Development of an inpatient assistant practitioner role


11 / 09 / 2012


  • The organisation
  • What we did and why
  • Intended benefits
  • How we did it
    Examples of trainee findings
  • Examples of manager findings
  • Results and next steps
  • Evaluation on the impact of the introduction of the role
  • Tips for other trusts
  • Contact details 
  • The organisation

    South Staffordshire and Shropshire Healthcare NHS Foundation Trust (SSSFT) provide mental health, learning disability and specialist children’s services across South Staffordshire. The trust also provides mental health and learning disability services in Shropshire, Telford & Wrekin and Powys.

    What we did and why

    The SHA provided the trust with funding for a project to develop a career and development framework for support staff, part of which was developing an inpatient assistant practitioner role.

    The trust identified a need for new ways of working within its mental health services. It was recognised that introducing an inpatient assistant practitioner role would deliver increased support to registered colleagues and also provide clear career development opportunities, increase job satisfaction and aid in retention.

    Intended benefits

    The intended benefits of the introduction of this new role included:

    • improve inpatient service-users access to physical healthcare
    • improve service-users access to therapeutic activities in an inpatient setting
    • enhanced multi-disciplinary team working based on clarity of role responsibilities and levels of accountability
    • it should help to enable professionally registered staff members to focus on utilising their higher level skills to aid delivery of patient services
    • provide for greater career development opportunities for the bands 1 to 4 workforce by creating a clear career pathway to both assistant practitioner roles and nursing careers.

    How we did it

    A multi-disciplinary project team with service-user and carer representation was established to develop the assistant practitioner role.

    The team identified a key focus for the role of inpatient assistant practitioner was to meet the physical healthcare needs of service-users. Using feedback from service-users, the team were able to develop a role to support the health and wellbeing to suit individual patient needs.

    An extensive mapping exercise was carried out using the following tools to identify the relevant drivers and standards:

    The team also used the Nursing and Midwifery Council standards of proficiency and skills clusters, the Healthcare Professions Council generic standards of proficiency, the Care Quality Commission mental health inpatient discharge surveys and the trust risk management reports to assist with the mapping exercise.  

    The team recognised that key to the development of the role was to identify the core and role specific competencies. The selection of the competencies was determined by clinicians who used the Skills for Health national occupational standards (NOS) and the range of psychological competences developed by Roth and Pilling.

    Working collaboratively with NHS West Midlands and Staffordshire University, the project team contributed to the development of a two year foundation degree in mental health. This included designing work-based learning for the trainee assistant practitioners which would provide evidence to support their Knowledge and Skills Framework  appraisal.

    The team also looked at what other regions had done to introduce assistant practitioner roles into their workforce. The main issue appeared to be the concern caused by the non-regulation of support workers.

    To address this issue the project team used the employer-led regulation model piloted by the Scottish Executive as a basis to develop an organisational code of practice. This was achieved with the support of the local joint staff partnership (made up of trust management and local representatives of staff side organisations) and colleagues at the Royal College of Nursing.

    As part of their evaluation process, shortly after the trainees started the programme the trust carried out interviews on each member of the cohort. This was to gather information on the individual's backgrounds, why they had applied for the position and how they felt about their experience so far.

    The trainees were interviewed again mid-way through and on qualification. The managers involved in the project were also interviewed to give their views on the following:

    •  expectations of the new role
    •  their experience of the  programme and
    •  the impact of the project on service delivery.

    Examples of trainee findings:

    • the role was seen as a way to gain job satisfaction and a stepping stone to move into nurse training
    • there were mixed views in relation to remuneration, as some would gain financially while others would have to take a pay cut
    • trainees felt there should be more clarity about where professional responsibilities would rest
    • a lack of consistency about the allocation of protected study time.

    Examples of manager findings:

    • all managers interviewed expected the role would support the registered nurses
    • there was recognition that the development of the role needed to be done carefully to maintain the right balance of staffing
    • the creation of the role was seen as an incentive  to career progression
    • managers identified the difficulties in finding ways to cover for trainees during their protected learning time.

    Results and next steps

    There were seven trainees in the first cohort and all successfully completed the course. Two have now progressed to an abbreviated degree in nursing.

    Evaluation on the impact of the introduction of the role

    The evaluation included audits of physical healthcare assessments in those areas and measurement of service-user satisfaction. The audits were undertaken at key stages of the foundation degree as described above.

    The data relating to service-user satisfaction is to be derived from local surveys developed as an element of the Productive Ward initiative. There was clear evidence that the new role was both valued and valuable in supporting improved outcomes for service-users particularly around meeting their physical health requirements.

    Some of the evidence includes:

    • managers reported a positive impact on wards as the trainees gained confidence and took on more responsibilities
    • managers also reported trainees had shown significant signs of development
    • the role was providing a clear career progression for the support staff.

    As a result, the trust has commissioned a further cohort and the role is now established in the inpatient setting.

    There has been further work to develop roles in community settings, forensic settings, early interventions services, crisis and home treatment services and assertive outreach services.

    Community roles were developed around the principles of recovery and a care pathway underpinning West Midlands care clusters – this has been well received by service-managers.

    Tips for other trusts

    Collaboration with other trusts is essential to develop a sustainable approach. Where there is no ready supply of people with appropriate qualifications this is of paramount importance to ensure the financial viability of programmes delivered by higher education partners.

    An inclusive approach to role development and recruitment is also advocated. A learning contract that clarifies the role of trainees, mentors, managers and lecturers has proved invaluable in protecting clinical learning.

    Progression agreements that enable a step up from apprenticeships are also vital to securing an effective career framework.

    Contact details

    Christopher Malvern
    Workforce redesign project manager


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