Professional advisory service

Support workers and assistants are becoming an increasingly vital part of OT services.

As the delegating occupational therapist, you must ensure that they are:

• suitably trained and experienced
• well supported
• supervised
• competent to undertake the tasks delegated to them.

This requires good supervision, risk management skills and the ability to achieve aims working through and with someone else.

As a registered OT, you are bound by our own and the Health and Care Professions Council code of ethics which clearly says that whoever delegates tasks must ensure that the staff they are delegating to are competent, have been appropriately trained and are monitored. 

More information can be found in the briefing about delegation.

Traditionally it was felt necessary to countersign the care records written by students and therapy assistants, but this has not been the case for some time.

The Health and Care Professions Council do not require this to happen. Instead, they state that:

'You have a duty to make sure, as far as possible, that records completed by students under your supervision are clearly written, accurate and appropriate.' (HCPC 2012, section 10)

This puts record keeping alongside any other task that you delegate to another member of staff or a student.

Our code of conduct and ethics states:

'When you delegate interventions or other procedures, you ensure that the person to whom you are delegating is competent to carry them out.

You provide appropriate supervision and support for the individual to whom you have delegated the task/s.

Although all registered practitioners are autonomous professionals, responsible for their own practice and professional judgement, you, as delegating practitioner, retain ultimate accountability for any actions taken.' (RCOT2021, 6.5)

Any practitioner who has adequate training and who is considered competent can write their care records, supported by adequate supervision.

Where a student or member of staff is still learning record keeping skills the supervising therapist is wise to read through the written records and ensure their accuracy and appropriateness, providing feedback where necessary. Where corrections are needed, these should be made by the student/member of staff and signed, as with any amendment.

You should follow local policy if it requires you to countersign the records of students/therapy assistants. If you wish to change this, you are encouraged to discuss it with your employers.

Are you planning for retirement with a NHS or Health and Social Care Pension?

Please note, RCOT is unable to give pension advice to our members. 

Unison support with pensions  

If your RCOT membership includes Unison membership, we would advise you to link in with Unison before signing any retirement paperwork. Unison run regular pensions webinars which are well attended.  

If you have a pension question or problem, please e-mail UNISON's Pensions Unit at pensionsqueriesformembers@unison.co.uk .  

NHS and social care pensions across the UK 

In England and Wales, the NHS Business Services Authority (NHSBSA) is responsible for administering the NHS Pension scheme on behalf of the Department of Health and Social Care. 

In Northern Ireland, the HSC Business Organisation administers the Health and Social Care pensions.

In Scotland, the Scottish Public Pensions Agency (SPPA) is responsible for administering the NHS and social care pensions.

We advise RCOT members that are eligible for NHS or Health and Social Care pensions, to obtain written confirmation of their pension benefits directly from the relevant administrators before signing any retirement paperwork.  

HCPC new standards of conduct, performance and ethics.pdf (PDF, 99.37KB)

The HCPC SoP for OTs can be accessed via the HCPC website.

• They set out the threshold standards that the HCPC considers necessary to protect the public, which are unique to each of the registered professions.  
• They set clear expectations of registrants’ knowledge and abilities when they start practising.  
• Registrants must continue to meet the SoP that apply to their scope of practice.  
• HCPC approved programmes equip graduates to meet these standards.  
• They outline what service users and the public should expect from their health and care professional.   
• The HCPC uses the SoP if someone raises a concern about a registrant’s practice.  

The standards set out in the SoP complement information and guidance issued by other organisations, such as us or your employer.

HCPC recognises the valuable role played by professional bodies in providing guidance and advice about good practice which can help occupational therapists to meet the standards in this document.

The updates to the HCPC SoP come into effect on the 1 September 2023.

Be sure to read our news piece breaking down what the new SoP will entail.

The HCPC has changed the wording of the standards to move registrants away from a passive understanding of the standards, and towards active implementation of them. As an example, they have removed ‘be able to’ from the beginning of several standards, e.g.in standard 1, it makes it clear that registrants must be able to ‘practise safely and effectively’ instead of being able to ‘practise safely and effectively’:  
 
The HCPC has introduced new standards about promoting public health and preventing ill-health. This is because Registrants are part of a larger healthcare system and play an important role in promoting good health in their professions. 
 
They have significantly expanded the role of equality, diversity and inclusion (EDI), placing specific importance on making sure that practice is inclusive for all service users. The HCPC is committed to ensuring that registrants can provide healthcare to all their service users and have strengthened their EDI commitment. 
 
The HCPC has improved the central role of the service user. This includes registrants understanding the importance of valid consent and effective communication in providing good care. The new standards ask registrants to take a wider range of circumstances into account when determining consent. Standards on confidentiality have also been strengthened and reference emerging technology implications. 
 
They have emphasised the importance of registrants looking after their own mental health and seeking help where necessary as a part of maintaining their fitness to practise. The previous standards were less about the registrant and their health and more focused on fitness to practise. This wording reflects the position of the HCPC as a compassionate regulator and their understanding of the centrality of registrant wellness. 
 
The HCPC has emphasised the need to be able to keep up to date with digital skills and new technologies. Technology continues to play an expanding role in the work of registrants. The HCPC has made it clear that they expect registrants to maintain their ability to use new technology relevant to their practice. 
 
They have emphasised the role and importance of leadership at all levels of practice. The HCPC believes in the importance of registrants being autonomous professionals and in displaying leadership without needing to be in a management role. 
 

• Are professional standards, that the HCPC considers necessary for safe and effective practice. 
• Describe what professionals must know, understand, and be able to do when they apply to join and remain on the HCPC Register. 
• Set expectations for professions on the HCPC Register and explain to the public what they should expect of a HCPC-registered professional. 
• Hold applicants to the standards at the point of registration, and registrants at the point of renewal and if fitness to practice concerns are raised. 
• Do not set out best practice, and do not limit a registrant’s ability to provide the best care they can. 
• Complement other sets of standards, such as the HCPC standards for conduct, performance and ethics, and policies and guidance from employers and professional bodies.

• The standards intentionally use verbs such as ‘understand’, ‘know’, and ‘be able to’, to ensure that both prospective registrants and current registrants will be able to meet the standards. 
• The HCPC writes the standards, so they are relevant to all registrants in a profession, regardless of their area of practice. 
• The HCPC uses the term ‘service user’ or words like ‘treatment’ or ‘intervention’, even though these may not be the preferred term for all. 
• The standards' language should enable them to stay relevant if there are changes in the law, technology or working practices. 
• The HCPC avoids referring to specific pieces of legislation or particular approaches, to ensure the standards remain relevant over time. 

Please refer to the HCPC website for the new SoP for occupational therapists.

No. 

For the HCPC CPD audit, the CPD assessors are assessing against the CPD standards, not the standards of proficiency for Occupational Therapists. The CPD standards are the ones you need to demonstrate you are meeting within your CPD profile. 
 
Please refer to the RCOT website for a webinar between RCOT and HCPC on supporting you with the HCPC CPD audit and the information on HCPC and CPD and the career development framework.
 
In addition, the gap analysis tool from the HCPC allows registrants to analyse the gaps between their current practice and their goal. This can point you in the right direction as to where you may wish to focus CPD activities or learning, to meet the updated standards of proficiency.

Please contact the Professional Advisory Service via professional.advisoryservice@rcot.co.uk or 020 3141 4630.

The service is open from Monday-Friday from 9am-5pm.

You are required by the Health and Care Professions Council to have suitable insurance for the work that you do.

Your BAOT insurance policy provides Malpractice & Professional Liability cover and Public & Products’ Liability cover in respect of occupational therapy work. It is cover for the individual member, whether “employed” or “self-employed” but not for their employer. The policy does not provide cover for any type of entity that is a company or a partnership. In these circumstances, a separate policy will need to be arranged in the name of that entity.

Your BAOT professional indemnity insurance covers members who are OTs, OT support workers and OT students who are engaged in the practice of occupational therapy work. Support workers and students must be working under the supervision of a qualified OT for this insurance policy to be available to them.

Further information on Professional Indemnity Insurance and other useful topics is available via an RCOT briefing.

If you have any enquiries regarding the insurance, please call Aon who are the brokers for our insurance.  Aon’s contact details are:

• Bob Litchfield (bob.litchfield@aon.co.uk) 0116 280 7041
• Rainer Tilley (rainer.tilley@aon.co.uk) 0116 280 7552

You may wish to become a self-employed member (arranging and paying your own tax), however, you will no longer benefit from Unison membership. For details on BAOT membership categories visit our joining page.

If you have any further questions please contact our Membership team via membership@rcot.co.uk or on 020 3141 4648.

The name changed from Criminal Records Bureau (CRB) to Disclosure and Barring Service (DBS) in 2012, when the CRB merged with the Independent Safeguarding Authority (ISA). 

The primary role of the Disclosure and Barring Service (DBS) is to help employers in England, Wales and Northern Ireland to make safer recruitment decisions and prevent unsuitable people from working with vulnerable adults and children. The DBS is responsible for:

• Processing requests for criminal records checks (in England and Wales) and
• Deciding if it is appropriate for a person to be placed on or removed from a barred list (in England, Wales and Northern Ireland)

In Scotland, the checking and barring service is operated by Disclosure Scotland and in Northern Ireland, disclosure is operated by AccessNI.

Do I need a DBS?

An employer may request a DBS check as part of their recruitment process.

It can be difficult for a self-employed or individual practitioner to apply for a DBS. You have to go through an umbrella body which is willing to do this for you. You will usually have to use one of the organisations who have set themselves up specifically for this purpose.

The Health & Care Professions Council (HCPC) require all occupational therapists to be registered in order to practise in the United Kingdom. They have a system that flags an individual if they have any cautions or convictions at the point of registration. The disclosure service informs the HCPC if a registered practitioner is on a barred list. The HCPC will then consider their registration status. In this way your professional registration also provides a level of assurance.

The HCPC has material to inform employers and clients about the value of registration and how to check the registration status of a practitioner.

It is advisable to speak with an accountant or the Inland Revenue about your change in income. You will need to complete self-assessments annually and register to pay National Insurance. Visit HMRC's website for more information.

Our professional standards for occupational therapy practice, conduct and ethics and the HCPC both stipulate that as a registered occupational therapist, you may only provide services for which you are competent.

It is therefore important to limit yourself to roles/jobs for which you are qualified by education, training and experience. If you wish to take on new areas of practice be sure that you have enough training and professional/clinical support to do them safely and effectively.

All occupational therapists must be registered with the HCPC in order to practice. There is not an additional HCPC register for independent occupational therapists.

No. If you become a self-employed member (arranging and paying your own tax) you will no longer benefit from UNISON membership.

Whilst the BAOT/RCOT members’ Malpractice and Professional Liability and Public and Products Liability Insurance policy covers BAOT/RCOT members engaged in occupational therapy work worldwide (excluding the USA and Canada), members working in other territories should check whether there is a legal requirement to arrange local cover. The policy will only respond to claims first made or filed in the European Union, the Channel Islands and Australia and will only pay damages awarded by courts of these countries.

As a consequence of the withdrawal of the United Kingdom from the European Union, the various British Overseas Territories (also known as the United Kingdom Overseas Territories) are also no longer part of the European Union. The insurance policy will not respond to claims first brought or suit filed against the Insured in any of the British Overseas Territories, which are: Anguilla; Bermuda; British Antarctic Territory; British Indian Ocean Territory; British Virgin Islands; Cayman Islands; Falkland Islands; Gibraltar; Montserrat; Pitcairn, Henderson, Ducie and Oeno Islands; St Helena and St Helena Dependencies (Ascension and Tristan da Cunha); South Georgia and South Sandwich Islands; Sovereign Base Areas of Akrotiri and Dhekelia (Cyprus); and The Turks & Caicos Islands. 

Further information: 

Tax relief & liability insurance for our members

Working abroad as an occupational therapist

The MHRA published the alert in August 2023 as it had been receiving (and continues to receive) reports of deaths and serious injuries from entrapment or falls relating to medical beds, bed rails, trolleys, bariatric beds, lateral turning devices and bed grab handles.

The MHRA Alert is available here.

Actions required

1.    Update your organisation’s policies and procedures on procurement, provision, prescribing, servicing and maintenance of these devices in line with the MHRA’s updated guidance on the management and safe use of bed rails.
2.    Develop a plan for all applicable staff to have training relevant to their role within the next 12 months with regular updates. All training should be recorded.
3.    Review the medical device management system (inventory/database) for your organisation or third-party provider for devices within your organisation, including those which have been provided to a community setting (for example, the patient’s own home). Keep this system up to date.
4.    Implement maintenance and servicing schedules for the devices in the inventory/database, in line with the manufacturer’s instructions for use and/or service manual. Prioritise devices which have not had regular maintenance and servicing. If this is outsourced, compliance with the schedule should be monitored.
5.    Review patients who are children or adults with atypical anatomy as a priority. Ensure the equipment they have been provided with is compliant with BS EN 50637:2017 unless there is a reason for using a non-compliant bed. Record this on the risk assessment and put in place measures to reduce entrapment risks as far as possible.
6.    Review all patients who are currently provided with bed rails or bed grab handles to ensure there is a documented up-to-date risk assessment. Complete risk assessments for patients where this has not already been done and for each patient who is provided with bed rails or bed grab handles.
7.    Implement systems to update risk assessments where the equipment or the patient’s clinical condition has changed (for example, reduction/improvement in weight or mobility), and also at regular intervals.

• We met with NHS England in Autumn 2023 regarding the MHRA alert to highlight the concerns our members have raised regarding the National Patient Safety Alert.
• We stressed to NHS England (alongside other agencies such as ADASS) that the March 2024 deadline for retrospective risk assessments put enormous strain on occupational therapy services.
• We contacted the Medicines and Healthcare products Regulatory Agency regarding this issue. It responded with the following information:

'MHRA have been responding to any enquiries which it has received regarding the National Patient Safety Alert.  In terms of concerns that have been raised, the most frequent of these has been regarding the deadline.  Anyone who is unable to meet the deadline should add this to their risk register.'

MHRA also informed us that the Medical Device Safety Officer (MDSO) network have been working on resources regarding the NatPSA guidance, including an FAQ document which MHRA provided input on. This has been published and can be found at: MDSO: Bed Rails FAQ and new TOR – NAMDET. 

• It is very important that organisations have clear plans to undertake reviews and have added any issues to its risk register.
• The ‘Prescribing beds for a domestic setting briefing’ was updated to include MHRA guidance on bed rails. You can find the briefing under the ‘RCOT resources’ drop-down on the following web page: Moving & Handling Activities (Members Only).

Key things I need to know about preceptorship?

We have put together a handy document for you to download.

Preceptorship fact sheet - March 2024.pdf (PDF, 153.73KB)

The Health and Care Professions Council (HCPC) are the regulatory body for all occupational therapists in the UK.

As someone with an occupational therapy qualification who has been out of practice and not registered with the HCPC for some time, you will need to satisfy the requirements of the HCPC, before you are able to return to practice.

To demonstrate that you are up-to-date in your skills and knowledge, the HCPC requires you to undertake a period of learning and updating. For example:

• 0-2 years out of practice – no requirements
• 2-5 years out of practice – 30 days of updating
• 5 years or more out of practice – 60 days of updating

For further guidance please see the HCPC return to practice booklet.

As a member you will be covered by our Professional Indemnity Insurance whilst out on placement.

Please refer to the Malpractice & Professional Liability and Public & Products’ Liability Insurance for BAOT Members briefing for further guidance.

If you are not a member, we would strongly advise you to consider rejoining as there are a number of key benefits to support your updating – as well as the opportunity to network with practicing  occupational therapists in regional or specialist interest groups.

RCOT has an online returning to practice resource that outlines the requirements and some of the ways that you may meet them so that you are able to demonstrate that your skills and knowledge are up to date and good enough for you to practice safely as an occupational therapist.

The Health Care Professions Council (HCPC) defines your scope of practice as ‘the limit of your knowledge, skills and experience and is made up of the activities you carry out within your professional role. As a health and care professional, you must keep within your scope of practice at all times to ensure you are practising safely, lawfully and effectively. This is likely to change over time as your knowledge, skills and experience develop,’ 

The HCPC states there is a not a set list of tasks that professions can and cannot perform and it varies from registrant to registrant.

When you first join the HCPC Register, the standards of proficiency will be your guide. They set clear expectations of registrants’ knowledge and abilities when they start practising.

As you progress in your career, you may carry out more specialist roles where you no longer meet all the standards of proficiency. Your scope of practice will develop with you and may become narrower in scope. It is for you to determine what is and is not part of your scope of practice, using your professional judgement.

When deciding whether a particular activity falls within your scope of practice, or when moving into a new scope of practice, you need to consider if the training and support you have received adequately equips you to perform the activity both safely and effectively.

The HCPC advises you to consider when you are thinking about your scope of practice, to ask yourself the following:

1. Do I have the skills and knowledge to carry out the activity safely and effectively?
2. Can I complete training or receive other support (such as supervision) that will give me the skills and knowledge needed to carry out the activity safely and effectively?
3. Is the activity restricted by law (e.g. prescribing) and, if so, can I legally do it?
4. Does my professional indemnity insurance cover the activity?

The HCPC has produced an FAQ and resource page to help you determine what is and what is not in your scope of practice.

You need to consider whether the activity falls within the general scope of practice of your profession. Please refer to the RCOT Scope of Practice briefing.

Your scope of practice may also depend on your job role, legal restrictions (such as prescribing or protected functions) and whether you would be covered to undertake the activity by your professional indemnity insurance.

Please refer to the information on tax relief and insurance for RCOT members.

You may find it helpful to speak to the Professional Advisory Service at RCOT who may be able to offer further advice. 

In their Standards of Proficiency – Occupational therapists (2023, page 2), the HCPC states:

‘At the point of registration, occupational therapists must be able to:

1) Practise safely and effectively within their scope of practice.

1.1) Identify the limits of their practice and when to seek advice or refer to another professional or service.

1.2) Recognise the need to manage their own workload and resources safely and effectively, including managing the emotional burden that comes with working in a pressured environment.

1.3) Keep their skills and knowledge up to date and understand the importance of continuing professional development throughout their career.’

The RCOT briefing on Scope of Practice (2023) refers to ‘at the heart of occupational therapy is the belief that the ability to participate in meaningful occupation is fundamental to health and wellbeing, and that occupation in itself has therapeutic value. From this it can be said that the core skills of an occupational therapist is the focus on the assessment of occupational needs and the facilitation of occupational performance/engagement. Thus any activity that an occupational therapist uses or does therapeutically, in order to enable or enhance occupational performance, may be considered within the professional scope of practice.

The practitioner concerned must be able to demonstrate that their professional rationale for any activity or intervention is the enhancement of health and wellbeing through the promotion of occupational performance/engagement. A number of activities or interventions that were once considered ‘extended scope’ would now be seen as part of the diversity of occupational therapy practice, providing the practitioner concerned can meet this requirement to demonstrate their professional rationale for the given activity.’

For further guidance, please refer to our Scope of occupational therapy briefing - September 2023:

Occupational Therapy Scope Of Practice (Members Only)

Scope of occupational therapy – September 2023 (PDF, 192KB)

Your employer will need to formally recognise the practice/role that you are doing, perhaps in your job description, service description or some kind of communication (email/letter). This means that their vicarious liability insurance should cover you, so long as you work within that description of your role.

With regards to your RCOT insurance, if asked, the practitioner concerned must be able to demonstrate that their professional rationale for any activity or intervention is the enhancement of health and wellbeing through the promotion of occupational performance/engagement. Therefore, you will need to use your clinical and professional rationale to determine whether you meet these requirements. If you do, we would then assume that you are covered by our insurance.

Find out more about tax relief and insurance for RCOT members.

The professional standards for occupational therapy practice, conduct and ethics state:

6.2.1 - ‘You only provide services and use techniques for which you are qualified by your professional education, ongoing learning and/or experience. These must be within your professional competence, appropriate to the needs of those who access the service, and relate to your terms of employment.’

6.2.2 – ‘You have sufficient knowledge, skills and experience to make reliable professional judgements, suitable to your level of responsibility and scope of practice.’

6.2.3 – ‘You seek advice or refer to another professional when you do not have sufficient knowledge and/or skills.’

6.2.4 – ‘You are attentive to and abide by the current legislation, guidance and standards that are relevant to your level and scope of practice and place of work.’

6.2.5 – ‘You make yourself aware of developments within the profession and current research, relevant to your level and scope of practice, applying these where appropriate and possible.’ (RCOT, 2021, page 36).

When you work in an emerging role, you may find it difficult to find supervision from someone who is more experienced than yourself. The kind of support / guidance provided through supervision and the person providing it, will depend upon the context for and function of the supervisory relationship. If clinical supervision is required for your diverse role, it may not need to come from an occupational therapist, but someone who has the skills, knowledge and experience necessary to support you. 

Consider using social media to link up with occupational therapists working in a similar field; provided you maintain confidentiality at all times, you may benefit from seeking general advice and support in this way.

You may find yourself as the only occupational therapist in a service or location. In this case look for other networks and support groups, perhaps via our communities platform. Make links with other occupational therapy services in your locality, even if they are within another organisation. You may be able to make use of their learning opportunities or other resources. 

Essentially, this is a local policy decision and not something that we can influence. Your employer can insist that staff wear a particular uniform if that is the policy of the organisation. If the employer is making a reasonable demand, then there would be little or no ground on which to challenge it.

Why do we need to wear a uniform?

If you are not happy with the uniform that you are being asked to wear, you are encouraged to find out why management is making this request. Is there a rationale behind it?

If you wish to raise your concerns with your employer there are a number of questions you can raise:

• is the uniform fit for purpose? 
• does the uniform affect the staff member’s ability to carry out their role effectively? 
• does it affect the quality of the therapeutic relationship with their clients?

Generic uniforms

Although a white top with a bottle green trim and bottle green trousers is the most common for an occupational therapist, this is a tradition as opposed to any overall ruling. Many occupational therapists feel that there is a risk to their professional identity if they are asked to wear a generic or shared style/colour of uniform. The most important piece of equipment for providing your professional identity is the way you introduce and explain yourself to your service users, backed up by your identity badge. It is important that your explanation of your profession and role is simple and easy to understand and remember.

If you are concerned about having a generic uniform, again you are encouraged to talk to your management. Consider the service user’s point of view. Do they like to be able to identify one profession from another? There may also be a safety element. Could the inability to distinguish between a nurse and a therapist lead to misunderstanding – the wrong person being asked to do the wrong thing?

Even following a discussion, you may need to wear the uniform for a while. If you find after some time that there is constant confusion, raise your concerns with your management and ask for a re-think.

The BAOT/RCOT members’ Malpractice and Professional Liability and Public and Products Liability Insurance policy provides cover for any work which falls within RCOT’s definition of occupational therapy. It does not distinguish between activities which are delivered in person or “virtually.” 

There are geographical limits and jurisdiction limits within the policy which apply irrespective of how the activities are delivered. The policy covers occupational therapy work undertaken anywhere in the world excluding the United States of America or Canada but only in respect of Claims first made or suit filed against the Insured in the Great Britain, Northern Ireland, Channel Islands, Isle of Man, the European Union or Australia. 

Further information: 

Tax relief and liability insurance for our members 
Digital occupational therapy 
Providing care and treatment remotely (hcpc-uk.org)
Occupational therapy scope of practice (Members Only)