Progress update on proposed changes to secondary care
We’re continuing to work with the sector to develop a clinically-led secondary care model for musculoskeletal injuries and have made some updates in response to feedback we’ve received.
We’ve heard valuable feedback about governance, specialist oversight, conflicts of interest, regional variation, implementation risk and the need for greater clarity on the scope of the proposed model. While the overall direction is becoming clearer, important design questions remain, and ongoing sector feedback is needed to shape those decisions.
Why changes are needed
Today, clients can experience very different secondary care journeys depending on where they live, who refers them, and which provider receives the referral. Inconsistent referral quality and limited visibility of provider capacity makes it difficult to track progress and ensure clients receive the right care at the right time. Growing demand for specialist musculoskeletal services is also increasing pressure on provider capacity and the financial sustainability of ACC.
What we’re proposing
The proposed clinically-led secondary care model aims to provide a more consistent, transparent, and coordinated experience for clients, helping them access the right care at the right time and supporting better recovery outcomes.
Key improvements include:
- Clinically-led care networks – Multidisciplinary groups of clinicians working together to deliver coordinated care across triage, specialist assessment, treatment and pathway management.
- Stronger clinical governance and accountability – Clear clinical leadership, decision-making criteria, and quality assurance processes to support consistency and accountability.
- Improved referral quality – Clearer referral requirements to support earlier clinical decision-making and reduce unnecessary administration.
- Greater visibility and transparency – Data and reporting to improve understanding of referral patterns, pathway decisions, outcomes, and system pressures.
- Coordinated clinical decision-making – A triage component to help direct clients to the most appropriate care based on their needs.
What this means for our contracts
The Clinical Services contract would be divided into two contracts – one for musculoskeletal injuries and one for non-musculoskeletal injuries. For musculoskeletal injuries, services will transition to the new clinically-led service delivered through multidisciplinary care networks operating under a single contract, rather than separate contracts held by individual providers. Procurement for the Clinical Services contract and the new clinically-led secondary care service contract will begin in March 2027, with both new contracts launching on 1 December 2027.
Strengthening through feedback
Sector feedback is helping refine several important areas, including:
- ensuring specialist expertise is available early in a client’s journey when clinically appropriate
- maintaining appropriate oversight of high-tech imaging referrals and review processes
- aligning secondary care improvements with other improvements underway in primary care
- strengthening management of conflicts of interest through reporting, audit, and contract controls
- developing governance, accountability, and quality assurance arrangements that balance national consistency with regional flexibility and innovation.
Clarifying what we’re not proposing
We want to clarify that the proposed model is not intended to:
- restrict access to specialist care when it’s clinically needed
- replace or override specialist clinical judgement
- create a standalone administrative gatekeeping service
- remove specialists from assessment, treatment or clinical leadership roles
- introduce a highly centralised model that ignores regional differences
- have ACC-employed clinicians making triage decisions
- shift allied health treatment or rehabilitation into secondary care services.
Seeking further sector input
Over the coming months, we’re continuing to engage with the sector to understand what’s needed to ensure the new model is effective. We’re looking for feedback on:
- what governance arrangements would build provider confidence
- what capability is needed to safely make pathway decisions
- where imaging should sit
- what makes a referral complete
- which cohorts should be escalated, bypass triage, or require specialist review
- what measures would be fair, clinically meaningful, and support continuous improvement.
To provide feedback, email us at engage.secondarycare@acc.co.nz.
For further information, visit our website to download our Sector Engagement slide pack: