Sustainability and Transformation Plans: occupational therapists and physiotherapists can support GPs

FINDINGS

The number of STPs in which keywords were found and the total frequency of the word use is presented in Table 1. One STP did not mention rehabilitation in any context, did not name AHPs, and had no reference to occupational therapy or physiotherapy. Reference to AHPs was limited to 34% of STPs; when used, the terms tended to identify the various members of a multidisciplinary team rather than suggest any specific role or intervention. Specific reference to physiotherapy was limited to 36% of all STPs, whereas occupational therapy could only be found in 13% of all STPs. These figures sit in contrast to the use of the word rehabilitation, which was discussed at least once in 39 (89%) of the 44 STPs. The concept of rehabilitation was predominantly used to describe the discharge process from acute hospitals and/ or to describe intermediate care provision thereafter. The absence, in many STPs, of reference to occupational therapists and physiotherapists to deliver rehabilitation plans is of concern. The source of delivery of rehabilitation therefore remains unclear, with the possible inference that rehabilitation would be provided by unqualified healthcare workers. The latent content analysis (Box 1) presents three related themes: theme one ‘new ways of working’ describes the vision for rehabilitation in the STPs; theme two ‘advanced clinical roles’ provides the detail of how occupational therapists and physiotherapists could deliver the rehabilitation agenda; and theme three ‘workforce issues’ illustrates some of the current barriers to service delivery.

‘New ways of working’ describes the vision for rehabilitation. Across many STPs this aims to be achieved through new specialist rehabilitation pathways. These pathways include musculoskeletal, neurology, cardiac, pulmonary, learning disabilities, and mental health services. A key component of these rehabilitation pathways was the further development of community-based rehabilitation. ‘Therapy at home or close to home’ was promoted as a more efficient mode of intermediate care that shifts healthcare delivery away from secondary care. Hence, the concept of short-stay rehabilitation and recovery beds and intensive home rehabilitation were endorsed.

The second theme draws together themes from across the STPs to describe how occupational therapists and physiotherapists could deliver rehabilitation and also prehabilitation through ‘advanced clinical roles’. Advanced clinical roles described as ‘community experts’ were endorsed in some STPs to ‘free up GP time’ and so produce more efficient services. Some of the STPs offered the possibility of new positions for AHPs, including integrated (health and social care) roles, extended scope, and primary care roles. Some STPs promoted the use of AHPs as a first point of contact, enabling service users to have the opportunity of direct access, potentially offering this as a 7-day service. Furthermore, public health roles for occupational therapists and physiotherapists were articulated across STPs. The need for prehabilitation through greater health promotion and prevention was seen by some STPs as an important agenda; the use of self-help, technology, early intervention, lifestyle management, and social prescribing by AHPs were seen as essential adjuncts for healthier lifestyle management.

The final theme ‘workforce issues‘ refers to the difficulties in developing an integrated AHP workforce to deliver specialist rehabilitation pathways, enhanced community/home rehabilitation, and health promotion interventions. One STP identified ever larger caseloads for occupational therapists, while another confirmed a current vacancy hotspot for both occupational therapists and physiotherapists, and noted recruitment and retention issues. Others mentioned these issues within case studies to reflect the effect of long therapy waiting lists on patient care. Some STPs highlighted the use of specialist commissioning teams to identify opportunities for improvement in rehabilitation pathways. Others emphasised problems in the joining of health and social care teams for a more seamless care pathway.