionalism for Physiotherapists are written against the Physiotherapy Standards and the Code of Ethics and Professional Conduct, so a certificate from either answers a concern framed in the Board's terms. Dealing with a Complaint or Investigation covers how to engage with the process, and Reflection for Fitness to Practise covers how to write the reflection the Board reads.

Each course is NZ$200, takes 2 CPD hours, is self-paced with immediate access, and ends with a dated certificate issued by Healthcare Ethics Courses that you can submit to the Board or put in your remediation plan. The remediation courses for physiotherapists facing a Physiotherapy Board investigation are listed on one page, and the Council and Board investigation process explained shows where each course sits. The guide to showing insight and building a remediation plan explains how to present the certificates with the rest of your evidence, and the guide to what happens after a notification to any Council or Board gives the whole HPCA Act process.

Sources and further reading

• Physiotherapy Board of New Zealand: the Physiotherapy Standards, the Code of Ethics and Professional Conduct, and the Board's pages on notifications, competence and health.
• Health Practitioners Competence Assurance Act 2003: sections 34, 36, 45 and 69 and Part 4 on Professional Conduct Committees and the Tribunal.
• Health Practitioners Disciplinary Tribunal: published decisions involving physiotherapists, with the penalties imposed and the weight given to insight and remediation.
• Health and Disability Commissioner: the Code of Rights and how a complaint about a physiotherapist is assessed and reaches the Board.

Frequently asked questions

A patient says I touched them without explaining why. What will the Board look at?

The Board looks at what you explained before you started, whether the patient agreed to that examination or treatment, whether you offered them another person in the room, how you protected their privacy and dignity, and what your notes recorded at the time. Under the Code of Rights a patient is entitled to information before they agree and to have a support person present, except where safety or another person's rights prevent it. Your response needs to show what you said and recorded for this patient.

Can an ACC billing concern go to the Physiotherapy Board?

Yes. ACC can raise a concern with the Board, and a claim for treatment that was not provided, or treatment beyond clinical need, can be both a records concern and an honesty concern. The Board will compare your notes, your appointment records and the claims made. Do not alter or complete notes to match the claims. Take advice before you reply to ACC or the Board, and make sure both replies say the same thing.

I delegated a task to an assistant. Am I responsible for what happened?

The Board expects a physiotherapist who delegates to decide that the task is suitable to delegate, that the person is competent to do it, and that there is supervision and a way to report back. You remain responsible for those decisions. Your response should show how you made each one, what instructions you gave and recorded, and what you have changed about delegation and supervision since.

What does the Physiotherapy Board expect in my written response?

An account of the facts from your notes with references, your clinical reasoning at the time, a plain acknowledgement of anything that fell short, what you have done since with evidence, and what you have understood, written in the terms of the Physiotherapy Standards and the Code of Ethics and Professional Conduct. Keep a level tone, make no comment about the notifier, and send nothing your adviser has not read. Where your account and the notes differ, the Board will rely on the notes.

Who should I contact first after a Physiotherapy Board letter?

Your indemnity insurer, the day the letter arrives, and Physiotherapy New Zealand if you are a member. Either can tell you whether a lawyer should be instructed. Do this before you write anything to the Board, your employer or ACC. Where the concern alleges a breach of a boundary with a patient or a colleague, dishonesty in a claim, or conduct that could reach a Professional Conduct Committee, ask about a lawyer in the first call.