Workforce planning is every OT’s business

We used quality improvement methodology and coproduction. We asked service users, students, clinicians and managers across our services to contribute through feedback, interviews and workshops. During workshops, attendees were split into four groups and were asked to come up with possible service models which met some key principles which addressed the problems above and kept the service user at the centre.  

Each group presented their model, then all voted on the overall model they liked the best and components from the other models they wanted to include. The service model grew out of these redesign options after just two workshops. The AHP team worked on different aspects to develop the detail, trial ideas and improve the design. They took ideas to service users, carers, users, carers and ward community meetings. Our students over that year contributed to and led different projects which all served to create our current model. 

We now have a single AHP service across mental health services, called One Referral: One AHP.  Our staff are based within the multidisciplinary teams across the geography, and it centralises line-management, professional development, budget and resource. 

The team operates along adult and older persons pathways and remain working alongside the service-user who may transition through access, acute, recovery or specialist services. Our physiotherapy staff and team providing therapeutic ward-based interventions across both adult and older adult acute services and can follow service users out into the community for continuity of care.  

Working with a single AHP has prevented repeat assessment and report writing which would have taken place at the point of each within-service transition. It has stopped repetition of difficult life experiences, which is more trauma-informed, is well received and recognises the increased relational complexity which our client groups often experience. Using value-stream mapping, this approach has saved up to half a day of registered staff time at each transition point, allowing cost improvements throughout the service. 

We have improved flow with a single point of referral, shared triage and allocation to the next assessment slot. This shared team approach has been welcomed by staff who have appreciated feeling less individually responsible. Before the implementation of the model, one individual AHP practitioner would be responsible for all aspects of the pathway within each clinical service. This was unmanageable as there was no-one covering the practitioner when taking annual leave, completing training, sickness episodes, and family related leave. The result was long waiting lists, burn out and problems with retention.  

The new model enables clinical demand to be shared ensuring flow across all clinical services. We are now more able to meet referral to treatment standards of 48 hours in acute care and four weeks in the community for AHP contact. Where there is a delay in allocating to the appropriate treatment pathway, we have implemented an active support offer, a co-developed personalised plan to begin working on goals, with regular telephone support. This enables timely re-prioritisation if needed, as well as problem-solving and building motivation together.   

Our clinical pathways now offer choice and increased clarity for the service-user. In turn this allows us to evaluate each pathway and predict changes needed in resource or staff development.  By working collaboratively, we offer a range of group interventions (including CAHPO award winning occupation matters) within service, and co-developed and deliver with local partners in our neighbourhoods.    

Our occupational therapists work to the top of their dual registration, reducing unnecessary onward referral and simplifying the experience for people who access our service. Similarly, our physiotherapists continue work to complete a treatment plan where indicated, rather than refer on to a separate service.  

The AHP team have developed leaders and structures to share knowledge and skills. Enabling specialisation in the service means we can establish a strong career pathway from occupational therapy assistant or activity co-ordinator roles through to apprenticeships and on to registration. The knock-on effect has been an increase in student placements and improved recruitment.  

At all stages staff’s skills are celebrated and supported. In a recent survey 100% of the team feel supported and involved in decision making and learning. Throughout we have reviewed skills mix and we have invested in training, in order to build depth in individual's specialist interest which is used to support the whole team. This has included improvement & research skill, and we have staff now doing PhDs.  

Centralised management and budget has enabled us to flex our staffing resource to meet service need. As well as reduced waiting times through sharing clinical demand we have also been able to maintain AHP provision across services at times of absence and vacancy. We have also been able to support through covering OT vacancy within services not included in the One Referral: One AHP model.  

Now we’re one AHP service we can be more innovative. We have received an award to pilot a physical activity and improved lifestyle project (PAIL) which has allowed us to explore approaches to enabling and sustaining movement, exercise and lifestyle improvements in partnership with our leisure and public health partners.  To meet a gap in local commissioning of services for those who have neurodiverse needs we’ve been able to deliver sensory training with community providers and set up sensory groups in the community.