The non‐professionally affiliated (NPA) worker as co‐producer of public services: how is the role experienced in UK mental health services?

• DOI: http://doi.org/10.1111/irj.12211
• Date: 01 May 2018
• Published date: 01 May 2018

The non-professionally affiliated (NPA)

worker as co-producer of public services:

how is the role experienced in UK mental

health services?

Stephen Procter, Deborah Harrison,

Pauline Pearson and Claire Dickinson

ABSTRACT

Recent workforce reforms have led to the widespread expansion of non-professionally

affiliated (NPA) support and assistant roles within UK public services. Research into

these roles has been confined to a limited range of settings, with a focus on the conse-

quence of change for professional workers. This article explores the emergence of ‘co-

production’, whereby NPA workers contribute alongside the professional in a distinct,

complementary way. Findings are drawn from semi-structured interviews with front-

line workers and managers within the context of mental health workforce reform.

The results build a picture of NPA working life characterised in part by autonomy

and responsibility. At the same time, NPA workers rely on colleagues for support

and are subject to being used indirectly by professionals. Contextual influences are

considered. The conceptual implications of the analysis are brought out, both for the

NPA role itself and for the broader issues involved in front line service work.

1 INTRODUCTION

Over the last two decades, UK public services have undergone an intensive period of

workforce restructuring, in response to the challenges posed by budget cuts, staff

shortages, increasing service demand and rising costs of care. Policy changes initiated

under the ‘modernisation’agenda of the New Labour governments of 1997–2010, and

continued under successive governments, have triggered widespread reform across

sectors including health, social care, education and the police force (Bach and

Kessler, 2012; Department of Health, 2000; International Council of Nurses, 2004;

McKenna et al., 2007; World Health Organisation, 2010).

The introduction and expansion of non-professionally affiliated (NPA) roles have

proved crucial to public service redesign (Davies, 2003; Nancarrow, 2004; Nancarrow

and Borthwick, 2005). The accompanying policy discussion highlights the opportu-

nity these roles provide to make better use of professionally qualified workers, while

❒Stephen Procter, Alcan Chair of Management, Newcastle University Business School, UK; Deborah

Harrison, North East Child Poverty Commission, Durham University Business School, UK; Pauline

Pearson, Professor of Nursing, Northumbria University, UK and Claire Dickinson, Trainee Clinical

Psychologist, Teesside University, UK. Correspondence should be addressed to Stephen Procter, Alcan

Chair of Management, Newcastle University Business School, UK; email: stephen.procter@newcastle.ac.uk

Industrial Relations Journal 49:3, 211–226

ISSN 0019-8692

© 2018 Brian Towers (BRITOW) and John Wiley & Sons Ltd

at the same time addressing staff shortages and aiding the ‘drive for better value’(De-

partment of Health, 2007: 82). These formerly ‘invisible workers’(Thornley, 1997)

have been raised to a new position of academic, policy and public interest.

The subject of this article is a particular type of NPA worker, one whose work is not

intended directly to ‘assist’or ‘support’the work of their professional colleagues, but

who operates in parallel with existing professional roles, most often with a client or ser-

vice user group as their main focus. Following Kessler et al. (2007), we call this type of

worker a ‘co-producer’. There are a number of reasons why we have these workers as

our focus. First, in picking up on Kessler’s and others’work in this area, we find that

the co-producer is the most underdeveloped of the basic types of NPA worker that they

identify. Second, this relative neglect is despite the co-producer role being a major con-

cern of government policy, which has resulted in significant growth in their numbers.

Third, the nature of the role means that there are number of important issues around

the work relationship between NPA workers and their professional colleagues.

Fourth, the client-facing nature of the role also means that NPA co-producers can

be seen as being part of the more general category of front line service workers, a group

of great interest in current debates in the study of work and employment.

It is against this background that we consider three main research questions. First,

using Kessler et al.’s work as an initial framework, how do the NPA workers experi-

ence their role as co-producers? In particular, how in practice do they experience their

relationships with professional and other colleagues? Second, what contextual factors

might be important in understanding how the co-production role is experienced? And

third, how might study of these workers contribute to the development of understand-

ing of front line service work?

Drawing on an interview-based study of NPA workers in UK mentalhealth services,

this article is structured as follows. Followingthis introduction, the article examines the

conceptual background against whichour empirical findings need to be considered.The

methods and thesetting used in the empirical researchare then set out. In the fourth sec-

tion of the article, the findings, the NPA workers areshown to be experiencing a certain

degree of separation from their co-workers. The study also reveals, however, the devel-

opment of important points of contact with other groups of workers. The contextual

factors that appear to shape the form taken by the co-producer role are also identified.

In the article’sfinal section, the wider implications of this analysis are examined.

2 CONCEPTUAL BACKGROUND

2.1 NPA workers and the sociology of the professions

In order to provide the conceptual background for this article’sfirst research question

—how do the NPA workers experience their role as co-producers, and in particular,

how in practice do they experience their relationships with professional and other col-

leagues?—we start by considering how discussion of the NPA workforce emerged ini-

tially within the sociology of the professions. Abbott’s (1988) The System of

Professions placed particular emphasis on how occupational groups interact and com-

pete with each other to strengthen their scope of practice—or ‘jurisdiction’—in order

to protect and, if possible, enhance their position within the occupational hierarchy.

Abbott (1988) suggested that NPA roles are created by the professions as a form of

boundary work to help defend professional jurisdiction. Later termed a ‘vertical sub-

stitution strategy’by Nancarrow and Borthwick (2005), the creation of subordinate

© 2018 Brian Towers (BRITOW) and John Wiley & Sons Ltd

212 Stephen Procter et al.