General practice is a challenging environment in which to work, particularly in the current financial climate. It is very likely that your practice team feels under more pressure now than it has at any time during the past few years. GPs and staff may be struggling to meet patient demand and staff pay rises are likely to be minimal. Morale could well be at an all-time low.
In these circumstances, what can GPs and managers do to mitigate the impact of forces outside their control, to support team members and lift their spirits?
In challenging times, leadership and communication are crucial to morale. Nothing will change or improve if those in positions of power stick there heads in the sand and take no action. You may feel powerless in the face of NHS organisational change, but you have influence over employed team members.
Start an in-house, multi-disciplinary group to look into morale in the practice. Devise a questionnaire, identify issues, consider all suggestions, take action and make it obvious you have done so via a notice board, newsletter and updates on the practice intranet. Resolving relatively small 'niggles' can sometimes make all the difference for certain team members.
High workload will almost certainly be identified as an issue, so look at ways of managing it. Tools from the (now defunct) NHS Institute for Innovation and Improvement’s ‘Productive General Practice’ programme are still available. These are based on ‘lean’ techniques for looking at how efficiently the practice works. At the very least, ensure that you delegate as much as possible and minimise review appointments.
Identify other high value priorities which benefit both patients and the primary care team and work on improving or developing them, to provide a positive focus. These might include an emphasis on boosting continuity of care, looking, in a structured way, at quality of care, training and development or boosting patient involvement. Clearly-defined (and realistic) goals are motivating.
As part of the planning process, identify organisational learning needs. Train staff so that they feel they are developing new skills and responsibilities. This will also give you a flexible workforce which feels valued and motivated, with members able to cover for each other and work interchangeably.
Improve internal interaction
Encourage the team to find time to have a coffee break together, or spend part of lunchtime together. Include yourself in this – ten minutes a day may reap rewards. Also plan social events and go to them. The impact of something simple like a ‘team bowling night’ is difficult to quantify, but anecdotal evidence shows it encourages bonding and improves teamworking.
Find ways of regaining the precious interactions that used to 'oil the practice cogs'. Resist the understandable temptation to enter the surgery in the morning, head straight to your room and spend the entire day there seeing patients or dealing with administration and referrals. This will involve taking positive action in terms of time management as there is no easy solution to increasing demand.
Consider your own behaviour and its potential impact on colleagues, particularly junior team members. If you are constantly moaning and realise you have turned into the archetypal ‘grumpy old man/woman’ you may be spreading negativity and contributing to the general low mood. Greeting a suggestion with ‘good grief, we tried that 25 years ago and it didn’t work then’ is unlikely to inspire people to come up with new ideas in future.
Those in a leadership position are under the spotlight and have a responsibility for team morale. If people feel put-upon or insecure in their jobs they may look for other opportunities elsewhere and the last thing you want is to lose good staff in difficult times.
Seek support or inspiration outside the practice
In order to feel less powerless, engage proactively with your primary care organisation (CCG, Board, CHP). Ensure somebody from the practice is involved in local decision-making and provides feedback to these organisations about problems you face. Know what is going on locally, from plans for federation to local trends in CQC inspections.
Without your contribution, decisions may be made which impact on you in negative ways. Keep staff informed about local developments and ensure they know they have a voice through you. Also get involved with the RCGP faculty or GP sub-committee locally; put yourself in the position of feeling that your voice is being listened to and you are contributing to (inevitable) change.
To inject some new positivity into practice life, look carefully for quality conferences to attend, make the time to go to them – even if this is difficult to achieve - and make the effort to share your learning and new ideas on your return. If you are a GP, consider developing a clinical interest and taking up a post outside the practice to stimulate you and balance practice-based activities; this should at least work out to be cost-effective so that there is no negative impact on practice colleagues.
Highlight the positives
Saying ‘the glass is half-full’ sounds trite and, perhaps, a little too optimistic. But positive developments are taking place, so flag these up at team meetings, rather than dwelling on negatives. For example, a package of support is being negotiated for practices hit by MPIG cuts. The crowds of protestors demanding the survival of local surgeries show just how strongly patients still value services provided by GPs.
In addition, the RCGP’s ‘Put Patients First’ campaign is putting pressure on the government to look again at the pressures faced by general practice. The recent GP Task Force report urged ministers to increase GP training numbers while decreasing hospital speciality training posts, to look at ways of encouraging experienced GPs back into practice and to promote general practice as a career choice. It also recommended that the GP workload survey should be re-commissioned. Meanwhile, the BMA is working on improving GP contracts.
For staff performing well in difficult times, there are non-monetary rewards that can be offered at no financial cost to the practice. Conversely, poor performance should be addressed. If it is ignored by the practice manager and GPs it will sap the energy and morale of even the most motivated team members. Staff require regular feedback about their effectiveness; support if they are not meeting standards expected; and warnings about what will happen if they fail to improve.