Designing retention through professional identity, workflow and leadership in Richmond and Wandsworth

This case study demonstrates how sustained professional leadership and practical service redesign can strengthen retention of regulated professionals. It brings together two connected elements: a career pathway rooted in frontline Occupational Therapy practice and a redesign of duty and screening that reshaped day-to-day experience for staff.

Together, these illustrate how role clarity, credible leadership and well-designed workflows create conditions in which Occupational Therapists feel supported, visible and able to develop.

Retention is strengthened when leadership grows from frontline experience and remains connected to practice realities.

The leadership pathway in Richmond and Wandsworth began in therapy assistant roles across NHS and private settings, followed by qualification as an Occupational Therapist in adult social care in 2011. Progression included clinical leadership roles, team leadership within the HM Prison Team where the first social care service in Wandsworth Prison was established, and responsibility for clearing a carers’ assessments waiting list within a financial year.

Further progression included Lead Occupational Therapist for Learning and Development across both boroughs, with responsibility for workforce development, professional standards and clinical leadership of the equipment contract.

In February 2020, following a major restructure, an independent Occupational Therapy service was established across Richmond and Wandsworth. This required aligning systems and processes across two boroughs, uniting culturally distinct teams and creating streamlined Occupational Therapy pathways supported by IT and performance systems. New roles were introduced, including remote duty and screening posts and a second Assistant Service Manager role. A joint Band 6 rotational post with the NHS was created, the first Occupational Therapy apprentice in Wandsworth was supported and wider improvement initiatives were led, including Voice Bot calls to people on the waiting list.

Leadership also extended beyond the boroughs, through chairing and vice-chairing national and London-wide Principal Occupational Therapist networks. This strengthened professional identity, strategic influence and visibility of Occupational Therapy within wider systems.

This continuity of leadership created the authority and confidence to reshape how work was organised locally. That context is central to understanding the redesign described below.

Between January 2025 and January 2026, the Occupational Therapy service received 3,825 referrals. Following screening, 44 per cent progressed to the waiting list. Of these, 28 per cent required a Preventative Service Assessment and 16 per cent required a full Occupational Therapy assessment.

Duty and screening therefore functioned as the gateway to the service, shaping prioritisation, referral quality and onward pathways. When this function became fragmented or inconsistent, the effects were felt across the whole team.

Staff feedback highlighted early warning signs of retention risk. Duty was experienced as disorganised, time-consuming and stressful. It disrupted casework and limited opportunities for CPD and professional development.

Practitioners reported that they were unable to continue with CPD due to workload pressures and that they had doubts about remaining in post.

This reflected pressure across several retention drivers. Professional Growth was constrained by loss of development time. Wellbeing was affected by chaotic workflow. Recognition and Belonging were undermined when professional judgement felt diluted within fragmented processes.

The issue was not individual resilience but service design.

The service redesigned duty and screening so that it became a clearly defined, dedicated role rather than a rotating responsibility shared across the team.

This created consistent cover, clarified decision-making authority and reduced duplication and contradictory advice. Remote duty and screening roles were developed, strengthening flexibility while maintaining accountability.

The intention was both practical and cultural: to streamline processes, protect professional time and reinforce clarity about the Occupational Therapy remit.

Following redesign, staff and managers reported improved continuity and fewer interruptions to casework. There was greater confidence that referrals reaching the service were appropriate and aligned to Occupational Therapy expertise. Duplication reduced, contradictory advice decreased and capacity for CPD, student supervision and project work improved.

Feedback described the introduction of a dedicated duty Occupational Therapist as “monumental”.

Management recognised that the redesigned role was attractive and supported recruitment and retention. By protecting CPD time and reducing chaotic workflow, the redesign strengthened Professional Growth and Wellbeing. By clarifying remit and increasing confidence in decision-making, it reinforced Recognition and Belonging.

The dedicated duty and screening role also generated clearer insight into referral patterns. A recurring pattern of inappropriate referrals from the Front Door Team was identified.

Rather than absorbing this pressure within Occupational Therapy, the service engaged directly with partner teams. The duty Occupational Therapist liaised with the Front Door Team, attended meetings and clarified referral expectations and remit. Attendance at Front Door meetings is now embedded as required.

This shifted learning upstream and reduced avoidable demand downstream. It demonstrates how professional leadership can influence system behaviour beyond the immediate team, strengthening Recognition of Occupational Therapy expertise.

• Leadership: Service redesign was informed by staff feedback and service data and led by Occupational Therapy leadership grounded in practice.
• Belonging: Clearer role purpose and consistent processes strengthened professional identity across boroughs.
• Professional growth: Protected CPD time and restored space for development, supervision and project work.
• Wellbeing: Reduced duplication and clearer workflow addressed stressors linked to retention risk.
• Flexibility: Remote duty roles supported more adaptable working arrangements.
• Recognition: Occupational Therapy expertise became more visible and valued across teams and partner services.

Authorities considering similar redesign may track referral flow, appropriateness of referrals, duplication of queries and time spent on duty versus casework. Workforce indicators such as protected CPD time, clarity of role and capacity to support students and apprentices provide insight into professional experience. Monitoring referral trends and upstream engagement with partner teams supports ongoing system learning.

These measures support reflection and improvement rather than immediate claims about retention outcomes.