View from the ground, by Dr Zoe Norris
I have been musing about how we can get better at retaining staff in primary care; this has largely been because I have found myself as the clinical director of my local primary care network. Now that the dust has settled around filling in various forms, signing agreements, and working out the flow of funds, we have moved on to engagement. Talking to different staff has opened my eyes to the fact that we remain very doctor-centric when we think about work stress and burnout. Even our practice managers are lucky to get a look in when we start talking about clinician burnout and its hazards. But they are just as broken and at risk as we are—and losing a good practice manager is as destabilising to a practice as losing a GP.
We all know of course that primary care is a team effort, and that it is not just about GPs. But like most of us I suspect, because my day-to-day job isn’t running the practice or dealing with the demands on the front desk, I have a gap in my knowledge about the particular stresses that our colleagues face. There are enormous overlaps with stresses that we clinicians experience, but they have their unique challenges as well. Our practice managers spend their days advocating for us, trying to protect their clinicians who they know are a scarce resource. Our reception staff do the same, trying to listen to patients, but all the while knowing that we are often running ourselves ragged behind the scenes. I was struck by how protective they are of their GPs, and left feeling guilty that I’m not always sure we do the same for them.
Accepting that we can’t change the challenges and pressures of working in the NHS, what we do have in general practice is the ability to make small changes for our teams. I have always said that the NHS is a dreadful employer, with no understanding of basic good human resources (HR) practice. But one of the things that makes primary care brilliant is that we aren’t tied to the same massive HR disaster—we can, and should, do things differently.
Firstly, that probably means finding out what good HR looks like—not in terms of running an accurate payroll and rota, but in terms of making staff feel valued. Clinicians don’t get this covered in their training, and while we are good at being kind to patients, we are trained in a culture of superheroes—vulnerability is seen as weakness, and weakness is seen as failure. This may well be the most useful doctors’ educational needs (DEN) you’ve ever put on your appraisal—look into basic HR principles and how to make staff feel valued.
Think about some basics—if you’re the practice where every staff member has to bring in and label their own milk, that’s not a good start. If you’re the practice that doesn’t even have a whiff of a mince pie at Christmas time, also not good. Little gestures, like thank yous, showing respect, treating all staff courteously, and splashing out on some nice handwash for the staff toilets go a really long way.
Money is a tiny part of feeling like you matter at work, and giving positive feedback has the same effect (and is a lot cheaper). Making sure your work environment is as nice as it can be; ask about colleagues’ lives, so they feel valued as individuals and not just because of the job they do—all the things we feel acutely as junior doctors and complain about, but then work gets in the way and we forget we can do it in our practice and get it right. I’m sure people bring in cake or biscuits sometimes? Make it a regular thing, and maybe chuck some fruit in there as a bonus. Use the instant messaging system to tell someone why they did a good job. Offer to make reception a coffee. While we may feel that the government doesn’t appreciate the job we do in general practice, we need to make sure that we appreciate each other. Spend a few minutes this week thinking about how you can show that appreciation to your colleagues, and maybe we can all have a slightly happier, albeit over-stretched and under-resourced, primary care.