Resources about research

In 2022, we carried out a survey of occupational therapists in the UK to discover more about their role and services offered in primary care. 

The survey was agreed by our project ethics and ran during April and May 2022. The email invite explained its purpose, consent and GDPR. We shared it by email and twitter with occupational therapists who work in primary care.

Our survey had 85 responses. 50 (59%) from occupational therapists in England; 20 (24%) from Scotland; 14 (16%) from Wales and one (1%) from Northern Ireland.

Job titles. We discovered that most occupational therapists who replied (62%) had the job title occupational therapist, followed by mental health occupational therapist (20%).

15 (18%) had different job titles such as advanced practitioner, mental health practitioner or clinical specialist occupational therapist.

Hours, pay and experience. We found that most occupational therapists (54%) worked five days a week, 28% worked four days a week and 8% worked three days a week.

Most occupational therapists (66%) were paid at the equivalent of agenda for change band seven, 19% at the equivalent of band six, 9% at the equivalent of band eight and 6% were paid at band five equivalent. 77 (90.6%) had more than five years post-registration experience. 

Employer and coverage. We learnt that most occupational therapists (31) were employed by NHS trusts, 22 (26%) by primary care networks, 18 (21%) by health boards, and nine were employed by a GP federation, cluster, or surgery. One was employed by a county council, and another was self-employed.

40 occupational therapists had roles that covered three to five GP surgeries. 30 had roles covering five to 15 GP surgeries. 15 had roles that covered one to two GP surgeries.

41 of the occupational therapists (50%) covered a patient population of 50 000 or less. 25 (30%) covered a population of 50 to 100 000 patients. Six occupational therapists (7%) worked across a patient population of 100 to 200 000 patients. Nine (11%) covered a patient population of more than 200 000.

Patient groups. We gave this question multiple options so occupational therapists could pick several patient groups if needed.

65 of the occupational therapists (77%) told us that they worked with older adults, 60 (70%) with adults with mental health problems and 43 (50%) with adults with work and health (vocational) problems. 

28 occupational therapists (33%) told us they worked with patients with other types of needs. From this group, 16 worked with patients with any occupational need, mostly over 16 years old, but a few saw patients of any age. 

Eight occupational therapists worked with adults with any type of physical health problem. Four worked with any age of person with mental health problems. Two worked specifically with 16 to 18 years old's and two worked with people with learning disabilities.

In addition, occupational therapists told us that they worked with patients with the following problems: Chronic pain; chronic obstructive pulmonary disease; post COVID syndrome; fibromyalgia; neurodiversity; cognitive problems; long term conditions; complex health needs; frequent attenders; musculoskeletal and rheumatology and ex-offenders.

Referral routes. We gave this question multiple options so occupational therapists could pick several referral routes if needed.

We discovered that 76 occupational therapists (90%) accepted referrals from other members of the primary care team such as GPs, nurses, or physiotherapists. 46 (55%) accepted patient self-referrals and 34 (40%) accepted referrals from outside of the primary care team such as from care homes. 

15 occupational therapists (18%) told us they used additional referral routes: Two used outreach or active case funding; two mentioned receptionists; two used risk stratification tools; one used a complex patient list and four told us their referral routes were still in development.

First contact practitioners. We found that half of the occupational therapists were fully or partially using the first contact practitioner (FCP) model and a third were using the occupational therapy roadmap to practice (This model is where experienced clinicians see patients with undiagnosed conditions without other members of the primary care team seeing them first. The roadmap guides them to develop the skill set for this approach in England).

19 (23%) told us they offered a first contact practitioner service and 37 (32%) partially offered this. 38 (45%) of occupational therapists who replied didn't offer a first contact practitioner service. 

16 occupational therapists were looking for roadmap supervisors or working towards stage one or stage two of the roadmap. 13 (23%) were planning to complete FCP masters’ modules at university. Four occupational therapists were new in post, three were thinking about it, two were completing advanced clinical practice masters' courses and one was not aware of the roadmap.

Evaluation. We learnt that 50 (59%) of the occupational therapists had not carried out a service evaluation while 35 (41%) had carried out some form of evaluation. 

Next steps. We used the survey results to help with an evaluation of the impact of occupational therapy for older adults in primary care. 
 

In 2023, we carried out a mixed methods study with Rocket Science about the impact of occupational therapy for older adults in the UK. 

The study went through the NHS research ethics service. We worked with three sites in England, Scotland and Wales covering 17 primary care practices which all had occupational therapists working with older adults.

We interviewed patients and carers, staff in the primary care team and occupational therapists working in the GP surgeries. We collected data about appointments and from the EQ-5D-5L (EuroQol) outcome tool. We also carried out a survey of occupational therapists in primary care asking about their impact and workforce challenges.

Volume of delivery. We found a large variance in appointment data.  On average, occupational therapists had a caseload of 30 patients, provided 26 to 50 therapy sessions of 30 to 60 minutes duration each month. On average 16 patients a month were discharged and 25% of patients had one to three appointments. 

Impact for older adults. We discovered high levels of satisfaction from patients receiving occupational therapy through their GP surgery.  Many told us that if occupational therapy hadn’t been available, they would have seen the GP. 77% of patients (n=60) showed improvements in their health through the EQ-5D-5L from initial assessment to point of discharge. 

Impact for staff. We learnt that primary care staff valued the skill-mix that occupational therapists brought to the team. They told us it was easy to work with them and that patient waiting times were reduced now they were in primary care. 

They felt that having occupational therapists had created efficiencies in the system. They told us the occupational therapists were providing timely access for patients without the need for a GP appointment. They consistently said that if the role was not available, it would result in longer waiting times, poorer patient experiences and outcomes. 

Experience of occupational therapists. We found occupational therapists had high levels of job satisfaction as they could provide early interventions and holistic care. However, they identified challenges when trying to establish the role in primary care. They found that extra time and resource was needed to educate the wider primary care workforce about occupational therapy.

Workforce challenges. We identified workforce challenges about recruitment from secondary care to primary care. This was due to differences in terms and conditions between primary and secondary care. We also identified fewer opportunities for career progression in primary care. Occupational therapists told us there was a gap in their ability to evidence outcomes and felt this was a priority for the profession. 

Recommendations. To amplify the impact and value that occupational therapy brings, we’ve suggested changes in three areas. 

First, we need to increase the evidence for occupational therapy in primary care. This could involve agreeing metrics and tools and supporting occupational therapists to use them.

Second, we need to raise the profile of occupational therapists working in primary care. 

Lastly, we need to tackle workforce challenges such as differing pay levels and the sustainability of working in GP surgeries. For more information, get in touch.

You can find the first occupational therapy specific textbook in our e-book collection. It's called Primary Care Occupational Therapy: A Quick Reference Guide. 

We’ve also produced an evidence spotlight about primary care with CPD exercises for you.

A scoping review of published articles about occupational therapy in primary care is also available.

In the UK, researchers are focusing on systematic reviews of occupational therapy in primary care and evaluation methods used by clinicians (see below).

If you are carrying out formal research about occupational therapy in primary care in the UK, get in touch.

Evaluation methods used by occupational therapists in primary care: a scoping review by Laura Ingham, Dr Catherine Purcell and Dr Alison Cooper from Cardiff University. 

Occupational therapy roles are emerging across primary care. However, there is limited understanding of how occupational therapists are measuring their impact. With an increasing need to establish value to ensure service effectiveness, the mechanisms used to evaluate this are not clear. 

The objective of our scoping review is to understand how occupational therapists are evaluating practice within primary care settings. By mapping what methods are being used, our second objective considers the evidence in relation to value-based healthcare (VBHC). 

We used JBI scoping review methodology to identify peer-reviewed journal articles and grey literature relating to evaluation methods in primary care. 

We imported the results into covidence software to enable analysis by two reviewers.  We analysed studies using JBI critical appraisal tools and findings were mapped against a VBHC framework.

From 2,396 articles, 16 met the eligibility criteria and were included. We identified a wide range of evaluation methods to measure individual and service outcomes. Most evaluation methods broadly aligned to three of the VBHC aims. The aim of reducing the per capita cost of health care was least represented in the literature. 

Our scoping review has highlighted an inconsistent approach to measuring the effectiveness of occupational therapy primary care. This makes it difficult for the profession to evidence its contribution to VBHC.