Roots of recovery: Occupational therapy at the heart of health equity
Primary Care
“Long COVID is now causing increased disability threatening people’s abilities to work and function…. early upstream access to OT support in primary care has never been more needed.” - GP, NHS Lanarkshire.
Primary care has a core role in tackling the causes and consequences of health inequalities. It is uniquely positioned in the heart of many communities and is the trusted first point of contact for medical and social needs.37 GP appointments make up 90 per cent of the public’s contact with healthcare professionals, providing a prime opportunity to reduce or minimise health inequalities.38 It is crucial to understand the local population of the GP surgery or primary care area. Then, building on this knowledge, to enhance the skill mix in primary care to target and tackle local inequalities.39
Across the UK, there is an expansion of occupational therapy roles in primary care to meet the increasing complexity of need that frequently requires more than a medical approach at a much earlier stage than secondary care. Occupational therapists are bringing their comprehensive understanding of why people, groups and communities are not able to engage in occupations that have health benefits. This includes identifying stigmatised and segregated groups that are at risk of exclusion from purposeful or chosen occupations.
Occupational therapists deliver community-based interventions, shaped around the needs and culture of the population, that prevent, maintain and improve recovery and occupational participation. This includes working with and empowering people, groups and communities to actively promote and manage their own health.40
Often occupational therapists see people who struggle to access, or benefit from, the existing primary care services of medicine, social prescribing and talking therapies but do not need referral to secondary care services. People may have higher degrees of complexity and undifferentiated diagnoses, where the presenting problem is not clear, but they have indicators which suggest serious underlying social or medical risk.41 An occupational therapist will work with them to make measurable changes in their everyday lives, so they are more active and able to look after themselves safely and effectively, to manage their home and access employment.
Work provides an income, benefits the family and society, and supports the economy. It is also an essential occupation to support longevity, health and wellbeing.42 Parental unemployment, for instance, is associated with poorer academic attainment in children.43 The GP is usually the first point of contact when someone’s health condition begins to affect their ability to work. Occupational therapists can support GPs with making judgements on fitness to work using the AHP Health and work report.44
This provides recommendations in highly specific terms about work ability, which GPs, employers and occupational health departments can implement to keep a person in work. Besides giving a detailed assessment of individual capacity and workplace requirements, occupational therapists can teach the person to manage any ongoing condition(s) and related symptoms such as pain and fatigue and deliver rehabilitation through agreed goals with the employee and employer.