New Ways of Working for Non-Professionally Qualified Workers Introduction

Non-professionally qualified workers (NPQWs) provide an important, substantial and sometimes under-recognised contribution to services for people with mental health problems. Such roles can provide significant benefits to service users and carers, service organisations and other staff. In many areas, such as in-patient care and many community settings, NPQW staff often spend more direct time with service users than staff with traditional professional qualifications.

A summary of many of the NPQW roles will be available at the NWW website, www.newwaysofworking.org.uk NWW provide an important opportunity both to develop new NPQW roles and to change and extend existing roles.

The term NPQW here refers to:

• those employed without the requirement for a traditional professional qualification; and
• those whose role is to work directly with people with mental health problems.

NPQW roles are found in both statutory and non-statutory sectors. Those in statutory sectors have traditionally been strongly linked with particular professions – e.g. support workers working to nurses or social workers – while those employed elsewhere have not – e.g. housing support workers.

A range of factors have influenced the development of NPQW roles, including an identified need for a totally new role, shortages of traditionally trained ‘professionally’ qualified staff, and the drive for better value.

New ways of working for established NPQW roles

A range of existing roles has been extended by increasing training requirements and extending the range of roles, for example pharmacy assistants have taken on new tasks and roles under the supervision of the pharmacist, and healthcare support workers have developed new skills/competences and become Associate Practitioners working with registered nurses.

Associate Practitioners

In Avon and Wiltshire Mental Healthcare Partnership Trust, Associate Practitioners have been trained, through a University of the West of England course, to work in support of qualified staff and allied healthcare professionals in the assessment, planning, implementation and evaluation of nursing care without the direct supervision of a registered nurse. They work as associate nurses in in-patient areas, ensuring that holistic care is delivered and standards of care are enhanced. They supervise and delegate work to Band 2 and 3 healthcare assistants. Contact: Jayne Hayes at This email address is being protected from spam bots, you need Javascript enabled to view it

New NPQW roles

Some of the major recent developments in mental healthcare have been supported by the introduction of a range of NPQW roles that have particularly focused on improving access to services or social inclusion. For example, Primary Care Mental Health Workers have been established to provide evidence-based brief psychological interventions, and Support, Time and Recovery (STR) workers provide intensive support to individuals to support recovery.

An evaluation of a new NPQW role

An evaluation of the impact of the introduction of STR workers showed:

• the effect of the introduction of the role ‘appears overwhelmingly positive’;
• the STR worker role is most effective when clearly linked to the process of recovery and the goals of social inclusion;
• the role generates positive and desired outcomes for service users – particularly through the provision of time, and continuity of support; and
• there is a generally high level of job satisfaction and respect.

Source: Huxley, P. et al. (2005): ‘No Recovery without Time and Support’.

Challenges to successfully introducing new roles or new ways of working

Introducing new roles can often be difficult. Problems can arise from a range of sources. New roles may be poorly understood or, occasionally, actively resisted; career structures may not support retention; and appropriate education and supervision may not be available. Many newer roles are not specifically linked to a single existing profession, making assimilation into services more complex.

Principles of good practice

In order to ensure that NPQW roles are able to make the greatest contribution possible to meeting the mental health needs of service users, particularly through NWW, the same general principles apply as to other roles.

Introducing new or enhanced roles

The North-West Strategic Health Authority has produced a document, Introducing New or Enhanced Roles, that provides detailed guidance and checklists to support new workforce developments. Issues covered include: needs analysis, education, costs and sustainability.
Contact: Helen Kilgannon at This email address is being protected from spam bots, you need Javascript enabled to view it

However, there are some principles that are particularly important to consider:

Recognising that NPQW staff already contribute enormously to services. Service providers can do much to ensure that the good work of existing NPQW staff is highlighted, for example through in-house publications.

Recognising the contribution

Leicestershire Partnership NHS Trust gives an annual award within its Older People’s services to recognise the contribution made by support staff, and their dedication and commitment to older people. Carers and service users are involved in various aspects of the process, including short-listing the nominations and presenting the awards. One recipient, Alison, reported: ‘I felt really honoured when I knew a carer had nominated me.’
Contact: Linda Stewart at This email address is being protected from spam bots, you need Javascript enabled to view it

Challenging the idea that ‘professional’ is always best

Organisations can actively challenge existing assumptions about traditionally professionally qualified staff always being the ‘best’ providers for care, where there is no evidence to support such contentions. This may include discussing such issues with service users and carers, who may understandably share such views.

Communicating new innovations/roles to existing staff

By engaging with staff groups early on, there is more chance that new roles will be understood and supported. It is important to give clarity about how changes will impact on/fit with existing staff. It is likely that communications will need to be repeated at later times as well, to ensure continued understanding.

Ensuring that issues about professional accountability are clear

The introduction of new roles may create new situations that existing models of professional accountability do not clearly cover. Consultation with regulatory bodies may be particularly useful in such circumstances.

Addressing accountability issues

Avon and Wiltshire Mental Healthcare Partnership Trust set up a large workshop around the introduction of Associate Practitioner roles into the Trust. It invited speakers from professional and regulatory organisations to discuss areas of accountability and responsibility with a large and informed audience.
Contact: Jayne Hayes at This email address is being protected from spam bots, you need Javascript enabled to view it

Ensuring appropriate education/training is in place

In the past, training has been missing for many NPQWs, despite the fact that they play key roles and often spend long periods of time working directly with service users. Widely recognised qualifications add to the ability of post-holders to transfer between organisations and roles, supporting career development.

An innovative training scheme

Southampton University and Hampshire Partnership have developed an ‘earn as you learn’ two-year postgraduate diploma in Mental Health Practice (MHP) whereby trainees are employed – in the first instance as support workers – while they attend university. Once they qualify, the trainees enter through the Band 5 gateway of Agenda for Change and receive a postgraduate diploma.
Contact: Mark Radcliffe at This email address is being protected from spam bots, you need Javascript enabled to view it

Ensuring that appropriate supervision is in place

Supervision can play a vital role in ensuring that standards are maintained, workers continue to learn from their practice and good practice is shared. In the past, NPQWs have sometimes not had the same access to supervision as their professional colleagues.

Providing appropriate supervision

Within Humber Mental Health NHS Trust, a clearly defined, robust supervision framework has played a major part in the successful implementation and development of the Support, Time and Recovery worker role. Supervision arrangements include peer group supervision every two months, individual clinical/practice supervision, individual STR role-specific supervision and email/telephone supervision outside normal supervision arrangements. Additional specialist supervision is arranged to meet specific needs.
Contact: Sarah Todd at This email address is being protected from spam bots, you need Javascript enabled to view it

Ensuring that all roles have defined career frameworks

Staff retention is often dependent on staff feeling that they have the opportunity to progress in their careers. Should staff not wish to seek roles with higher levels of responsibility, systems such as the Knowledge and Skills Framework in the NHS provide a means of continuing the identification of learning and development needs.

Defining roles and expected outcomes clearly

In order for a role to function well, the aim of the role must be clearly defined and the planned outcomes clearly stated. This provides a benchmark for implementation success.

Establishing processes for review

By building in processes and timescales for reviewing new/changed roles, there is the opportunity for all stakeholders to evaluate the contribution made, together with any difficulties. Formal planning in this way may reduce obstructive behaviour, as there is an opportunity to contribute to change.

Developing and supporting NPQW roles

Pennine Care NHS Trust has established a quarterly forum for Assistant Practitioners. The aim is to bring together post-holders from across all areas of a multi-sited Mental Health Trust to ensure maximum benefits are gained from such roles. Activities in the forum include sharing of experiences from the different service areas, problem solving, transformational thinking and innovation, and operational policy development. The forum has been in place for 12 months, and has been the catalyst for the successful development of two key pieces of work: a preceptorship programme, and a protocol and associated training programme to enable Assistant Practitioners to administer depot medication.
Contact: Kim Bennett at This email address is being protected from spam bots, you need Javascript enabled to view it