New Roles, New Challenges: Understanding boundary work to support the implementation of new roles in mental health Trusts
The NHS is currently dealing with a workforce crisis, as it faces huge challenges recruiting and retaining workforce capable of responding to increasing demand for care.
This workforce crisis is most acute in mental health services, which suffers from a higher turnover of staff and more vacant positions than the rest of the NHS. At the same time, demand for mental health services has risen significantly in recent years, exacerbated by the mental health impact of the Covid-19 pandemic and ongoing social and economic pressures.
One response to this challenge is to recruit staff to various new roles, such as:
Allied Health Professionals in Mental Health
Nursing Associates
Mental Health Social Workers
Peer Support Workers
Pharmacists and Pharmacy Technicians
Physician Associates.
Introducing these new roles also means changing the 'skill-mix' in mental health services, and this often means changing how care is organised and delivered.
This project
Previous research about these new roles has typically looked at each role individually to decide if they improve care. This is important but it does not tell us how the wider mental health team and the healthcare system is affected by the changes.
Introducing new roles inevitably means existing roles also must change; for example, current staff may do fewer tasks as others take on work but then have to spend time supervising these new colleagues, or may need support to develop new skills in systems working or leadership.
Research shows new roles can improve care for service users and lead to better job satisfaction and career opportunities for staff if managed well. However, as service users may receive care from larger teams, this may lead to a lack of continuity in their care, and it may not be clear what staff in these new roles do, causing confusion for both staff and service users.
Our aim is to discover how new roles should be introduced to make sure they work well and improve care.
To do this, we first need to know which new roles have been introduced, where, how and why.
We will talk to Mental Health Trusts across England about this.
We will develop a model to understand the different types of roles and why they are being introduced and we will test this model with NHS staff and service users.
We will share findings about what is happening across the country to help people understand the different ways in which new roles are changing care, and what is driving these changes.
We will then study these changes in practice by placing researchers in eight mental health teams across four Trusts in South Yorkshire that have recently introduced new roles, working closely with a team of peer researchers. Researchers will observe teams and talk to staff members and service users to understand how the introduction of the new role has affected how care is delivered.
Across the project, we will develop an understanding of:
The rationale for introducing new roles, compared with what happens in reality
The kinds of changes which happen when different types of roles are introduced
How far staff work together or compete with each other as new roles are introduced
How these changes affect how care is delivered
How these changes affect both new staff and existing staff
How these changes are experience by users of mental health services
How to do this better
Our research findings will provide guidance for those managing and planning new roles in NHS mental health services in the future. We will share our findings as reports, podcasts, videos, and infographics via this website and on social media, and make these available to the public as well as professionals and NHS leadership. Our findings will also be shared through research papers in academic journals and presentations at international conferences.
This project will help us understand how mental health services can best implement new roles, to maximise benefits for staff, service users and organisations.
In this short video Tim Kendall highlights why it is important to understand how implementing new roles in mental health services impacts on others working in the system.
The project (grant ref NIHR152665) is funded by the Health Services & Delivery Research (HS&DR) programme of the National Institute of Health Research (NIHR). The views expressed on this website are those of the author(s) and not necessarily those of the NIHR or the UK government.
Contact us
For further information, please contact the project’s principal investigators:
Professor Damian Hodgson (d.hodgson@sheffield.ac.uk)
Dr Emily Wood (e.f.wood@sheffield.ac.uk)