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Introduction of New Roles in Mental Health Trusts:
Early Findings Briefing
Introduction of New Roles in Mental Health Trusts:
Early Findings Briefing
The team started work on the New Roles project in April 2023. With Phase 1 & 2 complete what can we tell you so far. A summary briefing is provided below.
A pdf of this Early Findings Briefing is available for you to download and share with colleagues.
Background
Background
New roles are being introduced in mental health services to help with the staffing crisis, improve care, and provide new career pathways for clinicians. However, the introduction of new roles can be disruptive and have unintended consequences for teams where the new role is placed.
There is a need to understand the dynamic effects of reorganisation to ensure that new roles and skill-mix change can benefit service users and both the new and existing workforce and avoid negative impacts.
In April 2023 we started a research project to understand how new roles have been implemented in mental health trusts across England. We have completed phase one and phase two of the research.
Phase 1 consisted of a mapping exercise to discover which new roles have been implemented in mental health services. We interviewed heads of HR or professional leads in 31 out of 51 English mental health trusts, asking about how new roles had been deployed, the rationale for doing so, and their experiences of new role implementation.
In Phase 2 we held a number of stakeholder reflection groups to consider the Phase 1 findings, involving experts on new roles in mental health services ranging from policymakers, mental health trust leadership, professional leads, and representatives from other relevant bodies.
NHSE Region - Response rate
NHSE Region - Response rate
North East and Yorkshire 7/8
North West 2/5
Midlands 8/11
East of England 1/4
London 5/10
South East 5/7
South West 3/6
TOTAL 31/51
What we found
What we found
Almost 80 ‘new’ roles were reported across the 31 trusts.
However, what is considered to be a ‘new’ role varied significantly between trusts.
Data available on new roles was generally of poor quality, often due to erratic or inconsistent coding of new roles in the Electronic Staff Record.
It was also difficult to locate anyone with oversight of new roles who could provide reliable information without a lot of work.
QUOTE
QUOTE
“Some [roles] are absolutely new roles like the responsible clinician, and a new way of thinking about how we support people for instance, but some, such as mental health practitioner, isn’t necessarily a new role at all, it’s a new title.”
[Reflection Group Participant 2-F]
Why do trusts employ staff in new roles?
Why do trusts employ staff in new roles?
The predominant reason for employing new roles was staff shortages.
However, a range of other reasons were also mentioned, including:
To bring in people new to care as well as younger people and diversify the workforce,
To provide career pathways internally/grow own workforce,
To improve the physical healthcare offer in mental health services,
To support other healthcare professionals,
To provide help with waiting lists,
To bring new skills to teams and services e.g. recovery and lived experience focus, psychologically informed care.
How do staff in new roles change the skill-mix in mental health services?
How do staff in new roles change the skill-mix in mental health services?
Skill-mix describes the mix of different staff in a team, the range of competencies possessed by each staff member, and the ratio of senior to junior staff in the team (Nelson et al, 2018).
Introducing new roles into a team or service changes the skill-mix in various different ways. Below, five different kinds of skill-mix change are defined and explained (Sibbald et al, 2004; Nancarrow and Borthwick, 2005).
We found that most new roles in mental health trusts were described as a form of delegation.
Some new roles also involved horizontal substitution, specialisation and innovation, but no examples of diversification were reported.
However, roles may constitute more than one kind of skill-mix change, and many suggested that there was likely to be a difference between the intended skill-mix change and the actual way staff worked or were deployed in practice.
Delegation
Delegation
Adoption of tasks across occupational boundaries where levels of training, expertise, power, and autonomy between disciplines are not equal.
Horizontal substitution
Horizontal substitution
Adoption of tasks by one discipline that are normally the domain of another, but where levels of training and expertise between disciplines are similar.
Specialisation
Specialisation
Adoption of an increased level of expertise in a specific, narrower disciplinary area.
Diversification
Diversification
When a role expands to broader tasks and responsibilities within its own discipline.
Innovation
Innovation
Extending the scope of service provided by doing something new, either by adding new expertise or extending the remit of existing roles into a novel area of practice.
What facilitates the introduction of new roles?
What facilitates the introduction of new roles?
Key enablers for trusts and teams
Key enablers for trusts and teams
Participants described a range of things that trusts and teams could do to ensure that new roles were effectively introduced and could integrate into teams to best improve care.
Key factors included:
Adopting a strategic approach: having a coherent vision for what the new role could do, communicating this effectively with consistent top-down support.
Engaging with staff and clearly communicating what a role can and cannot do, where it should fit in teams and processes.
Enabling open conversations where ‘candid concerns’ about roles can be voiced.
Presence of a clinical champion, especially at the start of the process.
Sharing examples of successful implementation of the role elsewhere.
Setting up structures to support workforce planning for the new roles e.g. new roles oversight/advisory groups, new roles lead posts, wider governance arrangements.
Ensuring teams have capacity to take on additional work of formal supervision and informal mentoring of staff in new roles.
Participants underlined that the willingness to change is key (e.g. by repurposing vacancies which were not being filled).
Some mentioned that professional protectionism was a barrier.
Despite the need for detailed planning and communication, participants also noted the challenge of balancing flexibility and consistency when introducing new roles.
QUOTES
QUOTES
“People are so busy – we have to think about how to “pitch” the roles to them, “give them headspace to try and get their heads around it”
[Trust J1]
“I think as we've moved, as we've become kind of more mature in our approach to embedding things, we're taking a lot longer in planning. All it needs to look like and planning, making sure our job description is as tight as it can be, we know where things are going to fit”
[Trust G1]
“It's that balance between allowing things to organically develop and not stifling that creativity whilst getting some control and oversight and the organization what it wants and the governance. So it’s how do I hold those two things? That would be my tip, that you don't want to try and control everything, but you do need a degree of order”
[Trust T1]
National and regional support
National and regional support
Participants also suggested a number of things which could be done at a regional or national level to support the introduction of new roles.
Suggestions included:
National guidance/frameworks: There was a desire for “off-the-shelf” package for new roles, including job descriptions, competency frameworks, SOPs, career pathways, pay/banding, governance and regulation guidance, to accelerate the process and avoid duplication of effort.
Opportunities to share learning: Trusts were keen to learn from each other, either regionally or nationally, by sharing job descriptions, training agreements, best practice, policies, evidence from role evaluations etc.
Good communication, particularly between national/regional level (e.g. NHS England/ICBs); and local level (e.g. PCNs, London Boroughs).
Forewarning: Having sufficient time was seen as critical to effectively introduce the role, communicate the case for the role, and promote the benefits.
Often this need was revealed through experience of things going wrong, affected by the absence of guidance and support, or sufficient forewarning, leading to problems with implementation.
QUOTES
QUOTES
“You know something that people can take off the shelf rather than starting themselves…[there has] been so much work and time spent on all of those, you know, governance type issues in contract”. Nothing was available initially.
[Trust Z1]
“Mental Health Wellbeing Practitioners did not land well due to the tight turnaround, with no time for planning or the communication of role”
[Trust H1&2]
Importance of funding arrangements
Importance of funding arrangements
Finally, participants also spoke about how funding arrangements could facilitate or critically hamper the implementation of a new role.
Many argued that adequate, sustained funding was critical to the sustainability of new roles.
In practice, many encountered problems with the misalignment of funding and workforce planning cycles.
Short funding timescales were seen to drive limited, short-term thinking in trusts and teams.
The joint funding of posts could also create further challenges for sustainability.
The need for funding to also cover backfill, supervision, and ongoing support for new roles was seen to be important, as funding often only covered the role itself or the training period.
Contracting was often hampered by a lack of clarity about purpose and value of particular new roles, in terms of capability and also their eventual capacity.
Next Steps
Next Steps
In Phase 3 of the research, we will undertake 8 in-depth case studies across 4 trusts providing mental health services in South Yorkshire.
The aim is to understand how new roles are implemented and integrated in practice, and how this affects staff experience and care for patients/service users.
We have selected teams which employ the following new roles;
Descriptions of these roles, as well as insights into the challenges faced in introducing these roles, can be found on the Pen portraits pages.
AP
Advanced Practitioner
CAP
Clinical Associate in Psychology
EMHP
Education Mental Health Practitioner
MHWP
Mental Health Wellbeing Practitioner
MPAC
Multi-Professional Approved /Responsible Clinician
NA
Nursing Associate
PSW / LXP
Peer Support Worker
Lived Experience Practitioner
PA
Physician Associate
References
References
Nancarrow SA and Borthwick AM. (2005) Dynamic professional boundaries in the healthcare workforce. Sociology of Health and Illness, 27(7): 897-919 DOI: https://doi.org/10.1111/j.1467-9566.2005.00463.x
Nelson P, Martindale AM, McBride A, Checkland K, Hodgson D. (2018) Skill-mix change and the general practice workforce challenge. British Journal of General Practice, 68 (667): 66-67 DOI: https://doi.org/10.3399/bjgp18X694469
Sibbald B, Shen J, and McBride A . (2004) Changing the skill-mix of the healthcare workforce. Journal of Health Services Research and Policy, 9(Suppl 1):28–38 DOI: https://doi.org/10.1258/135581904322724112
Research presentation
Research presentation
Pauline, one of our project researchers, explains the findings from Phase 1 and 2 of the New Roles in Mental Health project in this short video.
Watch Pauline's 20min conference style presentation.
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