In this month’s HR clinic, Robyn Clark (aka JacksonR) and Susi O’Brien (HR Help advisor) explored how we as managers can support and improve the wellbeing of our teams, implement strategies to support staff and look after our own resilience.

Here is a summary of the questions we received, and the answers given.

Wellbeing seems like such a vague, wishy-washy term. How should practices know what to include within a wellbeing plan?

It does sound vague and it can sound wishy-washy, but employee wellbeing is actually really integral to running a successful organisation. Countless surveys have shown that pay is frequently not the highest motivator or key factor for employees when asked about what’s most important to them about their job. Regularly cited above pay is organisational culture, flexibility and relationships. So, it’s no surprise that pay reviews don’t often form a big part of wellbeing plans.

So, what sort of things would you include? Well, if you think people value flexibility, what’s your practice’s viewpoint on flexible working? And that might not mean just changing working patterns or reducing hours, but maybe remote working, TOIL and flexible working patterns, or even giving staff the opportunity to volunteer for a charity for a day or two a year.

What about pastoral support? Do you have regular 1:1s with your staff? Do they have appraisals? Are there team meetings? Do you offer a staff counselling service, or signpost staff to available resources like coaching or mindfulness? What about peer support? Do you have regular meetings across teams or roles where staff can share ideas and experiences with others doing the same job?

There are endless things you can include but they will be specific to your practice, to your staff and to the circumstances at the time – so the plan should be reviewed regularly. From my experience, if you feel like something’s a good idea to have in there, then go for it.

How do you measure someone’s wellbeing in a way that can be evidenced before and during the plan’s implementation?

NHSE love a concrete measure of performance, don’t they?! But it’s actually beneficial to you to know if your plans are working. So, this is where your staff survey comes in. If you carry out a survey before your plan is implemented, and then during and after, you can compare the results to see the impact. Best practice is to anonymise responses so you get a more honest response from your team.

There are other measures you can use as well. High sickness rates, low performance / output, high turnover – these can all be signs of a stressed, demoralised or unhappy workforce. Therefore, if you implement your plan and you see these stress levels reducing, there’s a good chance that the plan is helping!

Finally, you can get your whole team to carry out a stress risk assessment before making any changes. This isn’t only useful as a measure of success, but can also help you tap into the reasons for stress in the workplace and give you ideas about what you can do to tackle those issues.

Any tips on where to start with a wellbeing plan? I’m stuck!

Well, I think we’ve just given you some! Start with your baseline – only when you know what your starting point is will you know where to go next. You may even find out that you’re already doing everything you need to – which is great!

When you’ve discovered what the biggest bugbears are, you can start to formulate a plan to tackle them. And some ideas can be really simple – I’ve literally seen bringing in a water cooler completely change the atmosphere of a team! If nothing is forthcoming from the team, then consider what you think it would be nice to have, and then discuss your ideas with a wide range of different staff. Sometimes people need some inspiration and if you can demonstrate that you’ve acted on their feedback, that in itself can do wonders for wellbeing.

What about financial wellbeing? What can we realistically include under this heading given practice finances at the moment?

If you’re not in a position to be able to offer more money, then there’s not much you can do about it. But that doesn’t mean you have nothing to offer. What about an employee assistance programme? Some of these are really quite cheap to set up (a lot cheaper than blanket pay rises anyway!) and can offer staff free financial advice as part of their package. Are there other incentives or things you can offer instead – communicating about discount schemes for staff, setting up a noticeboard or WhatsApp group where staff can buy/sell/donate unwanted items to each other, things like that. We have lots of staff with young children in my practice and we arranged a social event one night in the surgery. The partners brought drinks and some nibbles and basically set up a “shop” of children’s clothes that were in good condition and had a clothes-swap event. The staff loved it; it saved some of them quite a bit of money and it also ticked our green agenda box for recycling!

We’re in a difficult position because we’re not getting more funding this year, whilst the rest of the NHS around us is, and sometimes we just have to be honest with staff and explain we wish we could do more. We can offer support and advice and understanding. We can also try harder to raise our collective voices about how general practice is funded and the impact this has on staff wellbeing and retention. A new contract is being developed next year and we need to do all we can to influence it.

I have a clinical member of staff who’s been off sick for two months with workplace stress. How can I help them get over this and back to work?

Well, you need to follow your sickness management policy – especially as this has now become a long-term sickness episode. I’d want to meet the staff member to discuss what aspects of work are contributing to the stress – if you don’t talk about it, you can’t do anything about it! Carry out a stress risk assessment with the employee as this can help you quantify the issues and put a plan in place to mitigate them going forward. I’d also be looking into what support they’re eligible for – NHS Practitioner Health is a good start, or the Looking After You Too Programme, as well as Occupational Health. Workplace stress is tricky but the worst thing you can do is ignore it as it won’t resolve and the absence will either get longer or lead to repeated absences if not addressed.

One of the biggest barriers to wellbeing in my team is the behaviour of partners who speak down to staff or just avoid engaging with them. As a practice manager, what can I do about this?

 Managing up is probably the hardest part of our jobs, isn’t it? How do you manage your boss and hope they won’t get mad at you and sack you! But it’s really important. I’m definitely one for calling things out when I see them, and it does take confidence but we PMs are a rare commodity, and partners will know how difficult it is to replace a good one – so I’d encourage you to rely on that and have an honest conversation. Call out the bad behaviour, but humanise it from the recipient’s perspective. Explain how it feels to be treated in this manner, and the impact it has on the team – turnover, poor performance, increased absence. All of these have an impact on service provision and financial performance – two things that partners should care about!

Another option is to try and get the partners to do a 360 appraisal. Sounds terrifying, doesn’t it? But it can work. I did this at my first practice and it was actually quite eye-opening for the partners. All feedback was anonymous, of course, and the partners were quite surprised to see how their behaviour can directly impact on the staff. One of the comments I remember well was about how every time a partner gives the patient what they want, just because it’s easier, the team feel they’re not being valued or backed up. That actually made a real difference to how the partners behaved towards staff as it made them realise they’re not the metaphorical punching bags – the front-of-house staff are.

One other good idea that I’ve used is to get the partners to spend some time shadowing the rest of the staff in their roles. Often the disparity comes from a lack of understanding or appreciation, and this approach can really help with that. I’ve had some of my partners shadowing reception staff and the impact has been really powerful.

I’d also try to encourage as much whole-practice interaction as possible. Breaks taken together, morning huddles to start the day, whole-team meetings. Getting them together as much as you can will only help to build relationships. And that can extend to social events too.

I’ve worked in practice for years and have never had any particular training on leadership like the QOF module mentions. Do you think it really makes a difference in the real world?

 Yes! Firstly, you don’t know what you don’t know, and secondly, it never hurts to learn something new. There’s a difference between being a leader and a manager, and unfortunately the majority of our job gets taken up with managing things and not being able to lead on them. Good-quality leadership training not only enables you to learn what kind of leader you are, but it can teach you the skills you need to adopt the leader role. Leadership training encourages you to be introspective as well – and we rarely get the opportunity as managers to stop and think about how we work, how we want to work or how we come across to others. Any opportunity for self-analysis and self-improvement is a good idea in my view!

We have a member of the team whose wellbeing is really poor, but it seems to be down to personal and family factors rather than work ones – such as problems with their partner who sounds potentially quite controlling. I don’t think there’s anything I can do as a manager about that, is there?

That’s a tricky one as there isn’t much we can do in terms of people’s personal lives. But you can offer some pastoral support here – let her know you have an open door policy, there’s no judgement if she talks to you, and if you see an opportunity to try and signpost her to some help then that’s okay. Just be careful you don’t overstep your boundaries – if the employee doesn’t want to engage with you then don’t force it. All you can do is show them you’re there for them if needed.

Do you have any experience of encouraging peer networking across practices in a way that really works?

I do! In our PCN we have specific meetings just for the practice managers on the board, any deputies and the PCN manager, enabling them to get together every other month. We use the meetings to talk about how we’re actually going to do all the stuff we’re meant to do, but also to share frustrations or examples of good practice and to learn from each other. Sometimes we just like to have a collective moan about the state of things! But it all helps.

We have similar meetings for our advanced practitioners and pharmacists so they have a chance to share experiences too. I know we’re super pressured in terms of our day-to-day duties and offering patients appointments, but we’re not a limitless service, and sometimes we have to block time out for these activities – especially if it helps to improve practice, but also to give staff some respite and support.

Who looks after the wellbeing of us practice managers?

A very important point! As I mentioned earlier, we spend a lot of time managing up as well as down, but who’s managing us? Ideally, it should be your partners. They retain overall responsibility for your health and safety, and stress does fall under the health and safety umbrella. I’d encourage all of you to speak openly with your partners if you’re struggling, and you can also seek support for yourself.

As I’ve mentioned, it’s a really isolating job so setting up a peer support network is extremely useful, whether that’s just in your PCN or a wider footprint – we have a locality-based group in my area which I chair. We control the agenda; we only invite people to attend who we want to hear from and we spend a good section of the meeting just having an open Q&A session or a discussion on a particular topic that we’re all dealing with.

There are external resources you can access as well – the Looking After programme from NHSE is quite good and not only covers how to look after yourself but also your team and your career, so I’d recommend tapping into those resources. I’ve found the support on the Practice Index forum and various Facebook groups is also helpful. And, of course, if you’re an IGPM member who’s struggling, you can contact your regional rep for advice and support.

The other thing I’d highly recommend ensuring you’re doing is delegating – we cannot do it all. And we have a tendency as professionals to think we have to, but we really don’t! If you’re already thinking how am I going to implement this wellbeing initiative with all the other stuff I have to do, why not get someone else to lead on it? See it as a developmental opportunity for someone else in your team. If they’ve got more capacity and more energy, there’s a chance they might make it even more successful, rather than getting someone who’s already overloaded and exhausted to take it forwards.

As leaders, we have to remember that we have people looking up to us, so it’s super important that our wellbeing is also looked after.

It would be great if we could have an example of a staff survey to use as a starting point?

I do love a good template! Well, some good news is that the NHS Staff Survey – which is currently mostly used by acute trusts and larger NHS-funded organisations – is finally being extended to general practice later this year, in the autumn. This survey is already rolled out on a massive scale and the information that comes back to the employing organisation is really useful in helping to understand what’s going on in the workforce. Responses are completely anonymous (the results can be split into employing organisation but that’s as far as it gets), so staff can feel more able to respond truthfully. Reports are provided to the employing organisation about the data and it can then be used year after year to track progress.

Practice Index Plus also has a template you can play around with – the link is below.

I am new to the PM role, is there any type of funding that can help towards staff wellbeing?

Not nationally. This would be something to investigate locally – speak to your ICB, LMC, Training Hub, GP Federations, if you have them. You could also consider your local authority to see if there’s any grant money available as well.

Ideas of questions that will promote positivity rather than negative responses that 9 out of 10 times are down to staff pay?

The NHS Staff Survey has set questions, so if you go down that route then you have no input regarding what gets asked.

If you’re looking to do your own survey, though, think about how you frame the question and what you want to know. You can get staff to start thinking positively at the beginning of the survey by asking them what they do like or what does work well. You can then ask questions like “How do you think we can improve on XYZ?” and try to look for positive ideas rather than providing the space to have a moan.

However, you shouldn’t really be doing a survey with the aim of getting a specific response. You want staff to be honest – if the only thing that’s wrong is pay, then surely that just shows you’re doing everything else right?

My opinion about the whole pay discussion is just to be honest and transparent. General practice is not funded like the rest of the NHS and we’re in the last year of a five-year contract which doesn’t allow for additional funding above a certain level. We’re unhappy about it – we all are! Various bodies are trying to negotiate on our behalf for the next contract so that things can be better. And if staff want to get involved, encourage them to lobby their MPs as well. Pay might be less good but we do offer staff access to what is arguably one of the best pensions in the world – so that’s a positive to highlight. And the other benefits – NHS discounts, not having to work evenings and weekends and bank holidays. Just try to highlight the positives.

How can you avoid burnout whilst also looking after the people around you?

 We’ve covered this slightly in the question about who’s looking after us managers, but I think this needs to be applied more widely to all staff with any kind of managerial or pastoral role. We can’t be all things to all people, and it’s really important to make sure we’re looking after ourselves as well. We need to be number one, because if we can’t look after ourselves, how can we look after anyone else?

Therefore, make sure your time away from work is really AWAY from work. It can be tempting to, but DO NOT have your emails on your phone. Mute your WhatsApp messages. Make sure your staff know that there are boundaries that should not be crossed! And when you’re away from work, do your best to fill your time with things that you’ll enjoy, that will refresh your energy levels and bring you joy. It sounds super cheesy, but it’s really important.

As managers, we often feel we have to take on other people’s problems but we really don’t – we listen, we empathise and we make suggestions. If you find it hard to distance yourself from those issues, you need to find a way to work on this. That might be through coaching, or counselling, or even just offloading to a loved one – while maintaining confidentiality, of course. You should also try and encourage staff to take ownership of their problems and be proactive in seeking solutions to them. Those personality exercises can really help with this, if just being a sounding board isn’t your cup of tea. I’m a very action-oriented type of person and I’ve made my staff aware of this. If they just want a moan but want nothing to change then I’m not the person to come and speak to – because if you give me a problem, I want to solve it. I’m like Vanilla Ice. And I’ve explained that I find “just a moan” to be really frustrating and have asked them to accept that. That’s my personality, that’s who I am. And it has worked!

One thing I find really helpful is to schedule that pastoral time into regular 1:1s. We all know how a corridor conversation can start at two minutes and then become an hour. Encourage your staff to save their issues up for their 1:1 so you can prepare for it. If you know it’s coming, you can get yourself into the right frame of mind. And you’re in an environment that’s aiming to be supportive.

And finally, to reiterate, find your tribe! Peer support is super important – not many other people understand what we do, so when you find them, stick together and help and support each other as much as possible.

How to deal with someone who doesn’t delegate easily?

This is tough, and I’m sure many of us have an element of the control freak in us that struggles to let certain things go. However, we’re all good people and we want to encourage and develop our staff, so I’d play to that. Encourage them to delegate as a form of developing their own team – by holding onto everything themselves, they could be preventing someone else from flourishing! And reinforce the need to look after their own wellbeing and resilience – becoming overloaded isn’t going to help anyone.

 What about the QOF module? What do we need to do?

I think most of us will find we’re being taught to suck eggs a bit here and are already doing most of what is “required”. Looking at the guidance document, basically we need to do a staff survey, if we haven’t done one already, to get some baseline information, to ensure we have a flexible working policy in place, to review our main reasons for absence and if excessive, consider an action plan, to identify what support staff have access to (and this might not be like an employee assistance programme or occupational health, it could just be 1:1s, appraisals, team meetings and an open door policy!), and what your induction programme for newbies looks like.

You then need to complete an improvement plan and implement it. And this is the bit that gets me, as I’m sure there are hundreds of practices out there doing this work really well already, and it’s part of the culture and your staff survey results don’t show anything that needs addressing. So, your improvement plan could just be to keep calm and carry on! The staff survey will be the best approach here as any suggestions for improvement will probably come out of it – so I’d be looking to that to help inform whatever plan you put in place.

Is there a template wellbeing plan on Practice Index?

The Health and Wellbeing Policy [PLUS] should contain the information required.

It would be good to get some positive stories about how people have improved staff wellbeing in practices. Can we have a bit of a sharing session?

This is a great idea!

In my practice, we merged the majority of our regular meetings into a quarterly training afternoon. So once every three months, we close the surgery for the afternoon and get everyone together. We put lunch on for the staff and encourage everyone to have lunch together, before going into the body of the meeting. During each meeting, we try to do something that’s aimed at all staff and focuses on something positive – so we’ve done a personality type exercise as a group, which everyone found really interesting, and we’ve done a session aimed at helping to develop our next year’s strategy – i.e., asking for ideas on what services or improvements we can make. The impact is great; the team members get to build relationships with each other. We always try to do something fun and it’s nice to have the phones off! We also found that we were actually saving appointments by having a regular closure rather than lots of different meetings dotted around the place with appointments being blocked out.

So, let’s open it up to the room – has anyone got any good ideas they want to share?

Here are some of the ideas that were shared in the session:

• A GP who has an interest in it runs mindfulness meditation sessions for staff. Flexi Fridays where our fitness-focused receptionists do a stretching session.
• We have a gardening group (we fund the pots, plants, etc.) which staff can participate in during their lunch or break times.
• Bacon butties every week.
• We take part in the Better Health at Work awards and have a group of health advocates who run wellbeing campaigns.
• If a staff member’s birthday falls on a working day, we let them have it off without affecting their holiday hours.
• I have a quarterly benefits sheet where I share the top discounts on Blue Light Cards.
• An ice-cream van visit during the hot months.
• Kebabs during monthly meetings.
• We celebrate long service awards like completing 20 years, 30 years… We offer free lunch on Tuesdays, Thursdays and Fridays.
• Plants in the offices and staffrooms, but not in patient areas.
• We’re about to start a fitness/healthy challenge board. Staff will be split into teams and they’ll have to try and do something that isn’t usual for them which will benefit their own health and also the environment. This could be walking to work one day a week, not taking the lift every time they go up a flight of stairs. The winning team will receive an award.
• We provided new chairs for all staff, which has made a massive difference.
• Seek advice from your local councils; they sometimes have pots of money for the community and you can wing it that helping staff will help the patients!
• The Headspace app is free to NHS staff. (Robyn also recommends the Calm app which can help with meditation and poor sleep.)

Useful links 

Health and wellbeing policy [PLUS]
Patient and staff surveys policy [PLUS]
Sickness absence management policy [PLUS]
Absence – Sickness absence policy (reporting procedures and rules) [PLUS]
Performance appraisal policy [PLUS]
360-degree appraisal feedback form [PLUS]
Mental Health in the Workplace (free eLearning course) [HUB]
Managing Yourself (GPFV) (Free eLearning course) [HUB]
Practice Index Podcast – Staff wellbeing and retention