Action examples

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 while Nicola Mead addresses doubts people may have about the value of OT in primary care. Finally, Helen and Hattie talk about their typical days working in care homes.

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.

Impact of developing a new occupational therapy service in primary care NHS Ayrshire and Arran: Working together by Gemma Murray and Arran 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.
 

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.

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.

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.
 

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.
 

Making primary care accessible for people with a learning disability; an occupational perspective by Aimee Nuthall from Sports 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.

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.
 

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, Natalie Jones from Sheffield Teaching Hosptial NHS Foundation Trust, Sheffield Hallam University, 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.

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.