Contents
1 Introduction
The 2007 amendments to the Mental Health Act 1983 introduced the roles of approved clinician and responsible clinician, enabling mental health professionals other than psychiatrists to carry out duties previously performed by psychiatrists. The introduction of these roles is intended to deliver enhanced quality of care while also ensuring the best use of our skilled and professionally diverse workforce.
The following two definitions are provided in terms of approved and responsible clinicians:
| Term | Definition |
|---|---|
| Approved clinician (AC) | A mental health professional approved by the secretary of state or a person or body exercising the approval function of the secretary of state. Some decisions under the Mental Health Act can only be taken by people who are approved clinicians. All responsible clinicians must be approved clinicians |
| Responsible clinician (RC) | The responsible clinician is the approved clinician with overall responsibility for the case. Certain decisions (such as renewing a patient’s detention or placing a patient on a community treatment order) can only be taken by the responsible clinician |
2 Purpose
The purpose of the policy is to provide specific guidance in terms of the allocation and governance of the RC and AC roles, to ensure that they are the clinician with the right set of skills to address the patient’s main treatment needs. This concerns enabling diversified AC workforce including psychiatrists, nurses, psychologists, social workers and occupational therapists where appropriate.
The purpose of the policy is to detail information about the allocation, selection, training, approval, and utilisation, within Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH).
3 Scope
All individuals ‘subject to compulsion’ under the MHA must have an appointed responsible clinician (RC) who is approved as an AC. The RC has overall responsibility for the purposes of the MHA, including detention, renewal, discharge, approved leave, decision making regarding seclusion and long-term segregation, and community treatment orders (CTOs). RCs are responsible for the legality of decision making impacting on an individual’s liberty and ensuring correct completion of legal paperwork.
Guidance in terms of allocation of RCs are set out by this policy. Where there is more than one AC available at the patient’s location, the RC will be the available AC with the most appropriate skills and experience to meet the needs of the patient. This can include the availability of the RC and service model of the service or ward.
This document applies to inpatient and community mental health services and is relevant across the Rotherham, Doncaster and North Lincolnshire care groups.
4 Responsibilities, accountabilities and duties
4.1 Clinical care delivery (section 5)
- Ensure that the patient’s responsible clinician is the available approved clinician with the most appropriate expertise to meet the patient’s main assessment and treatment needs.
- Ensure that it can be easily determined who a particular patient’s responsible clinician.
- Ensure that cover arrangements are in place when the responsible clinician is not available (for example, during non-working hours, annual leave and so on).
- Include a system for keeping the appropriateness of the responsible clinician under review.
These points are consistent with paragraph 36.3 of the Mental Health Act 1983 Code of Practice (CoP) which requires hospital managers to have local protocols in place for allocating responsible clinicians to patients.
This document does not attempt to describe all eventualities, but there are three basic principles which should be used to determine the correct course of action.
- All detained and CTO patients must have an RC at all times.
- A patient can only have one RC (but more than one AC may be involved in their care).
- The RC can change from time to time.
4.2 Workforce governance (section 6)
- Ensure there is a strategic approach regarding the selection, training, approval, implementation, and utilisation of ACs.
- Ensure that staff members are supported throughout training and into employment as an AC, including ongoing supervision arrangements.
- Ensure training expectations are clearly identified, and clinicians are provided the means to adequately meet these expectations.
- Ensure the full utilisation of the AC role.
- Enhance patient care and maintain patient safety.
| Role | Responsibility |
|---|---|
| Executive medical director, executive director for nursing and AHP’s |
|
| Approved clinicians |
|
| Approvals panel (NEAP) |
|
| Mental health legislation committee |
|
| Hospital managers (delegated to medical staffing and HR) |
|
5 Procedure and implementation
5.1 Recording
The RC must be recorded on SystmOne. It is the responsibility of the RC to ensure that this is done. When the RC is changed, it is the responsibility of the RC taking over care of the patient to record the change of RC. There is no need to change RC on SystmOne for short-term changes (up to 4 weeks) for example, leave and sickness cover.
5.2 Initial allocation of an RC
Unless there are other factors to be considered, the RC will be determined by the current location of the patient. Where there is more than one AC available at the patient’s location, the RC will be the available AC with the most appropriate skills and experience to meet the needs of the patient.
5.3 Non-medical ACs
If the most appropriate person to be RC is not a doctor, it may be necessary to allocate a second AC who is a doctor. For example, the most appropriate RC for a particular patient is a psychologist who is not a prescriber. The clinician in charge of the treatment must be an AC if treatment is being given:
- without the patient’s consent
- with the patient’s consent, but on the basis of a certificate issued under section 58 or 58A MHA
- pending compliance with section 58 and with the consent of a CTO patient who has been recalled to hospital, in order to avoid serious suffering
5.4 Community treatment orders (CTO)
Unless there are other factors to be considered, the RC will be determined by the location of the patient. Where there is more than one AC available at the patient’s location, the RC will be the available AC with the most appropriate skills and experience to meet the needs of the patient. On recall, the inpatient consultant will become the RC. If at the end of 72 hours of recall the patient is discharged then RC responsibility reverts back to the Community RC.
For further information see:
- RDaSH community treatment order policy
- MHA Code of Practice, chapter 29
5.5 Cover when the RC is not available
The functions of the RC cannot be delegated, but the patient’s RC can change from time to time and the role may be occupied on temporary basis in the absence of the usual RC. This may be necessitated by:
- annual, professional or study leave
- sickness
- part time working
- out of hours cover
For planned leave (including annual and study leave) the RC is responsible for making arrangements with a suitably qualified AC to act as RC in their absence. If the RC is unable to make such arrangements, they must approach their care group triumvirate to resolve the matter.
For unplanned leave (including sick leave) the care group triumvirate would be responsible for arranging cover from an appropriately qualified AC.
5.6 Out of hours cover
The trust has established arrangements for duty consultant cover outside normal working hours. The duty consultant, who is an AC, will provide cover out of hours for RC functions. This will include providing advice for any nominated deputies (for example, the nominated junior doctor on call) who are not approved clinicians (or doctors approved under section 12 of the Act).
5.7 Functions that can only be performed by an RC
If an AC is providing cover as described at 5.5 or 5.6 above to perform a function that can only be performed by the RC, for example to recall a CTO patient or to authorise S17 leave in an emergency, it is important to note that they are acting AS the RC and not acting on behalf of the RC.
5.8 Change of RC
As the needs of the patient may change over time, it is important that the appropriateness of the responsible clinician is kept under review throughout the care planning process. It may be appropriate for the patient’s responsible clinician to change during a period of care and treatment, if such a change enables the needs of the patient to be met more effectively.
If the patient requests a change their reasons should be established. In considering such a change it is also important to take account of the need for continuity and continuing engagement with, and knowledge of, the patient. The process for considering a patient’s request will be overseen by the appropriate associate medical director in the locality the patient is being treated within.
Where a patient’s treatment and rehabilitation require movement between different hospitals or to the community, successive responsible clinicians need to be identified in good time to enable movement to take place.
The existing responsible clinician is responsible for overseeing the patient’s progress through the system. If movement to another hospital is indicated, responsible clinicians should take the lead in identifying their successors.
When the RC is changed, it is the responsibility of the RC taking over care of the patient to record the change of RC. There is no need to change RC on SystmOne for short-term changes, for example, leave and sickness cover.
6 Training implications
6.1 Selection
The selection of an individual for AC training will be based on service need and identified within a business plan. There will be a clear identified need for the role of AC within the service, and the business plan will outline the expected utilisation of this role within the service. If there is an identified service need, this will be advertised internally to potential candidates.
The AC role is an addition to a professional’s current role within the service and does not replace it. However, staff identified as having the capability for future AC approval may be in a development role and following a pathway to gain the skills and knowledge necessary to work at the appropriate level for example, working toward consultant level in their current role. The achievement of the AC status will not automatically result in pay progression.
Individuals eligible to be considered for training are stipulated in the instructions with respect to the exercise of an approval function in relation to approved clinicians (2015), schedule 1. Candidates will be professionally qualified mental health professionals in one of the following groups:
- registered medical practitioners, including SAS doctors
- first level nurses whose field of practice is mental health or learning disabilities.
- registered occupational therapists
- psychologists registered in part 14 of the register maintained by the health and care professions council
- registered social workers
There are no official guidelines as to the standard of previous experience expected for individuals seeking to train as an AC (apart for medical staff). Approval as an AC requires individuals to demonstrate a range of competencies and have a comprehensive overall understanding of the role of the AC, including the specific role of the RC, as well as the legal responsibilities, functions and limitations of the RC role. The Instructions provide guidance at schedule 2 (see link at 9 below) as to the application, function, conditions of approval, professional requirements and relevant competencies.
Individuals wishing to apply for AC training or develop the skills necessary to work towards training as an AC, should discuss this with their supervisor in line with the trust appraisal process in order to identify areas of need. Development of skills does not guarantee selection for training and is not a guaranteed route for career progression.
Potential applicants will already have a strong grounding in the clinical and professional skills necessary for working within the identified environment. The level of professional experience necessary to be considered for training will likely include:
- significant post-qualification experience that enables them to demonstrate how they would maintain that professional identity whilst incorporating the AC responsibilities and tasks
- current employment within a senior clinical role and the necessary skills which accompany this role including:
- leadership skills and a clear understanding of how collective leadership would apply to them and the team in which they work
- management experience
- developing and maintaining appropriate professional relationships
- high level reflective skills
- complex decision-making skills
- evidence of continuing professional development
- clinical experience within the area in which the AC role will be implemented
For medical staff, there is an additional requirement that they must have a minimum of 5 years postgraduate experience in psychiatry and be section 12 approved for at least 12 months.
6.2 Training
All trainees must have a mentor identified prior to commencing training (and usually as part of the initial application process). The mentor will be an experienced AC, who is highly specialised within the area in which the trainee is expected to utilise their skills. The mentor is not required to be from the same professional background as the trainee. The mentor will advise and support the completion of the portfolio, identifying key learning needs, and a timeframe in which to complete the agreed learning.
The trust will ensure that the trainee has one session (half a day) per week for preparation of the portfolio, which would include shadowing opportunities, and preparation of reports. The trainee’s mentor will regularly review this with the respective governance leads. The trainee should inform their mentor and the governance leads at the earliest opportunity if they are not receiving appropriate time to complete the training.
The trainee is committed to completing all aspects of the training Set within the agreed timeframe. This includes attendance at a peer support groups. Specific training includes:
- attendance at a two day AC induction course
- for non-medical staff, completion of the postgraduate certificate in professional practice in law: mental health (alternatives can be considered by the governance leads)
- for medical staff, there is an additional requirement of having to complete section 12 approval training
They will also be expected to update the mental health legislation operational group at quarterly intervals of their progress and any barriers they need support with. It is the trainee’s responsibility to develop their portfolio over the time of the programme. The trainee will complete all aspects of their portfolio in order to demonstrate they meet the competences as outlined in the instructions with respect to the exercise of and approval function and the associated guidance Mental Health Act 2017 new roles. The NEAP panel provide a framework for completion of portfolios. They also run portfolio workshops and we would recommend people developing AC competencies to attend these. The trust would anticipate a two-year timeframe for the completion and submission of the portfolio, though this may be completed more quickly.
If the trainee is unable to complete the portfolio within the agreed timeframe, this must be brought to the attention of their mentor and to the relevant governance lead as soon as possible to discuss ongoing arrangements.
6.3 Approval process
Once the trainee has completed their portfolio and submitted to NEAP, the portfolio will undergo pre-panel scrutiny to ensure that all required evidence is present and sufficient. It may be returned to the applicant if it is not sufficiently robust and will only be sent to the Panel once it is of a suitable standard. NEAP will inform the candidate of the outcome in writing.
Psychologists have the option of submitting their portfolio to the British psychology society (BPS) ‘approved clinician peer review panel’ for review prior to submission to the approval panel. Peer review prior to submission is advised by the Department of Health however, this is not mandatory at present.
The approval panel will inform the trainee of the outcome and will add the trainee to the AC register. The trainee must inform the governance leads, mentor, supervisor, and line manager of the outcome. The trainee must have received approval from the approval panel before practicing as an AC. Approval lasts for five years (see section 6.6 for the re-approval process).
6.4 Implementation
Once added to the AC register, the newly qualified AC will meet with their relevant nominated lead to discuss ongoing arrangements regarding supervision, mentorship, application of the role, and continual professional development.
The AC will continue to be supported by a mentor for an agreed period of time following qualification, usually 1 year. There may be local arrangements, depending upon the needs of the service and, or individual, regarding the nature of the post in which the person is AC.
Following approval, the clinician is eligible to act as a responsible clinician (RC). Allocation of cases under the RC role is detailed under section 5 of this policy.
6.5 Supervision
All ACs will adhere to the relevant trust clinical supervision arrangements relevant to the role. Supervision, whether individually or in a peer group, will be by clinicians with relevant experience of the AC role. It is the responsibility of the AC to ensure that they are adhering to the supervision arrangements.
6.6 Monitoring, continuing professional development and re-approval
Approval is for a maximum of 5 years. ACs are required to apply for re-approval in a timely way to maintain registration as an AC within the trust. All ACs must maintain CPD activities in line with the standards of their professional regulating body. ACs will be responsible for ensuring that they continue to regularly attend appropriate care group and trust meetings and adhere to the ongoing training and development identified through the trust appraisal process.
NEAP will issue reminders to ACs when renewal of their status is approaching and at pre-set intervals and will maintain a record of all ACs via the DHSC national database. The AC will be responsible for maintaining their approval and the time-period for their re-approval and their manager will be responsible for ensuring that this has been undertaken. Update training and CPD is the responsibility of the AC. This will be identified and arranged on an individual basis in-line with the guidance for re-approval provided by NEAP. ACs are required to attend a one-day AC refresher course which must be within one year of their AC renewal date.
ACs will be responsible for maintaining evidence of their AC work throughout this period and applying for re-approval within the scheduled timeframe. A portfolio is not required. Following application for re-approval the AC must inform the relevant governance leads, mentor, supervisor, and line manager of the outcome.
All AC’s and RC’s will have approval via one of the national approvals panels, with subsequent ongoing approval via the NEAP Panel (North of England Approvals Panel) in order to undertake these duties. Approval is checked and monitored which has oversight through the MHL operational group.
6.7 Responsible and approved clinicians: allocation, selection and training policy
6.7.1 All MH and LD staff approved to train as an AC
- How often should this be undertaken: Approved clinician induction training course.
- Length of training: 2 days
- Delivery method: Face to face or virtual.
- Training delivered by: Relevant training provider.
- Where are the records of attendance held: ESR.
6.7.2 All MH and LD staff (desirable)
- How often should this be undertaken: Postgraduate certificate in professional practice in law: mental health or equivalent.
- Length of training: Variable
- Delivery method: Face to face or virtual.
- Training delivered by: Relevant training provider.
- Where are the records of attendance held: ESR.
6.7.3 AC refresher training
- How often should this be undertaken: Appropriate refresher courses, RC-PSYSCH register of courses (opens in new window).
- Length of training: Variable
- Delivery method: Face to face or virtual.
- Training delivered by: Relevant training provider.
- Where are the records of attendance held: ESR.
As a trust policy, all staff need to be aware of the key points that the policy covers. Staff can be made aware through a variety of means such as:
- all user emails for urgent messages
- one to one meetings or supervision
- continuous professional development sessions
- posters
- daily email (sent Monday to Friday)
- practice development days
- group supervision
- special meetings
- intranet
- team meetings
- local induction
7 Monitoring arrangements
As per section 6.6.
8 Equality impact assessment screening
To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.
8.1 Privacy, dignity and respect
The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.
Consequently, the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity, and respect, (when appropriate this should also include how same sex accommodation is provided).
8.1.1 Indicate how this will be met
No issues have been identified in relation to privacy, dignity, and respect.
8.2 Mental capacity act
Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individual’s capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.
Therefore, the trust is required to make sure that all colleagues working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason, all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005)to ensure that the rights of individual are protected, and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.
8.2.1 Indicate how this will be achieved
Not applicable.
9 Associated documents
All trust Mental Health Act policies.
10 References
- Department of Health (2015). Guidance for seeking approved clinician status via the portfolio route (opens in new window).
- National Institute for Mental Health in England (2007). Mental Health Act 2007 New roles.
- The British Psychological Society (2016). Guidance for registered psychologists in making applications to the BPS approved clinician peer review panel.
- The British Psychological Society (2017). Approved clinician frequently asked questions. British Psychological Society.
- NHS England (2008). Mental Health Act 1983 approved clinician (General) directions 2008.
Document control
- Version: 1.1.
- Unique reference number: 594.
- Ratified by: Mental health legislation operational group.
- Date ratified: 17 October 2023.
- Name of originator or author: MHA manager.
- Name of responsible individual: Executive medical director.
- Date issued: 13 November 2023 (amendment).
- Review date: April 2024.
- Target audience: All clinical staff.
Page last reviewed: April 30, 2024
Next review due: April 30, 2025