OT Unplugged: Community of Practice Insights

The NDIS support lists have only been in place since October 2024, but another significant change may already be on the horizon.

A new consultation is considering how NDIS supports should be defined, including proposals to reduce the number of support categories, simplify their descriptions and remove the replacement supports process.

For OTs, some changes could make the rules easier to interpret. Others raise questions about what happens when an everyday product is also the simplest solution to a disability-related functional need.

Why is the NDIS support list changing?

The current support lists were introduced in October 2024 as transitional rules defining what participants can and cannot generally spend NDIS funding on.

Feedback has highlighted several problems, including confusing categories, unclear descriptions and difficulties understanding replacement supports.

The proposal is to reduce 36 support categories to 18 broader categories, with simpler purpose-based descriptions and examples. These categories are also being developed to align with new framework planning and the introduction of support needs assessments.

Replacement supports could disappear

One of the biggest proposed changes is the removal of the replacement supports process.

Tablets, smartphones, smartwatches and accessibility or communication apps have been among the most commonly requested replacement supports. The proposal is for these types of supports to instead become stated supports where the relevant requirements are met.

This could create a clearer pathway for some disability-related technology. The bigger question is what happens to other products currently considered through replacement supports.

What happens to everyday products that solve disability-related problems?

Mainstream products do not always have mainstream purposes.

Consider a person with a spinal cord injury who can put clothing into a top-loading washing machine but cannot independently retrieve it. A front-loading machine could remove that functional barrier and allow them to complete their washing independently.

Similar questions arise with robotic vacuum cleaners, food preparation appliances and other household products. Sometimes a readily available mainstream product is the simplest and most cost-effective way to address a functional need.

Removing replacement supports could therefore have consequences beyond simplifying an administrative process. The detail of what remains fundable, and through which pathway, will matter.

Some disputed supports could move firmly onto the ‘out’ list

The consultation also identifies products and services where there has reportedly been confusion about whether they are NDIS supports.

These include electronic noise-cancelling headphones, fencing and gates, hairstyling tools, hydrogen fuel and electric vehicle charging costs and scuba therapy. The proposal is to specifically exclude them.

Noise-cancelling headphones are particularly relevant to OTs because they may be recommended to address sensory needs and support functional participation.

This also highlights why looking only at the proposed funded categories does not tell us everything. A product might appear to fit within a broad support definition but still be unavailable if it is specifically excluded elsewhere.

The new categories could make some OT roles clearer

There are areas where the proposed definitions provide welcome clarity.

The proposed therapy supports category specifically includes assessment by allied health professionals for support planning and review. It also captures assessment, prescription, implementation, adjustment and training in the use of assistive technology where required to support functional outcomes.

Home modifications similarly include the design, planning, implementation and review of modifications, alongside maintenance and repair of disability-specific fixtures and modifications.

Assistive technology categories are also being consolidated. While there would be fewer overarching categories, detailed descriptions would continue to sit beneath them, so fewer categories will not necessarily mean less complexity.

These changes are part of a much bigger planning reform

The support list changes cannot be considered separately from new framework planning.

Under the future model, a support needs assessment will play a central role in determining a participant’s budget. The proposed support categories are being designed to align with this new approach.

This means the practical impact of the support list will depend on more than which category a support sits within. It will also depend on how needs are assessed, how budgets are determined and how participants can use those budgets.

Further consultation on the new framework planning rules should provide more detail about how these pieces will work together.

Why OT input into the consultation matters

Funding rules can appear straightforward on paper but work very differently when applied to someone’s actual function, environment and daily occupations.

OTs regularly see where a mainstream product becomes an assistive solution, where a seemingly clear category creates ambiguity and where funding rules affect the practical options available to a participant.

That experience can help identify unintended consequences before proposed rules become established practice.

The consultation provides several ways to contribute, including making a submission, providing a video response, responding by email or requesting a phone call.

Key takeaways for OTs

* The NDIS is proposing to reduce 36 support categories to 18 broader categories
* The replacement supports process could be removed
* Some commonly requested technology may instead become stated supports where requirements are met
* The future of other mainstream household products currently considered through replacement supports needs close attention
* Electronic noise-cancelling headphones are among the supports proposed for specific exclusion
* The new support list is being developed alongside new framework planning and support needs assessments

These are still proposed changes. For OTs, now is the time to look beyond whether the new categories appear simpler and consider how they could work when applied to real functional needs and everyday recommendations.

New Framework Planning and NDIS Supports Consultation: https://consultations.health.gov.au/disability-and-carers-group/nfp-ndis-supports/

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NDIS reporting is changing, but one question remains fundamental for Occupational Therapists: why are we including this information?

Longer reports and more assessments do not automatically create stronger evidence. A useful NDIS OT report needs to demonstrate a participant’s functional needs, connect those needs to their goals and clearly explain why recommended supports are required.

This means moving beyond clinical terminology and assessment scores towards evidence that helps the reader understand what everyday life actually looks like for the participant.

Understand why the report is needed

Before beginning an assessment, Occupational Therapists need to understand why the report has been requested and what decision it is intended to inform.

A plan reassessment based on a change in circumstances requires evidence of a significant and ongoing change. This may involve changes to functional capacity, informal supports or broader life circumstances.

That is different from a situation where a participant believes their existing plan was underfunded. Understanding this distinction early can help avoid spending valuable participant funding on a comprehensive assessment that does not address the issue at hand.

Good onboarding is essential. Clarify what the report is for, what evidence already exists, who else is involved and what information is actually required.

Show what function looks like in everyday life

Once the purpose of the report is clear, the next priority is showing what the participant’s functional needs actually look like.

Occupational Therapists understand terms such as dysregulation, co-regulation, executive functioning and fine motor difficulties. The person reading an NDIS report may not interpret those terms in the same way, so clinical terminology needs to be connected to specific, functional examples.

If a participant became dysregulated during an assessment, what did that look like? What happened and what support did they require? If they have reduced fine motor coordination, how does this affect dressing, eating, handwriting or another meaningful activity?

This is where both top-down and bottom-up thinking have a place. Identifying an impairment such as reduced grip strength, balance or fine motor coordination can provide valuable clinical evidence, but the report also needs to explain what that impairment means for everyday participation.

Functional examples bring the reader into the assessment and make the impact of disability easier to understand.

Choose assessments that add meaningful evidence

With the functional picture established, consider what additional evidence is actually needed to support your clinical reasoning.

Standardised assessments remain an important part of Occupational Therapy practice, but not every available assessment belongs in every NDIS report. Ask: what additional evidence will this assessment provide?

A standardised assessment may validate observations, establish a baseline, support clinical reasoning or provide an outcome measure. In those circumstances, it can be extremely valuable.

However, completing multiple assessments can consume significant participant funding without necessarily changing the recommendations.

The same principle applies to presenting results. Pages of graphs, tables and scores can make a report longer without making it clearer. Often, the Occupational Therapist’s interpretation is more valuable.

Explain what the assessment showed, whether it aligned with other evidence and how the findings informed your recommendations.

Consider value for money

Being selective about assessment also means considering how participant funding is being used.

A useful question is whether you would feel comfortable asking someone to pay privately for everything you are proposing.

This does not mean compromising evidence-based practice or avoiding comprehensive assessment when it is genuinely required. It means being intentional about what each component contributes.

If observation, interview, existing reports and one carefully selected assessment provide sufficient evidence, adding several more assessments may not improve the outcome.

Good clinical reasoning is demonstrated by choosing the right assessment methods and interpreting them well, not by using the greatest number of tools.

Make recommendations specific and defensible

The evidence gathered throughout the assessment should lead logically into clear recommendations.

Simply stating that a participant requires a certain number of support worker hours leaves important questions unanswered. What will the support worker assist with? When is the assistance required? Is the support needed at home or in the community? Is it required during weekdays, evenings or weekends?

These details demonstrate how the recommendation was calculated and why the support is necessary.

Recommendations should also reflect the participant’s assessed needs rather than a provider’s rostering arrangements. If a participant requires one hour of assistance, the Occupational Therapist’s recommendation should reflect that need rather than being increased because of a provider’s minimum shift requirements.

The aim is to make the connection between functional need, required support and recommendation as clear as possible.

Stay within Occupational Therapy scope

Specific recommendations also require Occupational Therapists to be clear about where their professional scope begins and ends.

If an Occupational Therapist identifies a likely need for physiotherapy, speech pathology or another discipline and that professional is not yet involved, it may be appropriate to recommend funding for an assessment.

Prescribing another profession’s ongoing therapy hours without their assessment is different.

Support worker recommendations sit more directly within Occupational Therapy scope because assessing the assistance a participant requires to complete everyday activities is a core part of functional assessment.

Know when a full reassessment isn’t necessary

Providing strong evidence does not always mean completing another functional capacity assessment from scratch.

If a comprehensive assessment was completed relatively recently and most of the participant’s function remains unchanged, an addendum or supplementary report may provide what is needed.

The Occupational Therapist can explain what has been reassessed, identify what has changed and confirm which previous findings remain current. The original report can then accompany the supplementary evidence.

This can provide the required information without unnecessarily using participant funding or repeating work that has already been completed.

Better reports are not necessarily longer

Every assessment, paragraph, graph and recommendation should earn its place in an NDIS OT report.

Ask whether it helps explain the participant’s function, strengthens the evidence or supports the clinical reasoning behind a recommendation.

The goal is not to create the longest report possible. It is to give the reader a clear and accurate picture of the participant’s everyday life and make the reasoning behind each recommendation easy to understand.

Key takeaways for OTs

◆ Clarify why the report is being requested before beginning the assessment
◆ Keep everyday function at the centre of your evidence
◆ Use specific examples to translate clinical terminology into functional impact
◆ Choose assessments according to the meaningful evidence they add
◆ Interpret assessment findings rather than relying on pages of scores and graphs
◆ Make recommendations specific about what support is required, when and why
◆ Recommend according to the participant’s assessed needs rather than provider rostering requirements
◆ Stay within Occupational Therapy scope when discussing other health professionals’ services
◆ Consider an addendum or supplementary report when a full reassessment is unnecessary

Links

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Australian Assistive Technology Conference (11 Nov - 13 Nov) https://www.arata.org.au/aatc/aatc-2026/

Recent NDIS legislative changes are creating new considerations for OTs, particularly around plan reassessments and how participants may be able to use their funding. While some implementation details are still emerging, the potential impact on participants could be significant.

For OTs, the priority is understanding what these changes mean in practice. That includes knowing when a reassessment may be possible, clearly documenting support needs and identifying what could happen if recommended supports aren’t available.

As further guidance is released, practices will also need to review their clinical processes and reporting templates. The aim isn’t to predict every funding decision, but to make sure the participant’s needs and risks are clearly documented.

Changes to plan reassessments

Changes to unscheduled plan reassessments include a longer timeframe for the NDIA to decide whether a reassessment will occur. The timeframe discussed has increased from 21 days to 90 days, which could mean participants wait considerably longer for a decision.

There is also a higher threshold for an unscheduled reassessment. The change generally needs to be significant and ongoing, relating to the participant’s functional capacity, personal circumstances, environment or informal supports.

This distinction matters. A permanent change to a participant’s support network may meet the threshold for reassessment, while a temporary situation may be more appropriately addressed through a plan variation.

What this means for OTs

There is still uncertainty about how some of these changes will work in practice. OTs don’t need to predict every decision the NDIA might make, but we do need to understand how the changes could affect the people we support.

Our role is to clearly document what a participant needs to function safely and participate in everyday life. Recommendations should connect directly to functional evidence, risks and the likely consequences if those supports aren’t available.

That clinical reasoning becomes particularly important when considering support determinations and the possibility that participants may not be able to access all of the funding identified in their plan.

Understanding support determinations

The changes also introduce support determinations that may limit how much of particular NDIS budgets participants can use. The areas discussed include social, economic and community participation and improved daily living.

This could create situations where a participant’s reasonable and necessary supports are identified, but a proportion of the relevant budget is subsequently unavailable to spend. The exact impact will depend on the final support determination and how it is implemented.

OTs should therefore avoid assuming a particular percentage reduction before those details are confirmed. Instead, our reports need to clearly explain what the participant actually requires and why.

Make the impact of reduced support clear

Reduced community participation funding doesn’t necessarily mean a participant can simply spend more time at home independently. Some participants require support regardless of whether they are at home or in the community.

If a participant cannot safely remain home alone, this needs to be explicit in their functional assessment. Reports should explain their supervision requirements, why that support is needed and what happens when it isn’t available.

This may include increased vulnerability, exploitation, safety concerns, behavioural escalation or unsustainable pressure on informal supports. The important point is to connect any potential reduction in support with its real-world functional consequences.

Keep recommendations evidence-based

Knowing that funding may be reduced doesn’t mean OTs should increase recommendations to compensate. If the evidence supports 15 hours of assistance, recommending 30 hours in anticipation of a reduction isn’t clinically defensible.

Instead, document the actual level of support required and clearly explain the evidence behind it. Then describe what is reasonably likely to happen if that support isn’t provided.

Our role is to provide strong clinical evidence, not find ways around funding decisions. Clear, individualised recommendations give decision-makers a much better understanding of what the participant genuinely needs.

Consider the impact on therapy funding

Improved daily living funding may also be affected by support determinations. This could reduce the funding available for OT and other allied health services.

That becomes particularly challenging when a participant has limited funding for specific work, such as a functional capacity assessment. OTs still need enough time to complete assessments and reports to an appropriate professional standard.

Review AT and home modification pathways

Changes to reassessment processes may also affect assistive technology and home modification requests. Participants may become hesitant to request changes if they are concerned about what a reassessment could mean for other areas of their plan.

OTs should understand whether a participant’s circumstances require a reassessment or whether a plan variation may be appropriate. Choosing the correct pathway could become increasingly important as these changes take effect.

Clear communication matters here. Participants need practical information about their options without creating unnecessary fear about requesting essential equipment or supports.

Prepare your OT practice now

OT practices shouldn’t assume every clinician is keeping up with NDIS changes independently. Regular team discussions can help everyone understand what has changed, what remains uncertain and what needs to happen clinically.

Now is also a good time to review FCA templates. Consider whether reports clearly explain supervision requirements, foreseeable risks, informal support capacity and what happens if recommended supports aren’t provided.

At the same time, avoid changing templates based on speculation. Update them as confirmed information becomes available and make sure any new wording remains specific to the individual participant rather than becoming generic boilerplate.

Key takeaways for OTs
• Understand the new reassessment thresholds and longer decision timeframes.
• Keep recommendations grounded in the participant’s actual functional needs.
• Clearly explain what happens if recommended supports aren’t available.
• Identify safety, vulnerability and informal support risks where relevant.
• Don’t increase recommendations simply to compensate for anticipated funding reductions.
• Understand when a plan variation may be appropriate instead of a reassessment.
• Review FCA templates as confirmed NDIS guidance becomes available.
• Keep your clinical team regularly updated as implementation develops.



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The latest NDIS reforms bring another significant period of change for participants, families, OTs and providers. While legislation has progressed, many of the practical details still depend on rules, guidance and implementation processes that are yet to be developed.

For OTs, the priority is understanding what has changed, what is coming and what remains uncertain – without trying to predict decisions before the details are available.

New planning and support needs assessments

One of the biggest changes ahead is the introduction of new framework planning and support needs assessments. There is still uncertainty about exactly how these assessments will translate into participant budgets and how complex supports such as assistive technology and home modifications will be considered.

The role of professional evidence will also be important. Consultation feedback has highlighted the need for evidence from treating practitioners who understand a participant’s function and support needs over time. Testing of the iCAN tool is continuing, so there is still more to learn about how the assessment process will work in practice.

Functional capacity assessments are also coming

From 1 January 2028, access to the NDIS is expected to involve a standardised assessment of functional capacity. The reforms clarify that people can use common forms of assistance, such as glasses, hearing aids and walking sticks, during these assessments, while children can receive age-appropriate assistance.

The bigger question is how a standardised assessment will capture the complexity of everyday function. Occupational performance is influenced by environment, equipment, assistance and context, making the implementation of these assessments particularly important for OTs to watch.

Review rights could look different

The introduction of support needs assessments may also change what happens when a participant disagrees with their budget.

Rather than directly challenging the resulting level of funding, the review pathway described in the reforms may lead to another support needs assessment being completed. This raises questions about whether participants could find themselves repeating assessments when they believe their needs have not been adequately captured.

Changes to unscheduled reassessments

Participants will be able to request an unscheduled reassessment following a significant and ongoing change. Importantly, that change no longer needs to be ‘unanticipated’, which may better reflect the experiences of people living with complex or fluctuating disability.

However, the timeframe remains significant. If the NDIA does not decide on a reassessment request within 90 days, it is treated as refused, allowing the participant to move to a review rather than repeatedly submitting reassessment requests.

Greater clarity around parental responsibility

The reforms also clarify the distinction between ordinary parental responsibility and additional support required because of disability.

Parents are ordinarily expected to provide supervision, personal care, transport, emotional support and behaviour support. However, this does not include additional assistance a child requires because of their disability compared with a child of a similar age without disability.

For paediatric OTs, clearly describing this difference in functional evidence will remain important. The NDIS must also consider potential harm to informal supports, family relationships and informal networks if disability-related support is not funded.

Support determinations and critical supports

The reforms introduce mechanisms that could allow broader funding changes to particular categories of support. However, protections have been included for critical supports such as assistance with personal care and medication, mobility equipment, vehicle modifications, certain consumables and specialist disability accommodation.

Additional safeguards are intended for participants requiring continuous 24-hour care, including a plan variation pathway where broader funding changes could place their health or safety at risk.

Compensation and NDIS eligibility

From 1 January 2028, new applicants may not be eligible for the NDIS where their impairment results from a motor vehicle accident or work-related injury and another system provides compensation or benefits. Existing participants are expected to retain their current arrangements.

There are still significant questions about what happens when another compensation system only covers some disability-related needs. Further rules are expected to clarify these situations, so OTs should be cautious about predicting how the provisions will apply to individual participants.

The reforms also allow compensation to be considered when determining funding under new framework plans. Depending on the circumstances, an NDIS budget may be reduced to account for compensation a participant has received.

‘Appropriate treatment’ does not mean every treatment

The reforms provide some useful clarification about the requirement to consider ‘appropriate treatment’ when determining whether an impairment is permanent.

Participants are not expected to try every conceivable treatment. Treatment needs to be widely accepted and expected to significantly improve, reduce or manage the impact of the impairment. People are also not expected to undergo treatment that is unsuitable, carries significant risks or could cause major lifelong consequences.

For OTs providing evidence, the focus should remain on the likely impact of appropriate and accepted treatment rather than whether every possible intervention has been attempted.

NDIS support lists remain difficult to navigate

Consultation feedback confirms what many participants and providers have experienced since the NDIS support lists were introduced. Only 15% of respondents said it was easy to understand what could be funded, while 68% found it difficult. Around 77% had experienced or heard about situations where the rules were interpreted differently.

Feedback called for clearer ‘in’ and ‘out’ lists, greater flexibility around mainstream products and a simpler replacement supports process. These findings will help inform future changes, but there is still no clear picture of what the final arrangements will look like.

What OTs can focus on now

There are still many questions that cannot be answered. Participants may understandably want certainty about future plans and funding, but legislation is only part of the picture. Supporting rules and operational processes will determine how many of these reforms actually work in practice.

For now, OTs can focus on strong functional documentation, clearly distinguishing disability-related needs and following reliable updates as implementation progresses. Being able to say ‘we don’t know yet’ is also important when the information simply is not available.

Looking after yourself through ongoing change

Working within constant uncertainty can take a toll. OTs may understand what someone needs while having limited control over whether those supports are ultimately funded, creating frustration, moral distress and burnout.

Proactive wellbeing matters during periods of sustained change. For clinicians, business owners and teams, this might mean strengthening boundaries, creating space to discuss uncertainty and recognising that different people restore their energy in different ways.

The goal is not to personally carry every change occurring within the NDIS. Staying informed matters, but so does maintaining the capacity to continue doing good work as the system evolves.

Key takeaways for OTs
• New planning, support needs assessments and functional capacity assessments will significantly change how NDIS access and budgets are determined.
• The role of professional evidence remains important, but details about how it will interact with new assessments are still emerging.
• Unscheduled reassessments no longer require a change to be unanticipated, although significant timeframes remain.
• Paediatric OTs should clearly distinguish disability-related needs from age-expected parental responsibility.
• Compensation, support determinations and review rights are important areas to watch as further rules are developed.
• Consultation feedback confirms significant confusion remains around NDIS support lists and replacement supports.
• Avoid predicting individual outcomes while implementation details remain unresolved.
• Strong functional evidence, reliable information and proactive wellbeing will be important as the reforms roll out.

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Running an Occupational Therapy business has always involved more than delivering great clinical care. There are people to employ, systems to manage, invoices to collect and countless decisions about where limited time and money should be spent.

For OTs working within the NDIS, those decisions are becoming increasingly important. Changes to pricing and travel, alongside uncertainty about the future direction of the scheme, are prompting many practice owners to look closely at what it actually takes to run a sustainable service.

From payment processing and recruitment costs to workforce planning and advocacy, understanding the business behind Occupational Therapy has never been more relevant.

The true cost of running an OT practice

One of the challenges of running an allied health practice is that seemingly small costs can add up quickly. Payment processing is a good example.

Offering convenient card payments creates an additional expense for a business. But removing that option may make it harder for clients to pay, particularly families managing regular therapy expenses.

This creates an important balancing act. A payment system might carry transaction fees, but if it means invoices are paid promptly and administration staff spend less time chasing outstanding accounts, that cost may be worthwhile.

Rather than asking only, ‘How much does this system cost?’, practice owners need to consider the bigger question: ‘What does this system save us elsewhere?’

Administration time, unpaid invoices and payment follow-up all have a cost. Looking at the full picture allows practices to make decisions based on the actual impact on the business rather than focusing on one fee in isolation.

Making payment easier can support cash flow

Payment systems are not only a business consideration. They can also affect the client experience.

Families attending weekly or fortnightly therapy may be managing significant expenses. Removing convenient payment options could create additional barriers, particularly for people who rely on credit cards to manage their household cash flow.

At the same time, practices need reliable systems for collecting payment. A busy clinic can have dozens of appointments in a single day, meaning even a small proportion of unpaid invoices can quickly become a significant administrative and financial burden.

There is no single payment model that will suit every practice. The important thing is to understand the trade-off between transaction costs, convenience, administration and the risk of unpaid accounts.

Practices should also check current NDIS and consumer requirements before introducing surcharges, changing payment methods or passing additional costs on to clients. Business expenses cannot automatically be added to an NDIS participant’s invoice simply because the practice incurs them.

Recruitment is another significant business investment

The same cost-versus-value conversation applies to recruitment.

In a competitive OT employment market, recruitment agencies can provide access to candidates and reduce some of the work involved in finding employees. However, that convenience can come with a substantial price tag.

When recruitment fees are calculated as a percentage of a clinician’s first-year salary, the cost can quickly reach thousands of dollars. For a small allied health practice, that money might otherwise contribute to salary, supervision, onboarding, professional development or other supports that directly benefit the new employee.

That doesn’t mean recruitment agencies have no role. A practice that needs to fill a position urgently, has struggled to recruit independently or does not have internal hiring capacity may find considerable value in using an agency.

The key is to understand what you are paying for and whether that model makes sense for your business at that particular time.

OTs can look beyond recruitment agencies too

Understanding recruitment from the employer’s perspective is equally useful for OTs looking for their next role.

Recruiters can provide a helpful overview of available opportunities, but they can only introduce clinicians to workplaces within their networks. An excellent smaller practice may never appear in that search.

For OTs considering a new role, approaching practices directly can therefore be worthwhile. Even if a business is not actively advertising, a conversation may uncover an opportunity that would otherwise have been missed.

This can also give clinicians more control over their job search. Instead of focusing solely on salary or advertised benefits, they can explore the practice’s values, clinical approach, supervision, workload expectations and workplace culture.

Those factors can have a significant influence on whether a role remains satisfying and sustainable over time.

Good recruitment is about relationships, not just vacancies

Finding the right employee is not always about filling a vacancy as quickly as possible.

Sometimes an Occupational Therapist interviews with a practice and is an excellent cultural and clinical fit, but the timing simply isn’t right. Circumstances change. The Occupational Therapist develops new skills, the business grows or a different role becomes available.

Maintaining those relationships can create opportunities later.

The same principle applies when a valued employee leaves. Moving into a hospital role, relocating or exploring another area of practice does not have to permanently close the door. An employee who leaves on good terms may eventually become exactly the person a practice needs.

This shifts recruitment away from being purely transactional. Instead of asking only whether someone can fill today’s vacancy, practice owners can build genuine professional relationships with clinicians who share their values and approach to Occupational Therapy.

Clinical fit still needs to come first

For clinically led OT practices, being closely involved in recruitment provides another important advantage – the opportunity to understand the clinician behind the CV.

Qualifications and years of experience matter, but so do clinical reasoning, communication style, professional values and supervision needs.

Direct conversations and thoughtful referee checks can provide valuable information that may not be obvious from an application alone. A recruitment process should not simply establish whether someone can perform a role. It should help both parties determine whether the clinician and practice are genuinely a good match.

Hiring someone who is not suited to the role can be costly for a business and disappointing for the clinician. Being transparent about workload, expectations, support and workplace culture before someone accepts a position gives everyone a better chance of making a sustainable decision.

Business sustainability is connected to the NDIS

Payment processing and recruitment might sound like internal business issues, but they sit within a much bigger conversation about the sustainability of allied health services.

Changes to NDIS pricing and travel arrangements affect providers, but the consequences do not stop at business margins. If certain services or models of care become financially difficult to deliver, participants may ultimately have fewer choices about who supports them and how that support is provided.

A sustainable OT practice needs enough financial capacity to employ and support good clinicians, provide supervision and professional development, maintain accessible systems and continue delivering high-quality services.

When one part of that equation changes, the effects can flow through the entire practice.

For clinicians, understanding this business environment can also provide useful context for decisions employers make around salaries, recruitment, workloads and service delivery models.

Why OT voices matter in NDIS advocacy

The connection between business sustainability and participant access is also why advocacy matters.

The NDIS has supported greater participation of people with disability across Australian communities. Children and adults with disability are participating in schools, workplaces, recreation and community life, and access to appropriate supports can play an important role in making that participation possible.

When policy decisions risk affecting access to services, OTs are well placed to explain what those changes could mean in everyday life.

Clinicians see the practical consequences of policy. They understand what happens when someone receives the right support and what can happen when that support becomes harder to access.

That knowledge is valuable to policymakers.

Making advocacy practical and effective

Contacting a local MP or contributing to a government consultation can feel intimidating, particularly if it is unfamiliar territory. Advocacy, however, does not need to be confrontational or complicated.

The most useful starting point is to make the issue easy to understand.

Before meeting an MP, a short written brief can provide context and clearly outline the issue. Where several professions are affected, bringing together OTs, speech pathologists, physiotherapists, exercise physiologists, dietitians and other allied health professionals can also demonstrate that the concern extends beyond one profession or individual business.

During the conversation, focus on consequences rather than simply stating that a policy is problematic. Explain what the proposed change could mean for a participant, family, clinician, local service and community.

Following up with a concise written summary gives the MP’s office something tangible that can be referred to or forwarded to relevant ministers, departments or colleagues.

You don’t need to be a policy expert to advocate

It is easy to assume advocacy belongs to people who understand government processes, legislation or policy language. OTs already bring something important to the conversation – firsthand experience.

Occupational Therapists understand participation in everyday life. They see the relationship between support, independence, capacity and community inclusion.

The goal is not to arrive with every answer. It is to clearly communicate what you know, why it matters and what the likely real-world consequences of a decision could be.

Professional, respectful conversations supported by practical examples can help policymakers connect decisions about funding and legislation with the experiences of the people those decisions ultimately affect.

Building more sustainable OT services

Payment systems, recruitment costs and NDIS advocacy might initially seem like separate issues, but they all come back to sustainability.

Practice owners need to understand their numbers and be willing to question whether established ways of working still make sense. Clinicians benefit from understanding the business realities behind employment and service delivery. As a profession, OTs also have an important role in communicating how broader policy decisions affect access, participation and choice for people with disability.

Sustainable allied health businesses are not simply about protecting profit margins. They are part of maintaining a workforce and service system capable of providing high-quality Occupational Therapy into the future.

Key takeaways for OTs

• Look at the total cost of payment systems, including transaction fees, administration time and unpaid invoices.
• Consider client accessibility and cash flow when reviewing payment options.
• Check current NDIS and consumer requirements before introducing surcharges or changing how clients pay.
• Assess the true cost and value of recruitment agencies rather than treating them as the default hiring pathway.
• If you’re looking for an OT role, consider approaching practices directly as well as exploring advertised opportunities.
• Build long-term recruitment relationships rather than focusing only on immediate vacancies.
• Keep clinical fit, workplace culture, supervision and professional values central to recruitment.
• Consider how NDIS policy and pricing decisions may affect both provider sustainability and participant access.
• When advocating, focus on practical consequences and real-world examples rather than policy language alone.
• Remember that sustainable OT businesses help support sustainable Occupational Therapy services.