An exploration into the effectiveness of an occupational therapy service evaluation tool for a GP practice in Ayrshire

Executive Summary The following project was created in partnership with an NHS service in South Ayrshire, who provide occupational therapy assessment and intervention within a General Practitioner’s (GP) practice. The role is a temporary funded position, endorsed by Action 15 of the Mental Health Strategy (Scottish Government 2017a), alongside additional funding through NES Career Fellowship (NHS Scotland 2020). In order to sustain the role being developed, the service are expected to demonstrate the unique contribution and impact of occupational therapy. This was considered pivotal in influencing commissioning decisions and securing future funding to remain as part of the primary care workforce. The team initially developed their own service evaluation tool; however, concerns were raised regarding its effectiveness. An evaluation into the staff’s perceptions and experiences regarding the tool was therefore carried out, to explore these issues in more depth. Three semi-structured interviews were conducted and through thematic analysis, two themes and six subthemes were developed. Findings support current literature regarding data deemed valuable to obtain when evidencing the impact of a service to stakeholders, such as the patient’s satisfaction and their outcomes. New insights also emerged, such as the importance of documenting referral sources, so education around occupational therapy can be given to members of the multi disciplinary team (MDT) who are referring less frequently. A particular emphasis was placed on the limitations regarding the current tool, resulting in participants concluding that the impact of occupational therapy interventions are not being captured to their fullest extent. Key issues concerned language, timing and participant’s understanding of the Canadian Occupational Performance Measure (COPM) (Law et al. 2014). Unanticipated issues arose, relating to inconsistences in terminology used by participants to describe the service’s aims, specifically frequent use of the word ‘function.’ Literature suggests this may restrict the profession from highlighting its distinct role in enabling occupation (Wilding and Whiteford 2008). Unrecognised professions may struggle to achieve appropriate remuneration; as a result, the service’s long-term viability may be jeopardised due to a lack of adequate representation regarding occupational therapy’s value in primary care. It was recommended that the service clarify their aims and intended outcomes, so that patients, GPs and funders know the exact purpose of occupational therapy practice (Bitel 2007). It was further recommended that the service consider deploying the COPM as a standardised outcome measure, to either complement or replace the existing tool. This may support the service in detecting change in patients as a result of occupational therapy interventions, whilst potentially promoting the use of occupation-focused language (Maclean and Breckenridge 2015). However, the team may benefit from developing their understanding and awareness regarding the COMP’s theoretical underpinnings. The project may be of interest to those developing services within primary care and a conference abstract for the 18th WFOT Conference (2022) is included in appendix 1.

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