Scoping opinion: Speech and language therapists’ views on extending their role to the urgent ear, nose and throat pathway

Abstract

Background: In the UK, there is increasing pressure on ear, nose and throat (ENT) clinicians and departments, which is anticipated to amplify in the coming months and years due to the coronavirus disease 2019 pandemic and other workforce pressures. In the context of a national drive to advance practice of Allied Health Professionals to address some key challenges facing the National Health Service, we explored whether UK speech and language therapists (SLTs) felt it is possible to utilize and extend their existing skills to patients on the urgent 2-week wait (2ww) ENT pathway. Aims: To explore SLTs' views of extending their role to work with patients referred on the ENT 2ww pathway.Methods & Procedures: Two separate focus groups were conducted using nominal group technique to generate and rank benefits and challenges of the proposed extension of role. Participants were invited to take part through Clinical Excellence Networks relevant to head and neck cancer and voice sub-specialties.Participants were competent in performing nasendscopy in at least a highly specialist role in voice or head and neck subspecialties.Outcomes & Results: Nine SLTs from England, Wales and Northern Ireland attended two focus groups. All were employed in band 8 roles in head and neck and/or voice. Eight were competent to Royal College of Speech and Language Therapists' scoping level 3. Important benefits of the proposed novel service delivery model were generated and ranked by participants, with both groups identifying improved quality and efficiency of service for patients among the most important. Disadvantages were then generated and ranked across the two groups with potential for misdiagnosis ranked as the most important by both. Conclusions & Implications: Participants responded that extending the SLT role into assessment of 2ww patients would provide benefits for quality of care, healthcare efficiency and the SLT workforce. The identified disadvantages require addressing if the proposed SLT-led model of service delivery is piloted in This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Outcomes of a first point of contact speech language therapy clinic for patients requiring vocal cord check pre and post thyroid/parathyroid surgery

“…Although no formal time or economic analyses were conducted regarding ENT time, the clinic avoided 163 ENT appointments, and ENT time was reduced to only a few minutes per patient to conduct the initial triage and make their diagnostic decision. Hence, this paper contributes to previous studies that support that these types of FPOCC models can be used safely within low-risk populations, improve service delivery and reduce burden on ENT outpatient services and waitlists (Occomore-Kent et al, 2021;Payten et al, 2020;Schwarz et al, 2021;Seabrook et al, 2019).…”

“…A subsequent paper that reported data from 5 years of the same service re‐confirmed these findings and also confirmed a low re‐referral rate (Schwarz et al., 2021). Positive service outcomes have also been verified by similar FPOCC models running in other clinical services (Payten et al., 2020; Occomore‐Kent et al., 2021).…”

“…However, considering that pre‐ and post‐complications typically occur in only a small percentage of patients (Hermann et al., 2002), it is acknowledged that this population is at a low risk of presenting with pathology. As such, rather than increasing the clinical load for existing ENT services, this low‐risk clinical cohort could be managed under an alternate clinical model for low‐risk cohorts, such as an SLT‐led, first point of contact clinic (SLT‐FPOCC) model (Payten et al., 2020; Seabrook et al, 2019; Schwarz et al, 2021; Payten et al., 2022; Occomore‐Kent et al., 2021).…”

A retrospective study of patients presenting with speech and language therapy needs within multidisciplinary Long COVID services: A service evaluation describing and comparing two cohorts across two NHS Trusts

“…Occomore‐Kent et al. (2021) recognize that further exploration of the feasibility of SLT‐led low‐risk 2‐week wait service, which may also be beneficial to patients presenting with laryngeal dysfunction post‐COVID.…”

“…Of equal importance is the emergence of the extended, advanced practitioner roles for SLT-led videonasoendoscopy to assess laryngeal dysfunction, including voice, pharyngeal dysphagia and upper airway disorders in individuals with long COVID. The benefits of SLT-led assessment clinics have been shown to reduce waiting times, which led to prompter treatment (Payten et al, 2020;Seabrook et al, 2019), and predicted reduction in pathway costs (Occomore-Kent et al, 2021). Occomore-Kent et al ( 2021) recognize that further exploration of the feasibility of SLT-led low-risk 2-week wait service, which may also be beneficial to patients presenting with laryngeal dysfunction post-COVID.…”