Multi-Professional Approved Clinician

Multi-Professional Approved /Responsible Clinician
MPAC

How new is this role? [1-2]

Multi-Professional Approved/Responsible Clinicians (MPACs for short) have technically existed since the changes to the Mental Health Act (MHA) in 2007. However, initial uptake of the role in some areas across the country has been very low.
Health Education England (HEE) and NHS England (NHSE) set up funded training to support the development of MPAC roles. This is further supported in the NHS Long Term Workforce Plan (2023) which outlines an expectation of expansion in the role of over a 1000 new posts nationally.

Rationale [1]

To enhance patient choice/experience and ensure that the most appropriately qualified member of staff provides the MPAC role.

Approved Clinician

A mental health (MH) professional approved by the Secretary of State (or a person/body exercising the approval function of the Secretary of State). Some decisions under the Mental Health Act (MHA) can only be taken by people who are approved clinicians; for example making the initial decision that someone should be detained against their will for assessment and/or treatment of a MH condition. Until 2007 this role was delivered by approved social workers and psychiatrists only. This role is now open to psychologists, MH or learning disability (LD) nurses, Allied Health Professionals (AHPs) such as Occupational Therapists (OTs) as well as social workers.

Responsible Clinician

The responsible clinician is the approved clinician with overall responsibility for the care of the service user. Certain decisions, such as renewing a patient’s detention or placing a patient on a community treatment order (legal provisions under the MHA), can only be taken by a responsible clinician. Until 2007 this role was only delivered by medical staff; it is now open to social workers, AHPs, psychological practitioners and mental health/learning disability nurses.

Training [1]

The role requires multiple years’ experience at band 8a or above, plus a postgraduate qualification in Mental Health Law which is included in the funded NHS England training. Non-medical prescriber status is usually expected (for nurses only). Candidates are also required to submit a portfolio for approval to the Department for Health and Social Care (DHSC).

Expected pay band [1]

Agenda for Change band 8c.

Is it registered/regulated and by whom? [1]

In order to train as an MPAC, clinicians must be MH/LD nurses, psychological practitioners, AHPs or social workers who are registered with their appropriate professional body. DHSC must approve all applicants before they can work as MPACs.

What our research found*

Numbers reported in practice

16 Trusts reported employing or training MPACs.
10 of these provided specific numbers, ranging from 1 to 10, with only small numbers being trained.

Insights from qualitative interviews and stakeholder reflection groups (i.e. what is reported to be happening in practice)

MPACs were reported to be working in both inpatient and community settings.
The importance of ensuring that only appropriately qualified and experienced practitioners delivered the role was emphasised.

Reported drivers for/advantages of implementing the role included:

- - non-medical professionals such as nurses, occupational therapists or psychologists being more appropriate approved/responsible clinicians for some patients, regardless of the NHS doctor shortage
  - providing career progression, and bridging the gap between the nursing and medical professions
  - reducing reliance on locum medics.

Challenges to implementation included:

- - resistance from medical colleagues: “It was an absolute battle with our medical colleagues to get [the role] over the line” [Interview Participant B1]
  - resistance could sometimes be overcome by the presence of medical champions for the role, and/or visible examples of the role proving its worth, such as covering for junior doctors during strikes
  - pay disparity compared with psychiatrists coupled with a lack of guidance or standardisation on pay
  - some role holders not having the right to be a non-medical prescriber
  - low organisational capacity for consultant supervision and support: “[The role] worked brilliantly in pockets, not so well when psychiatrists weren’t on board. We learnt early on not to even try if they weren’t up for it – it was too hard for the person training not to have a supportive mentor” [Interview Participant K1]
  - a lack of strategic planning around the role.

* Research findings are based on 1) interviews with heads of HR or workforce leads in English MH Trusts and 2) stakeholder reflection groups with experts on new roles in MH services. The ways in which new roles were reported to be working in practice could differ within and/or between MH Trusts.

Sources [1-2]

Health Education England (2020) Multi-Professional Approved/Responsible Clinician: Implementation Guide Multi-Professional Approved/Responsible Clinician: Implementation Guide
NHS England (2023) NHS Long Term Workforce Plan NHS Long Term Workforce Plan