New Ways of
Working for Psychiatry
Aims and objectives
The NWW for Psychiatrists sub-group
has continued to meet every two months since the publication of the
Final Report in 2005. It is an advisory group with
multidisciplinary and service user and carer representation,
co-chaired by Professor Richard Williams (Royal College of
Psychiatrists), Dr Christine Vize and Dr Steve Humphries, Associate
Directors for NWW.
The objectives of the group through
2006 have been:
• to promote wider
awareness of NWW nationally;
• to gather data on the
extent of uptake of NWW;
• to widen the
consideration of NWW, which had been mostly concentrated on
adult services and
consultants;
• to undertake particular
pieces of work with a view to producing guidance and
advice;
• to contribute to the
work of other groups, including the identification of
common emerging themes to
form the basis of the next phase of
multidisciplinary work;
and
• to make the appropriate
links with other agencies and work streams.
Promoting awareness of
NWW
Members of the group have participated
in, led and organised a variety of events
across the country, with regions,
Royal College divisions and individual Trusts. These
have raised awareness of the
principles of NWW and provided opportunities to
explore local examples, progress and
difficulties, and have also fostered links between
teams developing the same approaches
in different areas of the country. They have
contributed to a DVD about NWW, and a
presentation template and supporting
material have been produced, with a
version aimed at service users and carers to
inform them about what NWW means for
them. The chairs of the group have met
with Louis Appleby, National Director
for Mental Health; Hugh Griffiths, Deputy
National Director for Mental Health;
and the President and Dean of the Royal
College of Psychiatrists. The chairs
have responded to a wide range of requests for
information, articles, etc., and are
involved in developing the NWW website.
Gathering data on
NWW
The group contributed to the
development of a questionnaire that has been sent
to all Trusts in England, asking
questions about NWW in general and in relation to
psychiatrists. The results are
reported elsewhere. In addition, the CSIP development
centre workforce leads and lead
psychiatrists have reported back on work in their
regions and organisations. Common
difficulties that have emerged have informed the
development of specific projects. The
chairs have linked with the workforce leads in
the NIMHE regions to monitor
progress.
Practice example
An NWW peer review was undertaken at
the request of Suffolk Partnership Trust.
This involved one of the Associate
Directors for NWW, the regional workforce
lead, a service user representative,
and a senior clinical leader from a neighbouring
Trust undertaking a day-long visit to
the Trust and meeting staff, service users and
managers. It culminated in a feedback
session for executive and senior staff and the
production of a report.
Contact: Paul
O’Halloran at paul.o’halloran@nemhpt.nhs.uk
Widening the scope of
NWW
The principles of NWW apply to all
services, but many well-known examples have
come from adult services. The group
has, therefore, discussed the particular relevance
of NWW to old age, child and
adolescent and forensic psychiatry.
A briefing paper was produced after
discussion with the College Trainees Committee
about NWW for trainees, both in their
training and as the consultants of the future.
There is concern among trainees about
two main issues: whether their training, both
before and after the introduction of
Modernising Medical Careers, equips them to be
an NWW consultant, and the potential
for erosion of their service role while training,
due to the advent of enhanced roles
for other professions, which can now undertake
many of the psychiatric trainees’
‘traditional’ tasks. The Trainees Committee now has
a representative on the group and is
developing the agenda for NWW for trainees,
and its concerns are being listened to
by the Royal College of Psychiatrists.
Practice example
Chris Ball, a consultant in old age
psychiatry, gave a presentation to the group on
an NWW project in Lewisham, South
London, where he has developed an inpatient
consultant role for an older adult
ward. The results are very encouraging,
similar in many ways to the gains seen
in adult units that have adopted this model
and have been reported previously.
However, of particular note is that the number
of slips, trips and falls fell
significantly, indicating that better team working was
resulting in better assessment of risk
and implementation of preventative measures.
Sickness levels among staff also fell,
indicating a benefit for staff morale.
Contact: Chris Ball
at chris.ball@slam.nhs.uk
New Ways of Working and
psychiatric trainees
The structure and content of
postgraduate psychiatric training is undergoing a
complete overhaul, with the
implementation of Modernising Medical Careers (MMC)
and the Royal College of
Psychiatrists’ new Postgraduate Medical Education and
Training Board (PMETB)-approved
competence-based curriculum. Trainees’ overall
clinical experience has also recently
changed, following the reduction in working
hours to comply with the European
Working Time Directive and the introduction
of specialist teams via the National
Service Framework. Independently, but
simultaneously, the working practices
of consultant psychiatrists are being reviewed
under the aegis of the NWW initiative.
The concurrent nature of these two separate
changes presents all those charged
with development of medical practices within
psychiatry with a distinctive
opportunity to work together to develop a seamless
system that trains new MMC/PMETB
trainees today to be ‘fit-for-purpose’ NWW
consultants tomorrow.
The implementation of NWW for
consultants has two major implications for
trainees. Firstly, the role for which
trainees are training will be different in the future.
This will require a regular review of
the new curriculum to ensure that training is in
line with service, particularly in
areas such as management, leadership and supervision of colleagues.
Secondly, as we move away from the traditional consultant role, we
need to consider mechanisms to retain the broad range of experience
required by trainees in order for them to become NWW consultant
psychiatrists competent in dealing with the most difficult and
complex cases and providing supervision to other multidisciplinary
colleagues.
The role of trainees within a team
should be clearly defined alongside the evolving
role of the consultant psychiatrist at
the time of local service reorganisation. This
process should involve all
stakeholders, including the consultant, the college tutor,
trainees and other team members, and
the following should be considered:
• Working in partnership
with service users, carers and other professionals should
be emphasised throughout
training.
• At a junior level of
training, ‘routine work’ is a necessary part of the training
experience. Without
learning how to assess, formulate, investigate and manage
‘simple’ cases, it is
impossible to learn how to manage ‘complex’ ones.
• Trainees should be more
involved in more multidisciplinary assessments and
follow-up, with an
increasing supervisory role as their level of experience
increases. Frontline
assessment and supervisory management of out-of-hours/
emergency clinical
presentations should be encouraged, depending on the
trainee’s level of
experience.
• As other members of the
team take on some of the tasks traditionally performed
by consultants, some of
the NWW consultant’s time should be utilised to revive
and promote the
traditional apprentice model, with emphasis on both the
management of complex
clinical cases and the supervision of multidisciplinary
colleagues in managing
such cases.
• Individual training
posts should be allocated to trainees to ensure that, upon
completion of training,
they have gained the necessary clinical and technical skills
to work as a consultant
psychiatrist.
• Taking on the role of
the care co-ordinator would be a valuable training
experience at a higher
level of training (ST4–6).
The Psychiatric Trainees Committee of
the Royal College of Psychiatrists will:
• take a lead in raising
awareness of NWW with trainees and trainers;
• work with the National
Steering Group to integrate trainees’ issues more fully
with the entire NWW
agenda; and
• work with the associate
directors for NWW and the college to develop the
training curriculum.
Contact: Amit Malik,
Chair, Psychiatric Trainees Committee, at
doctmalik@hotmail.com
Products
• Guidance on
the management of medical vacancies and the use of locums has
been produced
in collaboration with the Medical Directors network.
• The group advised on the
development of a successful bid for two Trusts to
become pilots for ‘Team
Working Handover and Escalation – Working Time
Directive 2009’, and these
projects are now under way.
• A paper on the use of
Section 5(2) was submitted to the Mental Health Bill team,
and its conclusions
accepted, resulting in a proposal to allow Responsible
Clinicians to use Section
5(2).
• An evaluation of the
proposed new psychiatric training curriculum with respect
to NWW has been produced
and submitted to the Dean of the Royal College
of Psychiatrists.
• A paper was produced
identifying where the requirements for data collection were
at odds with NWW and
distributed responsibility, and anomalies are being
rectified.
• Reference to NWW has
been incorporated into the Care Programme Approach
(CPA) review consultation
document. A paper on CPA-related issues has been
produced and submitted for
the consultation.
• Guidance has been
produced on working with the coroner. Some collaboration
with coroners has been
achieved over this. Thus far, it has fallen short of a joint
document, but further work
with the Coroners Society for England and Wales
will be pursued in
relation to new roles proposed in the Mental Health Bill.
• A working party on
complexity has been established, chaired jointly by Dr
Christine Vize and Felix
Davies, representing the British Psychological Society.
• The group has debated
and responded to the national consultation on the CPA.
• Work has been carried
out with the Healthcare Commission to incorporate
questions about NWW into
the staff survey for 2008.
• Vignettes have been
produced about psychiatrists developing NWW, as well as
a ‘diary of a modern
psychiatrist’.
• A ‘Frequently Asked
Questions’ document has been created.
• An NWW-friendly version
of the diary has been used in consultant job planning.
Contribution to the work of
other groups
Members of the group have contributed
to the work undertaken by psychologists,
pharmacists, primary care, nursing,
and the acute in-patient project group, which is
reported elsewhere. The group has
identified areas of work it wishes to pursue that
have cross-cutting themes, elaborated
elsewhere, and members have started to
participate in groups working on
leadership and non-medical prescribing.
Joining up the NWW
agenda
The chairs of the group have met with
Department of Health and CSIP partners
about:
• payment by results in
mental health;
• productive time;
• mental health Foundation
Trusts;
• the Mental Health Bill;
and
• homicide inquiries.
The chairs have been co-opted onto the
executive of the newly established Royal
College of Psychiatrists Medical
Directors network, the CPA review Steering Group,
and the Department of Health-funded
national evaluation of NWW that is being
undertaken by Newcastle
University.
Key conclusions from the work
of the group
• We have
many examples of successful NWW across the country. However,
development
is still patchy both within organisations and across Strategic
Health
Authorities.
NWW is about cultural and attitudinal change, not about
endorsing
a particular
service model, and as such it will take time to achieve.
• There must be a way for
organisations and individuals to access, and contribute
to, the growing data base
on NWW. NWW is about using skills to maximum
effect; reinventing wheels
does not do that.
• Moving towards
Foundation Trust status and sustaining financial balance are
likely to be the top
priorities for most Mental Health Trusts in 2007. It is
essential that NWW is seen
as part of these agendas, not a distraction from them.
Foundation Trust status
offers a wealth of creative opportunities for new
partnerships and ways of
working.
• We need to involve
commissioners more in understanding and developing NWW.
• Education and training
are vital in producing a skilled and adaptable workforce
that can work for the
benefit of the 21st-century service user and carer, and the
resources to provide them
must be protected.
Next steps
• Members of
the group will work with colleagues to develop the
cross-cutting
themes that
the professional groups have identified as needing further
work.
• Working with Medical
Directors to develop their role as champions for NWW
in their organisations,
linking the NWW agenda with the strategic direction
and objectives of their
Trusts.
• Continuing work at all
levels to increase knowledge about NWW and empower
staff to work in
collaboration with service users and carers to achieve it. The
NWW website will be an
important tool in this regard.
• Work with the Royal
College on NWW for trainees, and equipping them for
NWW consultant roles.
• Getting NWW principles
emphasised in the revised policy and guidance for the
CPA following the national
consultation.
Contact details for chairs of
the NWW for Psychiatrists sub-group:
Professor Richard Williams at Rjwwilli@glam.ac.uk,
Dr Christine Vize at christine.vize@awp.nhs.uk,
Dr Steve Humphries at stephen.humphries@tney.northy.nhs.uk,
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