Primary care related roadmap to guide practice has focused so far on services for older adults , adults with mental health , or work and health problems ( HEE 2021 ).
Primary care related roadmap to guide practice has focused so far on services for older adults , adults with mental health , or work and health problems ( HEE 2021 ).
Dorset innovation
Dorset has expanded the first contact practitioner approach to provide an upstream service for children and their families .
The Adams Practice , part of Poole Central Network ( PCN ), pioneered a paediatric clinic from June 2021 , covering six GP practices , working collaboratively with paediatric physiotherapists and occupational therapists from University Hospitals Dorset ( UHD ).
This collaboration meant the AHPs remained employed by UHD and were seconded , part time , to the new service . The clinic was piloted for an initial period of six months .
The pilot clinic offered children and their families a 20-minute joint session with a first contact practitioner paediatric occupational therapist and physiotherapist in the GP surgery . This provided the therapist with clinical assurance about the best approach when working in a new setting and at a different point of service intervention .
The success of the pilot meant that 12 months later , the first contact practitioner paediatric occupational therapist was able to offer an occupational therapy-specific clinic funded by the PCN .
The paediatric occupational therapy service in the GP surgery provides a broad scope of practice based on the local population needs . It differs to patients typically seen in paediatric therapy outpatient services .
For example , in primary care , most children and families are seen at the beginning of an emerging concern , such as a possible developmental diagnosis . Children are seen more quickly by a specialist paediatric therapy service as there is a lower threshold for acceptance .
By contrast , children and families locally can have up to an 18-month wait to see a paediatrician before being referred for therapy input if the need is identified . In addition , the occupational therapy outpatient sensory service is commissioned for children with an autism diagnosis with functional difficulties .
As many of the children seen in the GP surgery do not have a diagnosis , it ’ s unlikely they would meet the threshold for this area of the outpatient occupational therapy service .
• 56 % of patients were seen following GP face to face or telephone consultations ; this was usually because patients raised a of the children seen in the OT relevant OT area of concern during their clinics present with concerns appointment alongside relating to possible autism other needs . and ADHD
• 18 % of patients were referred from other staff working in primary care , such as practice nurses or first contact practitioner physiotherapists .
Types of problems seen
In the occupational therapy clinics many of the children have multiple concerns , but the percentages reflect their main presenting problems :
• Concerns relating to possible autism and attention deficit hyperactivity disorder ( ADHD ): 56 %.
• Concerns relating to sensory issues , picky eating , or behaviour : 22 %.
• Concerns relating to anxiety , sleep , or motor tics ( Tourette ’ s syndrome ): 13 %.
• Concerns relating to motor skills , coordination and development : 6 %.
In outpatient occupational therapy services , the most typical referrals are for motor skills and functional daily living skills . There are clear routes of referrals for schools and professionals to access this service in Dorset , thereby reflecting the lower levels of demand for these issues in the first contact practitioner clinic .
56 %
Typical interventions
The first contact practitioner occupational therapist role has been an opportunity for clinicians to offer support in primary care earlier in the patient pathway . Typical interventions include :
• Signposting , advising and delivering paediatric specific written material to reduce the need for children to be seen by the GP .
Access to the service
In line with the first contact practitioner model :
• 26 % of patients booked direct via eConsult , or were booked into the clinics from reception staff .
December 2023 OTnews 59