Widening the psychological workforce

Psychological professions in England need to expand by 60 per cent on 2019 levels by 2024 – and that's before increased need due to the Covid-19 pandemic is even taken into account – according to UK government plans. In real terms this means adding 10,640 full-time equivalent psychological professionals to the workforce.

One way to achieve this growth may be by focusing on competences rather than job titles, suggests a report published by NHS Health Education England in December 2021 (see 'We should be an inclusive home'). 'Focusing on competences, rather than professions or job titles, requires that we have service users, families and carers in mind from the outset, designing services and roles around the needs of people,' it states. 'It can also help us unlock knowledge, skills and experience already within our workforce, support staff retention and reduce barriers between professions.' The document Psychological Workforce Plan for England examines how some of the ambitions of the NHS Long Term Plan might be achieved and outlines a number of other approaches.

The changing psychological workforce is something the BPS has been looking at for a while; exploring how to recognise newer roles and welcome them into the Society. This week sees the opening of a historic vote asking members to agree on changes to the Society's Royal Charter and statutes for the first time in more than a decade.

Competences and expertise

Among these changes is a move to offer a new type of membership called Associate Membership to recognise professionals working within the wider workforce. Such roles include Psychological Wellbeing Practitioners (PWPs), Clinical Associate Psychologists (CAPs) and Education Mental Health Practitioners among others. The changes also move to recognise members' competences and expertise beyond graduate achievement.

The Improving Access to Psychological Therapies (IAPT) initiative in 2008 led to PWP posts becoming more popular among Psychology graduates. The BPS has led the course accreditation process for PWP courses since 2009. But what does this role entail?

Those doing the job are at pains to point out that the role is important for promoting wellbeing through low-intensity interventions – and can often be undervalued. And though rewarding, the role can be stressful and tiring with high caseloads, say some practitioners.

'There are also those who see us as "postmen of leaflets" on mental wellbeing,' as Sofia Airoldi, a trainee PWP in NHS Oxford Health recently wrote in her article. 'I find it upsetting when people underestimate my job, because there is so much more to being a PWP.'

Proverbial healthcare net

Clinical Associate Psychologists meanwhile aim to bridge the gap between being an Assistant Psychologist and a Clinical Psychologist. They aim to provide evidence-based psychological support within the community, focusing on one particular clinical population (unlike Assistant Psychologists). While NHS Scotland introduced the Clinical Associate role in 2005, it is relatively new in England as highlighted by Isabel Sherman's experiences as part of one of the first cohorts of CAPs in England. 'If we were able to fast-forward to 2025, I would hope to see the CAPs having a clearly defined role within the transformed CMHTs [Community Mental Health Teams], where all team members understand which tasks a CAP can carry out, and the psychological care is fully integrated,' she wrote.

Low-intensity interventions may also be used in different settings. For example, Ellie Kerry, a PWP at Great Ormond Street Hospital in London, has been working with colleagues to examine a stepped care approach with children and young people: 'families who might otherwise slip through the proverbial healthcare net'.

'To my surprise, my experiences so far have not only brought me in contact with families experiencing mild to moderate conditions, but also those who have been deemed too complex for some services and too mild for others,' she wrote in a Letter to The Psychologist.

Technology and AI

Others in the wider workforce have looked at the evidence-base of areas such as integrating religion in therapies including CBT or giving their professional and personal perspectives on clinical depression.

Transformations to the psychological workforce may also come through expanding technology as well as roles. 'Psychologists will need to enter their practice 'digitally empowered', as Michael Berger, Emeritus Professor of Clinical Psychology at Royal Holloway, University of London, said in relation to the Topol Review. This 2019 report by digital medicine researcher Dr Eric Topol considered major technological trends and their implications for NHS services and staff.

The evolution of technologies including artificial intelligence (AI) may also impact psychologists.

Unite the workforce

But the expansion in the psychological workforce means that recruitment hasn't quite caught up with changes – it's a complex area and the new roles don't always match historical job titles, or their competences aren't taken into account. To help address this issue, the BPS published guidance, Best Practice in Psychology Recruitment in 2021. Its authors Catherine Dooley and Hannah Farndon told The Psychologist: 'We're not trying to push people out… in fact, we're trying to be inclusive, to make sure that psychologists with unusual career paths and the like are not inadvertently excluded, and that posts are filled.' 

Developments in the last couple of years has meant that the number of clinical psychology doctoral places have also expanded to reflect growing need. However, the need for a diverse and inclusive intake has also been highlighted alongside this.

Many commonalities also unite the psychology workforce say Practitioner Psychologist Nick Hammond, and trainee Practitioner Psychologist Nikki Palmer; with individual professional competencies going across 'borders'. 'We must recognise differences, of course, but also place a far greater focus on commonality in order to remove borders, and move towards a shared interest (and competence) in applying psychology to make a constructive difference to human beings.'

Jeffrey Karp in his recent article also argued for 'a more uniform approach to conceptualising patients', which would benefit both patients and therapists.

Voting on the Society's charter and statutes will be open from 12 January to 11 February 2022, with the result announced on 17 February at a Special General Meeting.

To find out more about the BPS vote see www.bps.org.uk/member-vote-2022

BPS votes now happen online as standard. To find out more or to update your voting preferences see www.bps.org.uk/news-and-policy/modernising-our-voting-system