The role of the PCN occupational therapist

Ever wondered what the role of the occupational therapist entails within primary care? Melissa Chieza, a qualified OT gives us a detailed overview

CREDIT: This is an edited version of an article that originally appeared on The Primary Care Network

Primary care occupational therapists are Health and Care Professions Council (HCPC) registered and educated to a university diploma standard (having graduated from a training programme which is approved by the Royal College of OTs and the HCPC).

The main objective of their role in primary care is to support patients to optimise the quality of their everyday lives and / or assist in effecting necessary changes to a patient’s environment to enable them to live independently, more easily, and to achieve their individual lifestyle goals.

They provide holistic care and can support patients with all aspects of their lifestyle; from eating and sleep hygiene, to managing issues at work, housing, personal finances, and more. They will then signpost and assist with any required onward referrals which can be anything from an appointment with a GP or nurse, to liaison with social care and wider community support services.

Occupational therapists in primary care

OTs are commonly based within a multidisciplinary primary care team who are collectively focused on boosting patient wellbeing either in isolation, or in complementing any care or treatment related to any health conditions.

Within Melissa’s team, she currently works in the following roles:

• A Specialist Nurse (who is primarily responsible for medication and prescribing-related requirements).
• Outreach / support workers (who usually provide follow-up and potentially more domiciliary-based care when a patient has already been seen by the nurse or OT).
• A Recovery Practitioner (who is concerned with management of mental health and anxiety-related issues).
• Health Coaches / Care Coordinators.

How do referrals work?

A patient may be signposted directly to the OT or at the suggestion of a clinician or GP. Within Melissa’s practice, she offers a maximum of six, 30-minute consultations and clinics are booked four weeks in advance. OTs will typically see patients with physical needs (such as frailty) and those requiring support with managing mental health and wellbeing and / or practical support with their everyday lives.

Clinical supervision and support

OTs should have access to monthly supervision from a GP, consultant practitioner, or advanced practitioner. They should also, ideally, have support from an appropriate individual within the PCN to whom they can refer to for more general advice on a day-to-day basis. There is also a range of online support networks and resources available for OTs to access themselves, which we have also outlined below.

How OTs add value

The Royal College of Occupational Therapists (RCOT) say that Occupational therapists possess three main superpowers when it comes to supporting primary care:

Management of frail older adults

• Use of frailty indexes to identify people needing a proactive approach
• Rapid crisis response to prevent hospital admission or to speed discharge
• Assessment and interventions to ensure people can cope at home, including support for carers
• Short-term rehabilitation interventions and referral to specialist services, if indicated
• Use of digital and assistive technology to ensure safety at home

Management of people with mental health problems

• Risk assessment for acute distress
• Personalised care plans for self-management
• Patient activation to achieve personal goals
• Social prescribing, and signposting or referral to recovery support and services

Management of working age adults with employment difficulties

• Vocational rehabilitation
• Use of AHP Health and Work report in place of GP fit note for sick pay
• Tailored, specific advice about workplace modifications

What does the caseload look like?

Melissa is currently averaging 32 patient contacts per week and, in her role as a Mental Health Liaison Practitioner, these are some real-life examples of what she is covering right now:

• Managing those struggling with the post-Covid impact on their mental health.
• Supporting recovery and re-introduction into society following a change in circumstances and / or a deterioration in wellbeing.
• Working with a cohort of university students who may be struggling with anxiety or poor mental health whilst on campus.

Alongside her colleagues in their multidisciplinary team and working to the recommendations within the Royal College of Occupational Therapists’ (RCOT) Improving Lives mandate, they employ a range of creative and cost effective approaches to care and have established a wealth of local contacts in order to quickly and effectively triage and manage the needs of their patients, whilst reducing health inequalities.

As a team, they are equipped to support the Enhanced Access agenda by potentially diverting patients with mental health-related needs away from the GP and freeing up appointments. They are also appropriately skilled to adapt to seasonal pressures and are flexible in having the ability to manage their caseloads both in-practice and remotely.

Recruitment (and retention) of your Occupational Therapist

As with the other additional roles, there is often a lack of awareness about what an OT can manage and where they can be best deployed within the developing Primary Care workforce and vice-versa; when an OT is new to Primary Care and unclear about expectations and the environment.

There is also a need to be mindful that OTs are a long-term investment, and both patience, and planning, are key. Before you advertise for your OT, make sure you are clear on the following:

• The role, remit and responsibilities of the position. (To support you with this, check out NHS Jobs and the Royal College of Occupational Therapists website for outline job descriptions and information on core knowledge and skills).
• What you’re hoping to achieve in terms of outcomes / measures of success and how they can demonstrate their value.
• Who will be responsible for supervising and supporting the OT?
• What meetings and forums they should be involved in, and how you can best promote the service and their skills?
• What space is available for them to practice and be involved with the wider team, within the current estates’ setup?

Above all, Melissa advises PCNs to be bold, to be brave, and to be curious when it comes to their mindset around deployment of an OT. In her words, “it might not work out, but when it does – great!”