CONSULTANT OCCUPATIONAL THERAPIST

21 College of COT/ BAOT Briefings CONSULTANT OCCUPATIONAL THERAPIST Publication Date: August 2007 Lead Group: Professional Practice Review Date: August 2009 Country Relevance: UK Introduction The purpose of this briefing is to inform COT/ BAOT members of the development, purpose and role of consultant occupational therapy posts. This information should be read in conjunction with the national agreements on the introduction consultants in allied health professions (AHP). Each country has national policy relating to the development of these posts and roles for allied health professionals and therefore for specific country related policy you are advised to read the country specific guidance. The web links and titles of these documents can be found at: England: http://www.dh.gov.uk/assetroot/04/01/10/04/04011004.pdf Scotland: http://www.sehd.scot.nhs.uk/ahp/consultants.htm Wales: http://www.hiw.org.uk/page.cfm?orgid=477&pid=13894 Northern Ireland - there is no such guidance at present. Background National agreements and AHP policy have set out how the role of the consultant occupational therapist is developed and integrated into the health and social care workforces. Consultant occupational therapists are pivotal roles which enable the professions to retain clinical excellence within the clinical career structure and provide opportunities for experts to be retained in senior clinical leadership roles. These roles are commissioned and approved through Strategic Health Authority procedures. It allows for progression in a clinical career pathway for therapists who are in specialist roles who want to work at a consultant level, offering strategic and organisational development and working as an autonomous practitioner with the highest level of clinical responsibility. Other backgrounds of occupational therapy practice such as education, management or research are all types of experience which could help facilitate becoming a consultant occupational therapist. To date, the are aware of over fifteen consultant occupational therapists in varying areas of clinical practice, such as cancer care, chronic fatigue, elderly care, mental health, neonatal care, learning disabilities, stroke, vocational rehabilitation and social care. www.cot.org.uk Page 1

The focus of the consultant occupational therapist is on the delivery and practice of clinical care, tailored to local needs and based on local circumstances. The consultant occupational therapist can develop through a range of opportunities and routes, either as a specialist occupational therapist or generalist practitioner to consultant level in acute, community, intermediate and social care settings. The consultant occupational therapist works across traditional organisational boundaries and challenges current practice and ways of working. These roles have a wider role in influencing, driving strategic and service change, and using research and evidence based practice to improve outcomes for service users. The consultant role is pivotal in providing local and national leadership. The has been integral in developing the framework for consultant therapist posts, in conjunction with the other AHP professional bodies and actively welcomes this development within the profession. The College encourages members to be proactive in the development of these posts. The College supports the Consultant Occupational Therapist Forum in their meetings. Benefits of a consultant occupational therapy post The following bullets include some of the benefits perceived according to the perspectives of the purchaser, provider and service user. These include: High standard, cost effective, streamlined services with capacity to work across agency and professional boundaries. Rapid access to highest level clinical expertise, advice and mentoring. Raised profile of service / organisation, to attract new business, funds and / or improve recruitment and retention of staff. Practice based on rigorous evaluation and application of evidence, with risk management, audit and research. Initiation and drive of innovative schemes that improve quality and user experience Inspired, creative models of multidisciplinary, interdisciplinary and transdisciplinary practice to ensure best use of resources. Design, coordination and delivery of education to expand the pool of expertise and promote the growth of future specialists. Increase and promote inter professional understanding and respect, locally and nationally. Experienced, rational and imaginative contributions to policy and strategic plans. Challenge existing systems and practices, precipitating change and modernisation, ensuring quality and value for money. The role Consultant occupational therapy posts are structured around five core functions. The core function of expert clinical practice will be central to the consultant occupational therapist. The four supporting functions are essential to the success of the role but are weighted according to local need. www.cot.org.uk Page 2

The five core functions 1) Expert clinical practice 2) Practice and service development 3) Professional leadership and consultancy 4) Research audit and evaluation 5) Education training and development MODERNISING SERVICES Expert clinical practice Practice and service development Professional leadership and consultancy Research and evaluation Education training, and development 1) Expert clinical practice Up to 50% of the consultant occupational therapists time will be spent working in clinical settings with patients, service users, carers, professionals and communities to establish effective practice. Features include: Expert clinical skills in own practice area. Demonstration of advanced level of clinical reasoning, knowledge, and skills within area of practice. www.cot.org.uk Page 3

Promoting and demonstrating best practice, by integrating evidence into practice and by creating innovative ways of incorporating evidence into service delivery. Exercising the highest level of personal professional autonomy involving complex situations that require analysis; making decisions where a precedent may not exist. Responsibility for developing client centred services across traditional professional and service boundaries, to modernise service delivery via a whole system, patient focussed approach. Recognition as a source of regional, national and international expertise in own area of practice. Responsibility for adhering to ethical and moral dimensions of practice. Exercise a higher degree of professional and clinical autonomy. Facilitate and promote a learning culture within the organisation. Develop local and national, best practice standards and clinical guidelines. 2) Practice and service development Influence and develop local, regional and national policies and strategies for own area of practice. Initiate, influence and lead new developments and services. Influence practice developments through clinical leadership and clinical effectiveness networks with service providers across health and social care providers. Interpret and implement national policy in the delivery of services via effective change management and practice development. Create and sustain effective collaborative working practices and relationships with other services/agencies at a strategic and operational level. Promote and facilitate service user involvement in the planning and delivery of services. Provide a source of expertise to the strategic planning process. Facilitate change by identifying risks, boundaries and benefits of new developments in clinical practice. 3) Professional leadership and consultancy Provide visionary leadership motivating and inspiring others to deliver best practice at a local, regional and national level. Acknowledged source of expertise. Provide clinical leadership and influence for strategic planning and service delivery across professional and organisational boundaries. Demonstrate creative and collaborative thinking to influence service change and development. Contribute to debate within the multi professional arena regarding clinical, professional and service delivery. Represent and influence occupational therapy and practice area at a national level in clinical practice, service planning, and policy formation. 4) Research audit and evaluation Initiate and develop research and development programmes in collaboration with relevant research communities. Establish and maintain research partnerships with higher education institutes. www.cot.org.uk Page 4

Develop and facilitate research culture and opportunities for clinicians to engage in research and evaluation activities. Demonstrate evidence of an understanding and application of research to practice. Influence the development, use and evaluation of research and audit methods, to review practice standards and delivery. Influence policy and service delivery by highlighting evidence to support practice and services. Identify and facilitate research topics relevant to practice and service delivery, by commissioning, implementing and reporting the findings to relevant bodies and organisations. Disseminate knowledge through writing for publication, and speaking at local, national and international conferences. 5) Education, training and development Promote and develop the learning environment within area of practice and across service boundaries using a collaborative approach and providing equitable opportunities. Facilitate individuals, teams and organisations to identify and achieve their own learning needs which meet the needs of service users. Work in partnership with higher education institutes to develop and deliver and evaluate local, regional and national education opportunities in area of practice. Demonstrate experience of teaching and developing professional staff and/or students in academic and clinical settings. Provide education, support and supervision to others for their professional development at a local, national and international level. Provide education in specialist area of practice in a variety of styles and methods to meet the needs of the organisation and profession. Lead the development and implementation of educational initiatives and programmes for service users, staff and organisations. Contribute to educational policy for both pre and post qualifying practitioners. Development of consultant posts Posts are identified through service redesign and the recognition of the need for a clinical leader who can provide expert practice, clinical and professional leadership, research and evaluation and educational and service development. These are new posts and are not intended for the upgrading of existing staff. Consultant posts can be funded out of existing budgets identified via service redesign or an increase in staffing budgets. Proposals for a consultant occupational therapist will be based on an identifiable patient need, supported by the host organisation, and requires approval. - NHS employers intending to establish consultant posts should notify: -England - The Regional Workforce Development Officer/Director (RDWD) and /or the Regional Nurse (RN) - Scotland - The Chief Healthcare Professions Officer (CHPO) at the Scottish Executive - Wales Head of Regulation in the National Assembly for Wales - Northern Ireland www.cot.org.uk Page 5

Information required may vary locally but should include: An outline of the service benefits of establishing the post and the speciality involved. A draft job description (and job plan if here is one) and provisional assessment of salary. A work plan. A timetable and details of the appointment process. Consultant occupational therapists are locally matched against the National Job Profile for Allied Health Professionals Consultant Band 8abcd. The consultant occupational therapist should be; A registered practitioner with The Health Professions Council (HPC) A member of the professional body (COT) The nature of the consultant post requires a portfolio of career long learning and experience, and has to demonstrate that they are working at a higher level. They should be considered to be an expert within their clinical field and a visionary leader; having a master s degree or working at a masters level. Further study and postgraduate education is considered essential in terms of providing evidence to commitment to higher level learning and research. A PhD is not considered to be essential to the functions of the role of consultant therapist however many in these positions may be progressing to a PhD in an appropriately related area to the specialist role or work at this level. The requests that they are informed of any developing bids and newly established posts in order to link with existing networks and professional developments. The COT Consultancy Service is available to assist with the recruitment process i.e. development of a job description. They can also assist in providing an external assessor for the interview process. These services are chargeable, further information on the consultancy service can be found on the College website. www.cot.org.uk Page 6

References: The Framework for Role Development in the AHPs (2005) Scotland http://www.scotland.gov.uk/publications/2005/07/08145006/ (2003) Occupational therapist clinical specialist. (COT / BAOT Briefings 7). London: COT. Consultancy service,. http://www.cot.org.uk/newpublic/cotas/intro.php Accessed on 25.07.07. Cusack L, Richards J (2002) Occupational therapy consultants. Occupational Therapy News, 10(2), 27. Department of Health (2000) Meeting the challenge: a strategy for the allied health professions. London: DOH. Department of Health (2001) Arrangement for consultant posts for staff covered by the professions allied to medicine pt A Whitley Council. (AL PAM (PTA) 2/2001). Leeds: DOH. Available at: http://www.dh.gov.uk/assetroot/04/01/10/04/04011004.pdf Accessed on 25.07.07. Scotland. Scottish Executive (2003) Arrangements for allied health professions consultant posts for staff covered by the professions allied to medicine pt A Whitley Council: pay for 2002-2003. (PCS (PAM)(PTA) 2003/1). Edinburgh: Scottish Executive. Scottish Executive (2003) Building on success: future directions for the allied health professions in Scotland. Edinburgh: Scottish Executive. Scottish Executive (2003) Partnership for care: Scotland's health White Paper. Edinburgh: Scottish Executive. Scotland. Scottish Executive (2006) Delivering health, enabling care: harnessing the nursing, midwifery and allied health professions' contribution to implementing 'Delivering for health' in Scotland. Edinburgh: Scottish Executive. Scotland. Scottish Executive (2005) Framework for developing nursing roles. Edinburgh: Scottish Executive Health Department. Scotland. Scottish Executive (2005) Delivering for health. Edinburgh: Scottish Executive. Scotland Scottish Executive (2005) The Framework for Role Development in the AHPs. http://www.scotland.gov.uk/publications/2005/07/08145006/ Accessed on 30.07.07. Welsh Assembly Government (2003) Arrangements for Consultant Posts within Allied Health Professions staff covered by the Professions Allied to Medicine PT A Whitley Council and Speech & Language Therapists. (AL PAM(PTA)W 2/2003 and (SP)W 5/2003). Cardiff: Welsh Assembly Government. www.cot.org.uk Page 7

Further reading Benner P (1984) From novice to expert: excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley. (2000) Code of ethics and professional conduct for occupational therapists. London: COT. Craik C, McKay EA (2003) Consultant therapists: recognising and developing expertise. British Journal of Occupational Therapy, 66(6), 281-283. Craik C (2002) Consultant therapists: are you prepared? Therapy Weekly, 28(48), 8. Cusack L, Richards J (2001) The consultant allied health professional. Occupational Therapy News, 9(11), 8-10. Cusack L (2004) The consultant AHP. Occupational Therapy News, 12(2), 19. Dawson J, Cusack L (2003) Developing the role of the consultant therapist: an update. Occupational Therapy News, 11(3), 26. Department of Health (2000) The NHS plan: a plan for investment: a plan for reform. (Command paper 4818-1). London: Stationery Office. Harmer J (2003) A news release the first consultant occupational therapist post. Occupational Therapy News, 11(3), 27. Manley K (2000) Organisational culture and consultant nurse outcomes: part 1 organisational culture. Nursing standard, 14(36), 34-38. Manley K (2000) Organisational culture and consultant nurse outcomes: part 2 nurse outcomes. Nursing Standard, 14(37), 34-39. Mason K (2006) Consultant forensic occupational therapist. Mental Health Occupational Therapy, 11(2): 53 Mason K (2006) Consultant Forensic Occupational Therapist -- 14 months and 16,000 miles later. Mental Health Occupational Therapy, 11(3): 98 Mason K (2006) Consultant Forensic Occupational Therapist. Mental Health Occupational Therapy, 11(1): 29-30 Melton J (2006) Being an NHS consultant occupational therapist for people experiencing mental ill-health: one year in. Mental Health Occupational Therapy, 11(1), 9-10. Northern Ireland. Department of Health, Social Services and Public Safety (2002) Comprehensive review of the HPSS occupational therapy workforce: report of the project group. Belfast: DHSSPS. Available at: http://www.dhsspsni.gov.uk/occupational_workforce.pdf Accessed on 25.07.07. Northern Ireland. Department of Health, Social Services and Public Safety (2003) Workforce planning review. Belfast: DHSSPS. Available at: http://www.dhsspsni.gov.uk/occupational_review.pdf Accessed on 25.07.07. Northern Ireland. Department of Health, Social Services and Public Safety (2006) Northern Ireland Health www.cot.org.uk Page 8

and Personal Social Services workforce census. Belfast: DHSSPS. Available at: http://www.dhsspsni.gov.uk/ni_hpss_workforce_census_march_2006_web.pdf Accessed on 25.07.07. Oliveck M (2004) Consulting the consultants. Occupational Therapy News, 12 (2), 18. Scotland. Scottish Executive (2007) Co-ordinated, integrated and fit for purpose: a delivery framework for adult rehabilitation in Scotland. Edinburgh: Scottish Executive. Available at: http://www.scotland.gov.uk/resource/doc/166617/0045435.pdf Accessed on 30.07.07. www.cot.org.uk Page 9