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Action examples
The value of occupational therapists in primary care
We hope that sharing these action examples will help you see the value of occupational therapists in primary care.
They’ve been written by pioneer occupational therapists who are leading the way in primary care.
Some include short films or articles by occupational therapists giving their key learning. The examples were independently peer reviewed and presented at our Annual Conference in 2023.
We’ve grouped them by service type and those that target specific populations.
We also have action examples about the value of taking occupational therapy learners on placement in primary care.
Patients with any functional difficulties
Creating community referral pathways to support direct access to primary care occupational therapy: right person, right time, right place
By Lisa Greer and Sam Corrie from NHS Lanarkshire
We wish to share our experience and learning from an NHS Education Scotland AHP fellowship project. It focused on developing community-based referral pathways for direct access to a primary care occupational therapy service.
The NHS Lanarkshire primary care occupational therapy service offers a prevention and early intervention model of care. The service is for adults with a range of health and wellbeing issues affecting function.
We believe that access to self-referral and care navigation pathways would support people to seek help earlier on in their health journey. It would encourage those who may not attend their GP to engage with OT, reducing health inequalities and improving patient outcomes.
Our leadership journey has used quality improvement methodology to test our change idea for developing community referral pathways. In this blog, we discuss the tools we used, the challenges experienced, our learning and our plans for further service development. We’d like to hear from you about your use of information/awareness raising tools. This would improve our understanding of what works well, by sharing information and tools in a practical way.
Diversifying occupational therapy delivery models in primary care to meet population need: insights from a Welsh health board
By Alex Gigg and Christine Samuel from Swansea Bay University Health Board
We can demonstrate how mixed-OT delivery models work in one cluster in Wales to address a range of population needs for adults.
In Swansea Bay University Health Board, we’ve been able to demonstrate value in differing OT delivery models for adults within two primary care clusters. The strategic programme for primary care is driving how cluster initiatives are funded and prioritised. These are exciting times to show the breadth of skills OTs have to enable GP surgeries to better meet population need.
The two models are the virtual ward MDT concept which is core funded. Alongside this, the practice-based OT concept is cluster-funded. This demonstrates that one size doesn’t fit all and that a different models can co-exist positively within one service area. We’ve also shown how consistent standardised and non-standardised outcomes for both models enhance promotion of the OT role.
By demonstrating the outcomes of OT intervention in both medical and biopsychosocial models, we can highlight the breadth of OT interventions through either model.
OT is an essential and core member of practice teams. We have growth potential and capacity for the OT roles to continue to evolve with changing service and population needs. OT needs to be adaptable to change and use multifaceted outcomes to ensure stakeholders are engaged.
Co-producing a primary care occupational therapy service in Somerset
By Rebecca Keating and Nicola Mead from Somerset NHS Foundation Trust
Since 2020 occupational therapy has been included in the roles attracting funding through the additional roles' reimbursement scheme. Its intention is to increase the skills available to meet future needs of populations that primary care networks (PCNs) serve.
In Somerset we co-produced our model with primary care partners. We developed this service using a host model which offers support to our workforce in this emerging area of practice. We harnessed investment in prevention service based on the practice reflections and development considerations from our professional lead. We now have 18 occupational therapists over 11 PCNs.
We’re excited to share our learning and encourage our peers to shout about the potential our profession has to offer in primary care. We’ve shared learning from the perspectives of a strategic lead and a professional lead. Also, from one of our occupational therapists on how they have forged a role within this area of clinical practice.
We’ve produced a series of short films to raise awareness of additional roles in primary care such as occupational therapy.
- Dr Jeremy Imms introduces the additional roles that have been incorporated locally.
- Kyle Hepburn talks about skill mix and employing occupational therapists in primary care.
- Rebecca Keating talks about the benefits of the profession in GP surgeries.
- Nicola Mead addresses doubts people may have about the value of OT in primary care.
Helen and Hattie talk about their typical days working in care homes.
A narrative of how we co produced a Primary Care OT service in Somerset.
Realigning secondary care community occupational therapy services with primary care services
By Vicky Warburton from Betsi Cadwaladr University Health Board
Temporary stopping of community assessments due to the pandemic allowed us to make strategic changes to our occupational therapy provision.
We proposed that practitioners would align with primary care surgeries, This would enable referrals to be made sooner in the patient’s journey and facilitate improved multi-disciplinary team working. It would reduce demand on GPs, resolving underlying functional issues that are the root cause of multiple contacts with practices.
Our vision was also to reduce impact on secondary care services through reducing heath inequalities. We also wished to promote independence, health, and lifestyle skills alongside facilitating adaptation to disability due to long-term conditions.
This realignment was underpinned by public health agendas and Welsh government strategies like the AHP framework and a healthier wales. These highlight the need for new models of seamless health and social care at local and regional level.
Our project has two phases; phase one is already operational. Investment is proposed for phase two, which shifts focus towards preventative interventions, drawing on the expert patient role and reducing crisis responses.
Cohesion now exists between patients, occupational therapists, primary care and the third sector, reflecting the benefits put forward in political drivers. Alongside this, we’ve seen the delivery of greater provision of services, early interventions, and improved co-production in adult physical health.
This has resulted in a significant reduction in patient waiting times and urgent referral rates. It has provided us the opportunity to fly the flag for our profession and raise our profile in North Wales.
RCOT poster presentation support information
Impact of developing a new occupational therapy service in primary care NHS Ayrshire and Arran: Working together
By Gemma Murray and Ranah McAusland from NHS Ayrshire and Arran
We wished to promote the value of occupational therapy in GP practice multidisciplinary teams (MDTs).
Occupational therapy can meet the needs of patients in primary care by offering an early intervention/prevention service. This service can be offered to people with a functional decline due to either physical or mental health issues.
We have seen an increase in appropriate referrals and a reduction in GP appointments required following occupational therapy. We have also seen high levels of patient satisfaction and a small number of people referred into secondary services.
Primary care is often the first point of contact with services for people experiencing physical or mental health problems. We recognised this and began a pilot to offer occupational therapy to one GP surgery per locality (three in total).
At the start of 2022 we secured permanent funding and the Working Together service expanded to 16 practices across Ayrshire and Arran. The general medical service contract outlines that there should be a wider range of professionals available in practices.
The NHS Ayrshire and Arran vision aspires to provide better local access to MDTs in GP practices. Further investment is required to ensure all GP practices have access to occupational therapy. At present there are 53 GP practices in Ayrshire and Arran. By growing occupational therapy in primary care, we are expanding innovative opportunities for practice, education, and employment.
Older adults
Occupational therapists working proactively in primary care: sharing our success of implementing personalised and anticipatory care
By Sarah Tyreman from Yorkshire Health Network
We’ve implemented a new proactive occupational therapy service, working at scale in primary care. It’s demonstrated benefits to patients, carers and the health and care system. We’ve made potential annual cost savings of £767,204 and believe this model would benefit occupational therapists.
Yorkshire Health Network is a GP federation encompassing 17 practices. We set up the ProActive Care Team (PACT) in 2022 after identifying that rural, frail and housebound patients were at risk of health inequality. Our service aligns to the aims of the NHS Long-Term Plan. This sets out the commitment to preventative care and reduction of health inequalities at a time of increasing demand on the NHS.
We identify patients through risk stratification and offer personalised and anticipatory care in their own home. PACT provide both an assessment of current needs and advanced care planning discussions. In the first six months PACT provided 1,663 interventions. These included reducing risk and addressing patient concerns. We also supported goal attainment in areas such as falls, cognition, social isolation, maintaining independence and dignity. Critical analysis of this data has shaped the service development over the past year.
We also surveyed patients/carers and sought out feedback from the GP practices. One patient said ‘this is an exceptional service especially for people living by themselves. It was good that it wasn’t with a doctor, no structured questions, you could talk about whatever matters to you.’
Occupational therapists being the key contact professional in primary care for people living with dementia (PLWD) and their carers
By Andrea Duffy and Mark Shah-Hall from Betsi Cadwaladr University Health Board
Living with dementia can cause distress to PLWD and their carers. We found patients who’ve been discharged from memory services to the care of their GP report that they feel abandoned.
We know tailored, person-centred care reduces distress for PLWD and improves quality of life for them and their carers. Providing timely support is crucial. Developing a team around the person with a key contact ensures they’re properly supported and can access services when needed.
Our occupational therapy team became that key contact, based in primary care. We provided six-monthly reviews and home visits which aimed to improve their primary care support.
We’ve improved the wellbeing of PLWD and their carers and prevented crises of care happening. PLWD and their carers now feel more informed and supported which has improved their ability to self-manage their health.
We were able to provide relevant interventions and signpost/refer to local dementia support services. Health-related issues could be relayed to and dealt with by the multidisciplinary team. Any social issues were highlighted, and referrals made if necessary.
By providing assistance and advice on strategies, behaviour management and meaningful occupation, OTs can improve wellbeing for PLWD and reduce carer burden.
Developing and capturing the impact of an OT-led service in primary care, to support people in the early stages of their frailty journey
By Anya de longh and Joanna Payne from NHS Ayrshire and Arran
We established an OT-led service in primary care to work with older patients at an early stage of their frailty journey. We provide proactive input to support ageing well. Using a range of strategies to reach our target group of patients, we’ve demonstrated a positive impact, measuring with the EQ-5D, Self-Management Ability Scale and Indicator of Relative Need tools.
We established an OT-led service in primary care to work with older patients at an early stage of their frailty journey. We provide proactive input to support ageing well. Using a range of strategies to reach our target group of patients, we’ve demonstrated a positive impact, measuring with the EQ-5D, Self-Management Ability Scale and Indicator of Relative Need tools.
Primary care is often the first step in an individual’s journey through healthcare. To catch people at an earlier stage in their frailty journey, more proactive approaches are required beyond onward referrals from professionals following contact. To justify the resources, evidencing impact is crucial. However, at this early stage of frailty, many measures are not nuanced enough to capture the breadth or depth of OT interventions.
We’ve used different approaches to building relationships with primary care, through co-location, physical presence and traditional face time, as well as use of data and entries to medical records to increase visibility of OT.
We’ve explored the challenges of finding outcome measures that fully capture the OT-specific input of our work. Also, measures that resonate with the wider clinical landscape of primary care and maintain a person-centred approach. With increasing pressure to capture outcomes and integrate with an increasingly overwhelmed primary care system, using data provides a new angle to help develop OT in new fields.
Elevating occupational therapists through AI in primary care: Our journey in Somerset
By Sophie Lonsdale-Eccles from Taunton Dean West Primary Care Network (PCN), Helen Rostron, from North Sedgemoor PCN and Dr Matthew Dolman
In Somerset, we recognised the need for earlier intervention for older adults, to stop them from needing hospital admission. We trialled using Brave AI which predicts patients most likely to need admission, so we can intervene and help. We piloted it first in care homes where it reduced falls by 35%, attendances to A&E by 60%, and ambulance calls by 8.7%. We’ve been shortlisted for driving change through AI in the Health Service Journal 2024 Digital Awards.
Using Brave AI has helped us as OTs offer more proactive care. We have a dashboard, and we can search by PCN or by GP surgery. The AI looks at different patient variables from data in the GP care records, like age, falls, health, calls into the surgery, hospital admissions, ambulance call outs etc.
It means we can deliver personalised care through digital means so people can self-manage. It enhances the MDT approach by helping us know who to target so they get the right person at the right time. It saves time and is about upskilling patients. It means we can find people and enable them to live their lives and keep doing what they want or need to do, rather than being reactive and only seeing them when they’re in crisis. It’s a flexible tool so different places are using it differently. For example, Helen has no referral system and uses Brave AI instead.
It’s given us an extra tool to be more focused on OT and given us the ability to elevate our services in primary care. Brave is the first AI tool we’ve used, and it’s given us a seat at the table as leaders, so our voice is being heard. The project pilots helped define who we are as OTs. Brave AI is now being rolled out across the southwest of England.
For patients like Joan, a care home resident from Burnham on Sea it’s improved her health and saved the system money: “I can’t believe it, I’m 100% better. Last year I had 14 lots of antibiotics…this year none at all. I can’t believe the help Helen’s given me and the equipment she suggested I have. It’s made such a difference to me”.
The impact of occupational therapy cognitive screening in primary care
By Cheryl Fear, Suzy Usoro and Lister Mlambo from Danebridge Medical Centre in Northwich, Cheshire
Occupational therapists (OTs) working in a primary care network in England have developed OT cognitive screening clinics. We provide first contact for those experiencing memory concerns, meaning that the patient is booked directly into the OT clinic rather than being booked to see a GP. This service addresses GP pressures, the need for timely diagnosis and NHS priorities relating to dementia.
We developed a new pathway which includes the dementia screening blood-tests being arranged at the point the patient contacts the surgery with memory concerns. This significantly speeds up the process from first contact to onward referral to psychiatry at the memory clinic for diagnosis. As OTs, we complete standardised cognitive testing as well as holistic, biopsychosocial assessment of the person’s history and current circumstances.
The person is also screened for any OT needs or onward referrals needed, considering, for example, the impact of mental health, menopause or neurological symptoms. OT follow-ups are arranged for further intervention as needed.
We achieved the following:
- Delivered proactive OT interventions to promote healthy ageing.
- Reduced number of GP consultations
- Reduced waiting time for diagnosis by 45 days
- Increased acceptance rates of primary care referrals into the memory service from 77% to 100%
- Received positive feedback from patients about delivering personalised care.
We’ve demonstrated there’s an important role for OTs as first contact practitioners for those with memory concerns in primary care.
Mental health
Mental health and wellbeing: occupational therapists meeting mental health need in primary care, a North Wales example
By Alexis Conn from Betsi Cadwaladr University Health Board
Occupational therapists have been present in primary care in specific GP practices for some years in North Wales. Our project further evaluated a role focused on people in primary care with mental distress, including those living with physical health conditions. We’ve successfully piloted and evaluated the role and are now rolling it out across North Wales.
The rationale for this service development was to be able to provide focused early assessment and intervention. Using knowledge of the impact of individual function and environment on health, we’ve supported self-management including linking to community resources. We’ve collected outcome and impact data, including the use of patient reported experience measures. We’ve also used outcome measures and service level data to demonstrate a reduction of referrals to secondary care.
Our work is consistent with national Welsh policy drivers including the strategic programme for primary care and the AHP framework. Including occupational therapists in the primary care team has allowed delivery of NICE guidelines including those for anxiety and depression.
We’ve made a detailed exploration of this key role for occupational therapists in primary care and how its impact can be measured. The service now offers access to assessment and intervention by occupational therapists in primary care. It avoids the need for medical solutions to non-medical issues in a significant number of cases.
OTs meeting MH needs in Primary Care, Wales.pdf (PDF, 96.53KB)
The emerging role for occupational therapy in a new mental health wellbeing service in GP practices in rural and urban localities
By Susan Campbell-Jones from NHS Highland & NHS Greater Glasgow and Clyde
We’ve demonstrated the essential role that occupational therapy has in providing early, brief mental health assessment and treatment. This has been provided for GP practices in a hybrid rural and urban locality. The Scottish Government stated their vision for multidisciplinary mental health support from within GP practices in their recent mental health strategy.
In 2022 we identified funding to develop a mental health wellbeing service in five GP practices in Helensburgh and Lomond. The new service would include occupational therapy and nursing staff. It’s unique with urban and rural components, and covers a royal navy base, all of which have significant and differing needs.
To date there had been no mental health occupational therapy service provision in primary care. An occupational therapist was employed in October 2022 as part of the team. We used the initial period to service plan, develop an operational working agreement with GPs and scope the specialist role.
Our key priorities for this new service include maximising function through self-management approaches and vocational rehabilitation. We’ve tackled health inequities through improved access to proactive mental health support.
We believe there is a clear role for occupational therapy in primary care to provide specialist support. Our interventions give people with mental health difficulties improved quality of life by improving their engagement in meaningful daily activities. We’ve demonstrated impact across this unique community and area of Scotland.
Developing primary care mental health services in Northern Ireland
By Jane Reynolds, Louise Connolly and Linda Hamill
A 10-year plan to reduce health inequalities and improve health care in Northern Ireland, identified the need for GPs to widen their remit. Funds were made available to five GP federations to pilot multi-disciplinary intervention teams. The Causeway GP Federation was successful in their bid to be part of the pilot.
Three OTs and their colleagues designed a new service, providing proactive and preventative mental health interventions. Causeway GP federation now employ 11 primary care mental health practitioners, from different professional backgrounds.
The team provide short term assessment and intervention for those not requiring secondary mental health services. They offer psychoeducation, self-help and lifestyle advice and goal setting. Patients are also directed to local services such as activity-based groups in the community and voluntary sector. The occupational therapists in the team bring their knowledge and skills around meaningful and productive activity. Their service extends from childhood to older age.
In three months, the team provided about 6000 consultations. A patient satisfaction survey showed that 97% of patients were very satisfied or satisfied with input from the team. 70% of patients found the resources used were useful. The adult community mental health teams locally report a 43% reduction in referral rate. GP surgeries are keen to increase the number of sessions provided by the team, reporting reduced reliance on medication for people who benefit more from non-medical interventions.
Sandra (a patient) said, “They were helpful, friendly and approachable. I was listened to and understood.”
Developing Primary Care MH services in NI.pdf (PDF, 562.03KB)
Promoting the value of First Contact Mental Health OTs
By Catherine Seals from Nottingham West PCN
In Nottingham West PCN, we’ve been using mental health occupational therapists working from GP surgeries to identify and address mental health needs early on. People can access support from mental health OTs without a referral from a GP because we work as first contact clinicians, saving the GPs time.
Nottingham West PCN was one of the first in England to employ mental health OTs and we’ve worked hard to promote our service. For example, HRH The Princess Royal helped to launch our group therapy program that promotes conversations about mental health and offers practical, personalised steps to keep well. Desiree Gillespie, our AHP ARRS Ambassador from Nottinghamshire Alliance Training Hub, hosted a webinar about first contact OTs in primary care, which goes into detail about my mental health role. We’ve built on our successes and I’m now Team Lead.
Paul Cooke, 36, a father of three from Giltbrook and engineer at Rolls Royce, recently benefitted from the service. He described his experience of therapy with a mental health occupational therapist as “a breath of fresh air” and explained how working with them “helped me align more to my old self.” He’s returned to work after being off sick with low mood, anxiety and panic attacks. He says, “I’ve now got the confidence to go forward and take responsibility for my own mental health.”
Dr Kelvin Lim, GP of 32 years at Eastwood Primary Care Centre, wanted to spotlight “the pioneering approach of occupational therapists and their passion for giving good care to their patients. Nottinghamshire is one of the first areas to utilise the mental health skills of the occupational therapist.”
Health and work
The impact of an occupational therapy led vocational rehabilitation service in a primary care network
By Hannah Bright and Lauren Drake from Mid Yorkshire Hospitals NHS Trust and West Wakefield PCN
We used occupational therapy to improve return-to-work outcomes for patients either off work sick or at risk of going off work sick. We also reduced GP workload with our service.
We know OT is effective in supporting people return to and remain in work, evidenced though outcome measures and qualitative feedback. OT led vocational rehabilitation (VR) in primary care using specialist clinical skills has the potential to make a positively impact. We can support people to remain economically active and improve long-term health outcomes.
We used funding from the additional roles reimbursement scheme to develop a pilot service to provide OT led VR. We based the service on government drivers for health, work and disability and the NHS Long-Term Plan.
Evidence shows the longer someone is off work the lower the chance they will ever return to work. This negatively impacts their long-term health outcomes. Early intervention for VR is recommended to enable people return to work with adjustments and support in place.
We analysed the benefits of VR in primary care for patients and GPs through outcome measures, patient feedback and service data. The service has reduced GP workload and had a positive long-term impact on patients.
This is an emerging role, advancing practice and visibility of OTs within primary care. There is a potential to expand the workforce as evidence grows to support the success of VR in this setting.
Impact of Occupational Therapy led VR programme in a primary care network
Expanding fit note provision using occupational therapy in primary care
By Victoria Signorelli, Hackney Marshes PCN, and Catherine Atkinson, Homerton Healthcare Foundation Trust
OTs in primary care have been shown to decrease sickness absence from work, and use of fit notes in pilots in GP practices. Hackney Marshes PCN employed an OT to support the local population’s work and health needs, with a focus on patients with musculoskeletal and/or common mental health conditions.
The service, set up in 2022, supports patients across five GP practices offers two pathways of support including fit notes when required:
- Assessment and intervention for employed patients to return to and sustain their work role.
- Examples of intervention include increasing self-management, advice on work adjustments, fitness for work reviews and return to work recommendations.
- Assessment and signposting for patients who are unemployed, providing guidance and signposting to suitable local vocational services.
During the first ten months of the service 164 patients were seen, 107 of those were in employment.
- Sickness absence was reduced from 65% to 3%, and use of ‘not fit’ notes was reduced from 68% to 8% (collected at assessment and 12 weeks post discharge).
- Patients in work but with reported difficulty, reduced from 19% to 5%, and patients accessing reasonable adjustments increased from 2% to 31% (collected at assessment and discharge).
- 23% of all OT completed fit notes indicated “may be fit” with recommendations. This is significant in comparison with average GP practice use reported at 6.3%.
- Costs of a typical intervention (about £250) are less than the costs of unemployment (from approx. £4000- £17000 a year) and would be amplified over the whole service.
- The service supported patients with disabilities and health conditions accessing reasonable adjustments and promoting health equity in the workplace.
For more info see Expanding Fit Note Provision by Borthwick and Atkinson, OTNews, October 2023, p38-40.
Occupational therapy-led vocational clinics in GP surgeries
RCOT and project partners ran pilots of occupational therapy led vocational clinics in GP surgeries. Running across eight GP surgeries, these job retention clinics mainly focused on people with musculoskeletal and/or mental health problems who were off sick from work and struggling to return.
Using a stepped care approach, and the AHP Health and Work Report, sickness absence rates and use of fit notes reduced by approximately two thirds. The average person had just two contacts with the service to achieve this result. For more information including the full results, please see the summary below.
OT-led vocational clinics in GP surgeries.pdf (PDF, 85.08KB)
People with learning disabilities
Making primary care accessible for people with a learning disability: an occupational perspective
By Aimee Nutall from Sport for Confidence
We’ve used the Person-Environment-Occupation-Performance model to explore the demands placed on people with learning disabilities when accessing primary care. We’ve explored how occupational therapists can help identify and break down demands which become barriers to this occupation.
We’ve demonstrated how an occupational therapist working in primary care can contribute to new evidence and skills base in this area. We can raise awareness of the important role occupational therapy can play in tackling health inequalities for people with learning disabilities.
GP practices have been tasked with improving the uptake and quality of learning disability annual health checks. Since then, it has become clear that GP practices need to do more to make their services accessible. We’re collaborating with a nurse-led team, who’ve successfully implemented learning disability-friendly GP practices in Southern Health NHS Foundation Trust. We’re also working with patients and their families/carers to understand how we can make our GP practices more accessible to them.
Primary care plays a key role in supporting people to stay healthy. For someone with a learning disability, there can be many barriers to accessing primary care. In addition, there are challenges that many patients face with access in the current NHS climate.
Exploring these barriers is key to being able to make reasonable adjustments and embed them in primary care services. By framing accessing health care as an occupation, we can become stakeholders in making this happen.
Making primary care accessible for people with a learning disability; an occupational perspective
High intensity users
The impact of an occupational therapy led High Intensity User (HIU) service in primary care
By Tenar Batty from East and Central Brighton Primary Care Network and Sussex Community NHS Foundation Trust
We developed a high intensity user (HIU) service in Brighton. We aimed to uncover and meet the needs of these patients to improve their quality of life and reduce GP contacts.
Our results evidence the benefits of an OT led approach, reducing GP contacts by HIU patients by up to 19%. The service development gave OTs to opportunity to develop advanced skills across all four pillars of practice. It also provided client-centred, holistic interventions over longer periods.
OT led HIU services can contribute to meeting national NHS objectives. It can also inform future commissioning by assisting the identification of conditions/populations with unmet need.
With the NHS Long-Term Plan, COVID and strain across the NHS, services are reforming to meet the changing needs of the population. In light of this, East and Central Brighton primary care network commissioned this trial service.
Our assessment is occupational therapy led, using an approach that is holistic, client-centred, and trauma informed. Patient often have a combination of multiple mental/physical health, psychosocial and socioeconomic needs.
Our interventions are a complex web that addresses all areas of occupation and multiple need. The development of this service shows the potential for OT to successfully reach HIU populations in other localities.
Occupational therapy learners
Learning from student placements: how to make a convincing case for occupational therapy in primary care using service evaluation data
By Casy Goddard, Oliver Ridge and Natalie Jones from Sheffield Teaching Hosptial NHS Foundation Trust, Sheffield Hallam University and Primary Care Sheffield
The additional roles reimbursement scheme was introduced to implement preventative health care, expand primary care teams, and relieve pressure on GPs. We deployed two occupational therapy students on placement in a primary care network (PCN). It had high levels of deprivation and unemployment, and we asked them to scope the role of occupational therapy.
The students conducted a service evaluation. Our data collection included a GP questionnaire, two in-depth consultations with patients and a waiting room survey to understand patients’ views. The students explored population health data to understand the needs of patients. They also reviewed current policy and research and engaged with residents in a care home and in a homeless hostel.
The students attended MDT meetings and shadowed in-patient and community consultations to interact with stakeholders in and outside the network. This included speaking with GPs, nurses and first contact practitioners in the PCN.
We analysed the GP questionnaire data through survey software. The survey had been sent out by email for response and compilation. 46% of GPs responded. We delivered the in-depth consultations by phone and information was written down and anonymised for the report findings. The waiting room survey used a tally chart with numerical scaling, with which 19 respondents completed.
71% of GP respondents did not understand the role of OT in primary care. 57% of patients completing the waiting room survey had limited awareness of the OT role beyond a hospital setting. Findings suggest that more work is needed to promote the potential of occupational therapy in primary care.
GPs thought the most powerful evidence for employing an OT was patient case studies. In addition, examples of how OTs can contribute to improving the quality outcomes framework targets. Finally, they suggested an options appraisal demonstrating how OTs can address local population health needs.
We found that to make a successful case of need, qualitative and quantitative data from multiple sources need to be triangulated. This strengthens the rationale and presents a convincing argument for occupational therapy.
Plenary poster
Occupational therapy leadership placements: how business planning can lead to the creation of a new role
By Natalie Jones, Emily Brown and Simran Sangha from Sheffield Teaching Hosptial NHS Foundation Trust, Sheffield Hallam University and Primary Care Sheffield
With increasing pressure on GP services, the additional roles' reimbursement scheme allows GPs to grow the primary care workforce. First contact occupational therapists in primary care can provide specialist holistic and patient-centred care. We invited two students on leadership placements to explore the role of occupational therapy in a university practice covering 54,000 students.
We aimed to develop a business case for GP partners to help them decide whether to invest in an occupational therapy role. The students completed a service evaluation including a stakeholder analysis, quantitative data collection and analysis of referral, appointment, and outcome data. They also carried out qualitative data collection through stakeholder consultations, shadowing the primary care team and benchmarking with similar services.
Our business case included findings from the service evaluation and an outline of two proposed roles. These focused on mental health and neurodiversity including the delivery of a wellbeing programme.
Our findings suggested that patients needed support focusing on wellbeing, healthy lifestyle, and behaviour change. They also required support in the transition to independent living. An outline of the knowledge and skills required, a finance plan and recommendations for operationalising the posts were included.
The students presented a compelling business case supported by a range of data and research evidence. This has led to the primary care network pursuing the recruitment of an occupational therapist.
Collaborative working in a range of primary care settings to provide new leadership placements for OT students
By Helen Blomfield, Charlotte Sutcliffe, Kathryn Rawlings, Maryum Sultan, Anna Williams from Sheffield City Council, Township Two Primary Care Network and Sheffcare
Collaborative working across health and social care, gave us the opportunity for 14 new leadership placements in settings across Sheffield. Our new student placements benefited the host organisations. These included care home teams, charities and services supporting older adults, particularly those living with a diagnosis of dementia.
Occupational therapy students learnt about leadership by delivering projects designed by their long arm supervisors. We provided the students with a programme of online teaching, resource folders, regular supervision, and leadership courses. They presented their projects to their colleagues, host sites and supervisors. The perspectives of supervisors, host sites, students and the university were positive.
Short video to explain a collaborative project to offer 14 new leadership occupational therapy student placement in various settings across primary care in Sheffield.
Children, young people and families
First Contact Practitioner children's occupational therapist in primary care
By Alannah Pasokhy-Holmes, Caroline Morris and Karina Parish from University Hospitals Dorset NHS Foundation Trust
Across the UK, there has been increasing demand for occupational therapy (OT) for children. In response, Dorset have expanded the First Contact Practitioner approach to provide an upstream service for children and their families. The Adams Practice, part of Poole Central Network pioneered a paediatric clinic from June 2021 covering six GP practices, working collaboratively with paediatric therapists from University Hospitals Dorset (UHD).
The paediatric OT service in the GP surgery differs to most patients typically seen in children’s services. For example, the primary care service sees children and families more quickly, at the beginning of emerging concerns. The OT clinics see children with:
• Possible Autism and ADHD 56%
• Sensory issues, picky eating, or behaviour 22%
• Anxiety, sleep problems, or motor tics 13%
• Problems with motor skills, coordination, and development 6%.
Typical OT interventions include:
- Signposting, advising, and delivering paediatric specific written material to reduce the need for children to be seen by the GP.
- Directing parents to local parenting courses and early help services for children with behavioural based support needs.
- Providing sensory based advice, parent hand-outs, picky eating advice, useful links, and sensory parenting online training.
- Referring children for pre-school muti-agency assessments
In 14 months, 130 patients booked into the OT clinics. 98% of new patients needed only one appointment and only 15% needed onward referral to UHD’s Child Development Centre.
This early intervention-based approach and sign posting has made a significant difference for children and their families. It’s improved their health and well-being, satisfaction, and access to services. It has reduced appointments for GPs and there are low re-referral numbers back to the GPs.
For more info see the Impact of Exploring Innovative Practice by Pasoky-Holmes, Morris and Parish, OTNews, December 2023, p58-60.
Pain management
Moving from painkillers to pain management: Practice-based occupational therapists improve patient outcomes and reduce need for GP appointments
By Dr Kieran Dinwoodie, and Anne Sanderson from Calderside Medical Practice, NHS Lanarkshire
Chronic pain is a public health issue, present in around one in five GP consultations. These consultations are often unsatisfying for both clinicians and patients. NICE 2021 chronic pain guidelines have emphasised the limits of analgesics, whilst promoting holistic management.
Since 2020 several GP practices in NHS Lanarkshire have had occupational therapists (OTs) join the practice team. This retrospective review was of patients living with chronic pain, across seven GP practices, who received OT interventions.
The effectiveness of the OT intervention was measured using the Canadian Occupational Performance Measure (COPM), a validated outcome measure designed to capture a patient’s self-perception of performance and satisfaction in everyday roles and activities. The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) was used to measure changes in mental health and wellbeing.
A total of 112 patients with chronic pain attended occupational therapy within the first 12 months of the service. 65 patients (58%) had improved outcomes, including improved COPM and WEMWBS scores and quantifiable improvements for example, returning to work and reduction in medication. The total number of patient attendances to a GP were also reviewed six months before and six months post-discharge from OT.
Overall, GP attendances were lower by 22% following OT intervention. Patients who demonstrated significant progress had a 47% reduction in GP appointments. Having an MDT approach with OT improves outcomes in the majority of patients with chronic pain. This helps to improve function and participation in roles and responsibilities whilst also offering alternatives to analgesics which are often ineffective or harmful. In the context of the current challenges in general practice, having a wider MDT approach can promote general practice sustainability.
OT-led pain management in primary care
By Amy Finch, Emma Stribblehill-Meyrick & Mikala Flynn, from Rugby Health Primary Care Network
Rugby Health PCN covers 12 GP practices and aims to move from reactively providing appointments, to proactively caring for local communities. In the GP based occupational therapy team, we provide specialist symptom management advice, supporting people to reduce barriers to meaningful activities.
In response to medication reviews to de-prescribe opioid painkillers, we identified a group of patients that would benefit from non-drug, pain management strategies. Using an OT lens and biopsychosocial approach, we created a pain management service, embedding activity analysis, motivational interviewing and cognitive behavioural therapy. We developed specific pathways to include support of symptoms from co-existing chronic conditions, such as fibromyalgia and rheumatoid arthritis.
We set individual goals to support patients to focus on the impact pain has on their occupations, and the powerful tool occupation can play in improving their health and wellbeing. We offer face-to-face and virtual sessions to improve accessibility, covering what pain is; support structures; how to pace, plan and prioritise activities; sleep hygiene; taking part of low-level physical activity; work and volunteering.
By using Goal Attainment Scaling (GAS), we’ve demonstrated that most patients who use our service successfully achieve their goals. An example of recent patient feedback has been: “The support, advice and service were really welcomed. It helped me use and think about techniques and tools which could aid me in dealing with pain. The course had practical tasks which helped me engage and reflect on my daily routine and outlook, physically and emotionally. I found this very useful as it questioned things I had not thought about. I know that there is not a quick fix to long term pain, but I now feel I have strategies in place to help.”