Understanding service commissioners' priorities

it is more important than ever that occupational therapists can understand, and respond to, the priorities of their service commissioners

A recent helpful publication by the King’s Fund (Imison et al 2011) highlights 10 priorities for service commissioners as they strive to deliver a sustainable healthcare system – and almost all of these priority areas offer the potential for occupational therapists to promote how their service delivery can contribute to achieving the overall objectives.

1. Active support for self management
   This objective seeks to improve self-management of long term conditions, including information provided to service users and their carers. Many occupational therapists already promote and engage in self-management programmes and provide information sheets to assist their service users.
    
2. Primary prevention
   Health promotion is a high opportunity area for occupational therapists, and we have a growing evidence-base in areas such as the wellbeing of older people (NICE 2008) and lifestyle redesign in obesity (AOTA 2007).
    
3. Secondary prevention
   Occupational therapists can contribute to secondary prevention of illness by engaging with a range of opportunities that exist to improve service users’ long-term health. Find evidence-based examples at www.cot.org.uk/influence-service-commissioners.
    
4. Managing ambulatory care sensitive conditions
   Whilst not terminology widely used by occupational therapists, this objective relates to maintaining wellness and independence in the community for people with chronic diseases, in order to reduce hospital admissions.
    
5. Improving the management of patients with both mental and physical health needs
   With their skills in working with people having both mental and physical health needs, occupational therapists are ideally placed to promote a range of their services to commissioners and to demonstrate where occupational therapy contributes to the care pathway.
    
6. Care co-ordination through integrated health and social care teams
   As the profession that works most closely across health and social care, occupational therapists are well-placed to demonstrate how they offer client-centred care that is co-ordinated across a range of settings and care pathways. Schemes such as Early Supported Discharge (www.evidence.nhs.uk) and reablement services (www.cot.org.uk/influence-service-commissioners/re-ablement) provide evidence that can be used to influence service commissioners.
    
7. Improving primary care management of end-of-life care
   Occupational therapists have a key role in facilitating discharge from hospital and effective care in the community, working with others to support service users who desire to spend their final days at home.
    
8. Effective medicines management
   Some occupational therapists already have a contributory role in ensuring that service users are able to manage their medications effectively or independently. Prescribing is a growing area for extended scope practice for some occupational therapists.
    
9. Managing elective activity – referral quality
   The opportunity for closer working within the new commissioning structure will extend the incorporation of occupational therapy information to pathways for elective referrals – and some OT services can now be directly referred to via Choose and Book.
    
10. Managing emergency activity – urgent care
    This objective relates to developing a more integrated approach to care for people who have an injury or illness that requires immediate attention but not a visit to A&E. The occupational therapy evidence published by Logan et al (2010) demonstrated the benefit of a community falls programme for older people who had called an ambulance after a fall but not been taken to hospital.