Australian Occupational Therapy Journal (2005) 52, 293–301 doi: 10.1111/j.1440-1630.2005.00531.x Blackwell Publishing, Ltd. Oxford, UK AOT Australian Occupational Therapy Journal 0045-0766 2005 Blackwell Publishing Asia Pty Ltd December 2005 52 4 Feature Article EVALUATING ASSISTANT PRACTITIONER S. Nancarrow and H. Mackey The introduction and evaluation of an occupational therapy assistant practitioner Susan Nancarrow 1 and Hazel Mackey 2 1 Trent RDSU, The University of Sheffield, Sheffield and 2 North Staffordshire Combined Health Care Trust, Bucknall Hospital, Stoke on Trent, Staffordshire, UK Background and Aim: This paper describes the introduc- tion and evaluation of an extended role occupational therapy support worker, called an ‘occupational therapy assistant practitioner’. Methods and Results: The evaluation took place within a single health care trust and involved focus groups with four groups of stakeholders: assistant practitioners; their supervi- sors; managers; and service users. The evaluation identified a lack of access to appropriate training; ambiguous supervi- sion and accountability relationships; and a lack of a clear career direction for qualified occupational therapists, creating uncertainty about which aspects of their job they should be ‘giving away’. Conclusions: There is a need to clarify career structures and accountability relationships between existing and new staff members and ensure that appropriate training is available to support staff in their new roles. KEY WORDS accountability, assistant practitioner, new roles, supervision, support worker. Introduction This paper presents the findings from a qualitative evaluation of the introduction of a new level of occupational therapy support worker, an ‘assistant practitioner’ in a UK Healthcare Trust. The new role was designed to both fill a gap in service delivery and acknowledge the already extended roles of existing occupational therapy support staff. The evaluation examined the introduction of the new role from the perspectives of the occupational therapy assistant practitioners, occupational therapy supervisors, managers, and service users. A number of recent UK policies encourage modern- isation of the professions and challenge traditional working practices (Department of Health, 2000a; 2000b; 2002a). The key themes involve a strategy for growing and developing the health workforce, a major redesign of jobs, the introduction of a ‘skills escalator’ to promote career progression and personal develop- ment, and a system of fair pay that will reward staff according to the value of their work rather than by complex hierarchical pay scales. The introduction of ‘assistant practitioners’, higher level support workers who complement the work of registered professionals, is one of the modernisation initiatives (Changing Workforce Programme, 2003). In addition to the national drivers, recruitment difficulties in the National Health Service (NHS) have led occupational therapy managers to review the ratios of support workers to registered practitioners in their staffing (Alsop & Cooper, 2005; Department of Health, 2000a; 2000b; Smith & Brown, 2005). Skill mix initiatives have been found to lead to greater organisational effectiveness, although the increased use of less qualified staff will not be effective in all situations (Buchan & Dal Poz, 2002). The question of roles and boundaries between qualified occupational therapists and support work- ers has been debated intermittently in the literature on occupational therapy (Atkinson, 1993; Forte, 1988; Green, 1991; Spashett, 1991; Tigges, 1980). In the USA and Canada, however, the demarcation in roles and education has had a more recent and wider debate (Russell & Kanny, 1998; Von Zweck & Gillespie, 1998). Despite decades of protection of professional titles and roles, it is well-documented that some forms of care can be delivered by more than one type of practitioner (Booth & Hewison, 2002; Cooper, 1998, 2001; Cooper, Laud & Dietrich, 1998; Richardson, Maynard, Cullum & Kindig, 1998). Doctors, nurses Susan Nancarrow PhD, BApp Sc(Pod), MAppSc (Research); Primary Care Research Coordinator. Hazel Mackey MA, PGCE, DipCOT; Occupational Therapy Service Manager. Correspondence: Susan Nancarrow, Primary Care Research Coordinator, Trent RDSU, ICOSS Building, The University of Sheffield, 219 Portobello, Sheffield S1 4DP, UK. Email: s.nancarrow@sheffield.ac.uk Accepted for publication 12 August 2005. © 2005 Australian Association of Occupational Therapists