1. Dr. Mary Morley, Helen Miles and Jane Smith, June 2017
Factors Influencing the Recruitment and Retention of Senior Mental Health OTs
Dr. Mary Morley, Helen Miles and Jane Smith,
June 2017

2. Context in London 2016 High Band 6 OT vacancy rate in our Trust of 29%
London-wide shortage of OTs - highest number in mental health
Slight reduction in commissions leading to London shortages
High cost of living lack & of affordable housing
Occupational therapy is not on the UK ‘Shortages’ list for overseas OTs
Removal of bursaries could exacerbate shortage of those studying OT as a second degree or on part time courses
Most trusts are looking for local solutions to close vacancy gaps & reduce turnover.

3. Overall Trust Initiatives to Recruit Clinical Staff
Accommodation
NHS discount schemes 
Cycle to work/Bike loan 
Childcare vouchers
Season ticket loan 
Car lease scheme
Work life balance
Looking after your health 
Free gym membership 
Subsidised car parking 
Staff restaurants 
Plus an OT specific action plan informed by an electronic survey completed in July and August 2016

4. Mental Health OT workforce
Survey of mental health OT in the South East (Birken 2015):
Key factor in job satisfaction is being enabled to provide OT as well as any generic role
25% had less than one day a week on OT specific clinical duties
A bio-medical or a psychological focus in practice limited ability to deliver OT
Local NHS staff surveys since 2010:
OTs score highly on the extent to which they agreed their role makes a difference to patients (between %).
BUT when asked ‘Are you satisfied with the quality of work and care you are able to deliver?’, OTs respond with the lowest score each year (55-71%)

5. Gathering the Views of Local OTs
 On-line survey carried out to inform a Trust-wide OT recruitment and retention strategy and action plan.
Participants were asked:
 What things do you like/ dislike about your current role?
What are the positives/less positives about working in the Trust?
What are the things that make people stay or leave the Trust?
What one thing could we do to make posts more attractive?
The results are consistent with similar exercises conducted in the trust and elsewhere. 

6. Themes from Local OT Survey
Professional infrastructure:
Largely positives but concerns re lack of leadership in some boroughs
Strong OT supervision and professional CPD
Professional status
Valued by teams but trust doesn’t acknowledge contribution
Job design
OTs seek posts with OT specific component (not just care coordination)
Move from Band 5 to Band 6 roles is challenging
Workload
OT roles are eroded when caseloads are too high

7. Main OT themes contd. Career Progression
Lack of OT roles for career advancement beyond Band 6
Ideas to extend career pathway included:
Support for secondments
Develop formal programme to support move from Band 5 to Band 6 roles
Develop rotational posts
Create more opportunities to try out other roles
Provide more protected OT time in community posts

8. System-wide OT action plan
Review of professional leadership structure to ensure OTs are supported in OT practice including strengthen Band 7 roles
Nominated an OT to facilitate recruitment process with Lead OTs assisting with job design
Agreement to reinforce OT specific activities in particular in CMHT roles
Co-location of some OTs to strengthen professional support
‘Preceptorship plus’ to ease the transition from Band 5 to Band 6, piloted in two boroughs

9. Preceptorship Plus
Trust-wide review to introduce developmental posts for nurses and OTs to move from Band 5 to Band 6
Shared competencies for care coordination augmented by profession-specific skills
Supervised by senior practitioner for 6 months as engage in work-based learning to achieve objectives

10. Preceptorship Plus: Feedback
I find it a struggle to protect the OT caseload as demand for care co-ordinators is so high but we had a vacancy in the team for so long … I realise we have to take on someone with less experience and train them up ourselves. (Feedback from Manager) .
Comprehensive and relatively easy to understand.
Good tool to use in supervision to help monitor progress
Some points are difficult to evidence as are quite abstract

11. Restructuring Community Mental Health OT Provision
As part of community transformation, a new way of working has been introduced for CMHOT
The OTs retain the split between care coordination and OT but the OT component is pooled.
Referrals are made to the hub from all community teams and in some instances inpatient wards.
OTs within the Hub remain attached to a given team and retain their care co-ordination role.

12. OT Referrals
 The hub co-ordinator is a band 7 lead OT who carries a caseload & manages the referrals
All OT referrals to the hub are received through a single point of access, where they are triaged and prioritised.
All referrals will be responded to within 7 days. Urgent referrals have face to face contact within 3 days.
Priorities include referrals that directly impact on community teams such as:
Functional assessments that inform accommodation / package of care and discharge from ward
Support for people with disabilities to have equal access to services and safe discharge
Recent request from courts for report

13. Feedback from OTs
OTs working in the hub feel supported to engage in profession- specific care as well as retaining their care co-ordinator role within the MDT.
Newly qualified staff or staff moving from Band 5 to Band 6 role now have the opportunity to gain skills with more experienced staff and have varied experience.

14. (Feedback from Manager)
The hub has really helped me to maintain a sense of identity whilst under a lot of pressure to fulfil a more generic mental health care coordinator role.
It has brought a sense of team work and increased quality of communication & collaboration across the OT’s in the team.
Given me time out to actually do OT work.
The challenges include balancing the hub with other more urgent risk and crisis management tasks involved in care coordination.
It has also provided a really useful place for students to learn about what a more OT specific role in mental health looks like.
It takes time to shift a culture.
OT Hub is about the OTs working in a targeted way to help facilitate discharge from the team.
(Feedback from Manager)

15. Six Month Evaluation of OT Hub
Significant improvement in the efficiency and responsiveness in the OT service whilst still allowing OTs to manage the role of care co-ordination.
Significant increase in referrals for OT and greater throughput on cases
More seamless service with service users receiving more appropriate packages of care

16. Looking Forward
Formal evaluation is planned but early indication that the development posts and the revised OT model are improving staff satisfaction as well as meeting trust objectives.
Acknowledge that other services will have similar challenges and we are keen to share ideas and learning with colleagues

17. References
COT (2006) Recovering Ordinary Lives. The strategy for occupational therapy in mental health services 2007–2017
SurveyMonkey (2015) Available at: (accessed 6 January 2017)
Haig L Summerfield –Mann L (2016) An investigation into the occupational therapy workforce in London. Health Education England

18. Contact Details Helen.miles@swlstg-tr.nhs.uk