I had a traditional start to my occupational therapy career in that I did a broad-based rotational job which took me through acute medicine, rehabilitation, rheumatology, vascular surgery, care of the older person and inpatient and outpatient trauma and orthopaedics. I worked within a very cohesive occupational therapy team at a fantastic district general hospital and when I got a senior post in Trauma and Orthopaedics, it felt like I was probably in there for the long haul.
One fateful day, I spied an advert in Therapy Weekly for an Arthroplasty Practitioner and it piqued my interest. I’ve always been led by my heart more than my head and I ruminated that perhaps I should explore it, not least because that particular Therapy Weekly was two weeks out of date and would normally have been thrown out.
The post was advertised for an occupational therapist, physiotherapist or nurse. The remit was to work alongside two consultants to develop a practitioner led service for the review of routine patients following total hip replacement which would enable them to focus on increasing new patient appointments.
Two plane trips to suss it out and one successful job interview later, I found myself in post in early 2003 and before I had even started, it had grown to include review of patients with total knee replacement.
The learning curve was steep and I can’t say that the first six months was an easy road at all. The novelty value of having my own office lasted one afternoon and initially the feeling of isolation was pretty brutal!
Advanced clinical practice in a generic role, particularly in lower limb musculoskeletal conditions, was pretty unique for an OT in 2003 and I had to use a lot of resources from the Chartered Society of Physiotherapy to write learning outcomes for myself and develop protocols.
Twenty two years down the line, a lot has changed, although there is still perhaps some reticence on the part of OTs to believe that we can inhabit the advanced practice space and there is probably a lack of understanding on the part of other professionals to believe we can do so. Not all Trusts will offer these roles to OTs because we are not yet able to be independent prescribers. This is short sighted because there can always be work arounds and in my opinion, an OT’s ability to undertake activity analysis is the bedrock of getting to the crux of the impact of a lot of long term conditions.
Ironically, as the years have progressed, I feel more true to my OT roots than when I started work in 1997. Although it might look as though my days are filled with generic tasks, for example, listing patients for surgery and undertaking steroid injections, I’m always looking at things through an occupational lens.
I remember when I felt this most acutely. It was in 2015, not long after the Montgomery Ruling came into effect in terms of medical consent. In essence what it means is that it is incumbent upon the person taking consent to ensure that they have covered all the risks which are likely to be meaningful to that person. I remember a consultant colleague asking me ‘how can we possibly know what is meaningful to each patient?’ and I realised that not everyone thinks like an OT!
In 2025, the remit of the job remains as it was when I started; to undertake the routine work to free up the consultant staff and registers to do what only they can do. This would normally be theatre time or more complex patients in clinic.
My timetable is a mixture of face to face, telephone and virtual appointments. I developed a distance management service in 2021 as a means of trying to safely review our patients during the Covid 19 pandemic and continue to use it as a way to deal with our significant backlog.
My caseload is a mixture of people with primary and revision total hip, hip resurfacing, knee and ankle replacements and those yet to undergo surgery.
My skill set includes clinical examination, imaging and clinical test interpretation, joint injections, patient specific counselling pre surgery, hip and knee bracing and health promotion.
I have a specific interest in optimising patient health pre surgery and focusing on quality of life post surgery and in those situations where surgery is not an option. I am a member of the British Society of Lifestyle Medicine and hope to undertake my Lifestyle Medicine Diploma and Public Health Masters in the next few years.
If you are working in advanced practice or are interested in this type of career pathway, it would be wonderful to hear from you. Claire Stevens, Advanced Arthroplasty Practitioner, Orthopaedic Outpatient, Royal Derby Hospital clairestevens@nhs.net
