Occupational therapy

‘Be the occupational therapist you trained to be’

The move from NHS to independent practice can be a daunting prospect, with many myths and misconceptions surrounding what working in the private sector can entail. 

NR Times speaks to Rehabilitate Therapy Ltd about their pioneering approach to debunking the falsehoods and giving clarity around the subject - while being clear about its many advantages for clients and occupational
therapists alike.

The concerns of NHS therapists around working fully, or partially, in private practice are common and understandable. Is it ethical to work in private practice? Will I be supported? Is being self employed for me?
And what about tax!?

Fear around taking such a step into the unknown is something that occupational therapy practice Rehabilitate Therapy experience often in their recruitment. As a rapidly-expanding business, needing to move beyond their traditional channels of recruiting by recommendation, the conversations with would-be new additions to the team highlight the same longstanding concerns. 

“I think once you work in private practice, you realise the opportunities there are to be the therapist you trained to be, to get to know your clients and to invest the time in doing that. But we realised the challenges that exist in supporting OTs to see and believe that,” says Dr Kate Heward, clinical director of family-run Rehabilitate.

Option Too - demystifying private practice
In response, and to help support the decision making of occupational therapists (OTs) in making the choice as to whether working in private practice is for them, Rehabilitate has created an initiative called Option Too to support and educate OTs that private practice is an option too. 

The unique approach comprises material compiled wholly with input from Rehabilitate OTs who have made the move from NHS to private practice, and includes videos, surveys, blogs, Q&As and also a – soon to be available - downloadable guide. There are also events and online forums to attend. 

Dr Phil Crowther, business director of Rehabilitate Therapy - which is recruiting OTs across the North and Midlands, to add to its existing team of 45 associate OTs - says Option Too was designed to “debunk” the myths and false perceptions about what moving into private practice may mean, and provide authentic and straightforward information and views. 

“Option Too is the background to our recruitment, it’s a really open conversation about what working in private practice is like and to support OTs to make a really informed decision,” he says. 

“We know people worry about whether it’s totally ethical to move into working privately, but we have a whole team here who are doing an amazing job as OTs and most of them also continue to work in the NHS alongside working with us. 

“No OT has ever come to work for us and has got six or 12 months into it and thought independent practice is not for them. I think once you have the understanding of what it really involves, that’s such an important step, and that’s why we wanted to open the conversation.”
The ‘ethical’ conflict many perceive is also often cited as a concern, says Dr Heward. 

“Ethics are often a consideration in making the decision to move, but probably more so since COVID, because of the pressures on the NHS and how stretched the resources were, which saw many of our OTs needing to give much more to the NHS because of that,” she says. 

“It’s often a real shock for OTs when they come to work with us, how much opportunity they have to spend time getting to know a client, establishing the trust and rapport to really develop client centred goals. 

“We’ll tell them you don’t have to go in and immediately be chipping away at the perceived goals if you’ve got a challenging situation. You can build that into your plan, build the rapport to get a relationship going, and take it from there. 

“Seemingly small gains, but that are really important to the clients, are then often the gateway to generating more significant goals, new things have come about because of the client’s progress and their relationship with their OT.

“There’s a big mind shift in knowing you can incrementally do that, with the resources and support of Rehabilitate and the MDTs.

“I think it’s enlightening and gives them a fresh look at therapy.”

Infrastructure to support change
Branching out from the NHS and becoming partially, or even fully, self employed with different working practices can be a daunting thought - but one which Rehabilitate has the infrastructure in place to support, says Dr Crowther. 

“I think people know the NHS and what that offers, you’ve got the structure of support, the infrastructure, the backing, so it feels safe. But then the other extreme is being an independent practitioner, where you’re totally accountable for everything from reporting, marketing, invoices to budgets and insurances, everything. So that’s daunting,” he says. 

“But with us, we’re in some ways the ‘middle ground’ to that. We’ve got 45 OTs now and there’s a fantastic community here of autonomous and empowered people, but with the business infrastructure taken care of, and also mentoring, supervision and support in the background. 

“On the business side, myself and the team assist with all of that - it’s not the case of the OTs get paid when we get paid, like with some OT businesses. Timesheets and invoices are routinely processed monthly and OTs are paid quickly. 

“And, from speaking to our team, they actually feel really backed and supported in our environment because everything is really clear and there is a very strong team ethos. 

“We come from an NHS background ourselves and understand the bureaucracy and barriers that can exist, so we double down on that and aim for simplicity so OTs can get on with being brilliant OTs.”

Dr Heward continues: “Myself and Phil pride ourselves on being approachable as directors, we don’t have layers of management, we are always supportive and contactable. 

“We have OTs joining us who haven’t had clinical supervision for years, which is a requirement of the HCPC. So every month, either individually or in a group, we discuss and explore our clients and what is happening. It’s really important we do that, both as individuals and as a team. 

“We have ‘new OT mentors’ who are really experienced members of our team and they will take new associates through the whole process from the clinical induction through to supporting them through their first assessment and report writing, and then take them through to a point where they're ready to be put into our peer supervision groups. 

“For example, we find that we need to give support around the shift in independent practice and also working within medico legal process – to achieve this we have additional monthly workshops to explore this. You’ve got to be able to justify what you do to the solicitors or insurers who are funding your recommendations, which I think is very different about independent practice. 

“Reporting needs to be much more detailed with justifications of the value and implications if it is not funded, having to be very explicit on that to ensure the client gets the OT they need to maximise their rehabilitation potential. Our OTs tell us how different this is to the reporting in the NHS.

“So that’s quite a big shift, and one we do find is one of the main areas where support is needed - but that’s where our infrastructure can really help and where our mentoring and support really comes to the fore, along with report proof reading and editing to ensure our OTs are totally supported and protected.”

Demand-led growth
Rehabilitate’s recruitment drive stems from a surge in instructions across the North and Midlands. The business is currently recruiting generally across these
areas but with a particular need in Cumbria, the West Midlands, East Yorkshire and Lincolnshire. 

“This is totally demand-led, we are advertising for OTs for the first time.

"Initially, we did it through Kate’s network and through the network of our OTs, and while this continues, we need to look beyond that to ensure we can respond to the demand,” says Dr Crowther. 

“Demand is ever increasing, and is particularly crazy at the minute, we’ve never done any marketing campaigns to generate work, this is all based on our growing reputation and the work we do for clients, which leads to repeats referrals. 

“Our approach to recruitment is really flexible and informal. As well as Option Too, which is all about being open and starting conversations around independent practice, we are happy for informal and exploratory chats with interested or curious OTs, and often they also chat to our OTs to find out exactly what it’s like.”

“We’ve been growing for some time, but especially since the pandemic. It has really grown a lot, and in response our service has really developed” adds Dr Heward. 
“When the pandemic came, we moved to working online really quickly, so we could continue what we offered to clients but also add in new groups and innovations to really help push on with the rehab. That proactive approach has really been very successful and the opportunity for us to facilitate ‘client to client' interactions and relationships has become a really important aspect to our service. 

“Geographically too, we are also growing all the time, on the strength of the work that is coming in. It’s a really exciting time - and now we are hoping to add the people to our team to help us continue this. We are really keen to work with evermore talented OTs, but also it’s great for OTs as they can be the OT they trained to be.”

To learn more about working at Rehabilitate and moving from NHS into private practice, visit https://rehabilitatetherapy.co.uk/option-too