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 jayne.hayes@awp.nhs.uk
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 helen.kilgannon@northwest.nhs.uk
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 linda.stewart@leicspart.nhs.uk
• 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 jayne.hayes@awp.nhs.uk
• 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 macradcliffe14@btinternet.com
• 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 sarah.todd@humber.nhs.uk
• 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 kim.bennett@nhs.net,
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