GP partner Dr Arvind Kochar and advanced practitioner Lisa Greer explain how occupational therapists can support GP practice teams based on the experience of a primary care occupational therapy service operating in Scotland
NHS Lanarkshire is the third largest health board in Scotland, serving a population of approximately 655,000 people across rural and urban communities in North and South Lanarkshire.
The board launched a primary care occupational therapy (OT) service in 2017, in partnership with two Lanarkshire GP practices, one of which was MacInnes Medical Centre. This work was funded by the Scottish Government’s Mental Health and Primary Care Transformation Programme, with the aim of identifying new models of practice that could reduce pressure on GPs and respond to the changing health needs of Scotland’s population.
The service has evolved since then and currently operates within two of its 10 locality areas, Hamilton and Bellshill, serving 21 GP practices and approximately 125,500 people.
The GPs at MacInnes Medical Centre acknowledge that their understanding of OT was limited before the service was launched. Their perception was that the workforce was hard to reach, that OT focused on the provision of adaptations and had little to offer in the way of mental health support. GPs were also concerned that the service might identify problems in patients who would then return to the practice and create more work, instead of reducing their workload.
However, as a busy urban GP training practice, functioning over two sites with a patient population of 7,857, it was keen to take up the offer of expanding its practice team and offer a wider range of treatment and care options for the adult and older adult populations. The practice’s appreciation of the full range of skills and services that occupational therapists (OTs) can offer has grown considerably in the four years since they joined.
The OTs are based on each site between one and three days a week depending on practice size and workload. Referrals for any patient aged 16 or over are accepted from all members of the practice team including GPs, trainees, practice nurses and pharmacists. Using a standard operating procedure, the OTs provide comprehensive biopsychosocial assessment and intervention to individuals aged 16 and over who are experiencing functional decline as a result of changes in health. This includes people with:
Their assessment employs a ‘What Matters to You’ approach, to help identify an individual’s functional difficulties and priorities for change. Intervention very much depends on the goals identified by the patient and could include any, or all, of the following:
OTs are qualified at BSc or pre-registration MSc level and registered with the Health and Care Professions Council. All OT clinicians are dual trained across physical health and mental health at undergraduate level to provide a ‘whole person’ approach to assessment and intervention, supporting individuals to overcome or manage the difficulties they experience with performing everyday life activities or occupations, as a result of ill health and disability. This includes activities carried out within a person’s home environment, within their workplace or within their local community.
The OT team has a robust clinical governance framework aligned to NHS Lanarkshire policies and a standardised supervision structure, which ensures that all clinicians receive professional clinical supervision and informal support from senior occupational therapy staff within the team.
The GPs at MacInnes Medical Centre regularly catch up with OTs for informal discussions, for example to discuss a particular referral, and are confident that the OTs bring any patient-related concerns to their attention to agree a safe and person-centred solution.
The GP partners are also consulted and informed about service evaluation and improvement, with regular GP practice-level and service-level updates and presentations.
Evaluation completed in May 2021, and that relates to 18 GP practices across Bellshill and Hamilton localities, including MacInnes, shows that having OTs as an integral part of the practice team brings a range of benefits. These include:
Dr Kieran Dinwoodie, GP at Calderside Medical Practice, adds that: ‘Having an OT in our practice has been transformative. It is improving patient outcomes and reducing GP stress. [Patients] are in less distress and attend less frequently.’
Due to the positive outcomes achieved during the initial testing phase, the primary care OT workforce has grown from two advanced practitioner clinicians to a team of 13. They have permanent contracts with NHS Lanarkshire to allow them to continue to provide a service to GPs in Bellshill and Hamilton localities. We would like to see the service further extended across all 10 Lanarkshire localities.
Their next challenge is to develop self-referral and care navigation pathways and a first contact practitioner role, improving direct access to occupational therapy for patients who would benefit from early intervention to reduce the functional impact of mild to moderate health and wellbeing issues.
Dr Arvind Kochar is a GP partner at MacInnes Medical Centre in Motherwell and Lisa Greer is an advanced clinical practitioner in occupational therapy based at the practice. She is employed by NHS Lanarkshire Primary Care Occupational Therapy Service
As of 2020, the Network Contract DES Additional Roles Reimbursement Scheme (ARRS) allows PCNs to be reimbursed the costs of employing OTs. There are certain criteria for the role which can be found in Annex B of the Network Contract DES guidance.
GP practices in Networks can either hire OTs themselves or as part of an agreement with local providers.When hiring an OT, practices must ensure they have access to a clinical supervisor and another individual in the PCN to help out on a daily basis.
OTs employed under the ARRS must:
The salary for OTs working in primary care, at an advanced level of practice, falls in band 7 on the NHS Agenda for Change pay scales. After the government’s award announced in July 2021, this lies approximately between £40,000 and £46,000.
Advanced level of practice means being able to work across the four pillars of clinical practice, leadership and management, education and research, or be working towards gaining these skills. This is usually a MA degree or its equivalent, and a minimum of five years post graduate experience.
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