Libby Brown and Melanie Larkin have been working as occupational therapists (OTs) at PCN1 Tower Hamlets since 2020 and are currently working to become first contact practitioners. They explain what OTs do and how they can help reduce pressure across primary care
What is occupational therapy and what do you do?
OTs help people perform routine tasks like self-care, work and leisure activities that have become difficult due to ill health or life circumstances. This includes teaching new skills and adapting the home environment with necessary equipment. We work with patients of all ages with physical or mental health issues for weeks or months, depending on their needs.
For example, we worked with a 79-year-old woman with Parkinson’s disease and a history of falls. After our assessment, we identified the cause of her falls: the chair she was using was the wrong height, with armrests at the wrong angle. She wore a nylon slip and nylon housecoat, which were making her slide out of the chair. She also kept her legs raised on another chair to reduce swelling but that meant her feet were not on the floor when seated, making her unstable.
We adjusted the height of the chair and advised her not to use the slip and coat. We were also able to get her a leg lifter so she could more easily get on and off the chair. Since making these changes, the patient has had no more falls.
What qualifications and skills did you need to work as an OT at a PCN?
For entry level OT jobs there is a degree level requirement, Bachelor’s or pre-registration Master’s. But in primary care, OTs need to be quite experienced – at least five years post-qualification – because we’re working with undifferentiated diagnoses.
Our portfolio needs to have evidence of different clinical skills to demonstrate we are able to work in a primary care environment, which is not typical for OTs, this is very new.
For example, at our PCN, an OT would need broad experience working with a range of complex health conditions and in the community. We need to feel comfortable working alone as well as in a team, and be able to cope with uncertainty. Having a higher level of clinical reasoning is essential for roles at a PCN, as is being open to change since teams and roles keep evolving. Building relationships is also a key part of this job, so strong interpersonal skills are required.
These skills are covered in Health Education England’s (HEE) Roadmap to Practice, which outlines that OTs who want to be in a first contact practitioner (FCP) role need to demonstrate skills across a range of different areas at Master’s level. This would be the equivalent of Level 7 in the Royal College of Occupational Therapists (RCOT) career development framework.
As well as subject-specific understanding, the generic abilities and skills required include:
– being able to use initiative and take responsibility
– solving problems in creative and innovative ways
– making decisions in challenging situations
– continuing to learn and develop professionally
– being able to communicate effectively.
We are working towards the FCP role via the portfolio route. This will soon become an entry requirement for primary care but it had not been introduced when we were recruited in 2020.
The pay scale we are currently working at is equivalent to Band 7 in Agenda for Change.
What was the hiring process like for you?
Melanie: I was working as an OT for The Mission Practice in Tower Hamlets as part of a pilot in 2018 to assess patients with complex health needs. One of the GPs felt they weren’t getting to the root of their patients’ problems and wanted to try a social-functional approach, instead of a biomedical one. The GP understood the value of OT and advertised for one. I applied and got the job. It was only supposed to last three months but it was eventually extended because it was so successful.
When my post was then transferred to the PCN, I was asked if I would to join the PCN instead. Libby was recruited as an additional OT and joined a few months later.
My day-to-day job changed with the transfer. I now cover four surgeries in the network instead of just the Mission Practice and work as part of a team. However, I continue to assess patients with complex health and social needs and complete the social/ functional assessment as part of a yearly review to meet QOF and DES targets.
Libby: I found the advertisement for the OT job on the NHS jobs website and was interviewed by the PCN’s clinical director and another OT. I was given case studies of patients I might work with and asked questions about them. What attracted me to the job was the range of patients we see but also the proactive preventative nature of the work. There’s less opportunity to do this in secondary care, where I worked for 10 years.
What is your routine at the PCN?
Neither of use are attached to one particular practice, we work across all four practices in the PCN.
We start the week with an online team meeting with our colleagues and pass on any relevant information. We then do a telephone triage with our patients to see if they need any help. In some cases, we need more information so we schedule a home visit. Then we’ll write up an assessment for the GP electronic records, in which we will raise any red flags. We also spend time liaising with community services and the practice teams.
We work autonomously, managing our own caseload and day to day work. We do receive supervision in line with our Health and Care Professions Council (HCPC) registration and have ongoing support from GPs and managers within the PCN.
How do OTs bring value to PCNs?
The main value we bring to the PCN is being able to unpick what the patient’s problem is, why they are not able to manage their health and other activities. This comes from observational assessment in the patient’s own environment.
For example, one of our patients with diabetes and thyroid problems was repeatedly going to the hospital because her blood results kept showing as out of range. Assessing her at home made it clear what the problem was: she was taking her medicine at irregular times because of poor vision. We were able to tell the GP and community services and arrange for help in the form of a telecare medication dispenser and support from social care. Once that was all in place the patient’s thyroid function and diabetic management improved. Without this information, the GP may have tweaked her medication but it wouldn’t have worked because this was not a medical issue, it was about how she could function.
We also add value to the PCN by working with the wider community. For example, we have conducted sessions with elderly people and staff at day centres on how to prevent falls and how they can get support. There isn’t much awareness about this.
We have also provided sessions for medical students about occupational therapy as an emerging role in primary care.
We asked our colleagues for feedback on our work, and GPs told us that they now spend less time on their consultations. They also felt the patients we work with present less in a crisis situation, which means GPs can do more preventative work. And they have more information about their patient’s context.
Our PCN clinical director, Dr Rofique Ali, told us: ‘The patients have really benefited from the OT contribution. I have seen patients who have a better quality of life, fewer hospital admissions and require less time from GPs.’
Patients told us they like how OTs assess them at home and give them time to make changes at a pace that works for them. They also value how OTs work on their personal goals.
Pharmacists said patients have better medication compliance as a result of OT input because we can find out why patients are not taking their medicines properly. We also work with pharmacists to come up with solutions to non-compliance.
The community teams, like nurses and social care services, said because of our work they are better connected to GP practices and have more information about their clients.
What kind of support do you get from the PCN?
We have regular meetings with the clinical director, PCN managers, pharmacists, and health and wellbeing coaches, social prescribers, care coordinators, and HCAs. We are encouraged to raise any learning points because the PCN focuses on fostering a learning environment. We also have a weekly session with GP trainees and conduct joint visits with them.
We have access to the Community Education Provider Network (CEPN) and also an external OT who supervises us, in line with the HCPC requirements. We are also in touch with the other OTs through the RCOT.
Practices in the PCN regularly invite us to their social events, which helps us maintain a good relationship with them.
Can you offer any advice for PCNs looking to hire an OT?
During the hiring interview, it would really help if PCNs discussed the patient group OTs are expected to work with. OTs work in a number of areas, but in primary care the focus is mainly on frailty, mental health and vocational rehabilitation. PCNs would benefit from thinking about the needs of the population within their practices so that they can recruit OTs with the right experience.
For example, here in Tower Hamlets the GPs identified that patients most in need of OT input were those with complex care needs and this is what they recruited for.