This site is intended for health professionals only
Saturday 22 October 2016
Share |

Bad news

General practice is never far from the headlines and the news is rarely good. In the face of this media glare it’s important to keep moral high and stress levels low

Whether it is the newspapers, TV or social media you cannot escape being told how the NHS is on its knees, crumbling or generally finished! For those of us working in the health service this can be very unsettling but at least we have some insight into what is going on and why. But what about the average patient, who reads the morning paper, watches News at Ten before going to bed, and listens to the misinformation and speculation in the pub on a Friday night? Spare a thought for how he/she must be trying to make sense of all of this based on little more than a few brushes with the GP practice and the odd outpatient appointment.
Despite all the media coverage the health service receives, people do not understand the workings of the NHS and, for most of the population, general practice is an even bigger mystery. People are astonished to learn that the practice’s IT doesn’t speak to the hospital’s system, that the GPs regularly work 12-hour days (and more) and they have no notion of what it is like to man a reception phone when there are no appointments for a week.
So how should practice managers deal with patients’ anxieties in relation to the constant doom and gloom about the NHS? Are you just reactively responding to questions as these come up or are you taking a more proactive approach, anticipating what the main issues will be and tackling these head on before they arise?

Working with patients
Better informed patients are far more likely to be sympathetic to any challenges the practice might be facing and more prepared to be supportive and understanding. There are many ways to communicate with patients. Noticeboards, newsletters and/or TV screens in the waiting room are ideal places to provide an update on the recruitment of that new GP or the reason why the podiatry service is being transferred to a city centre site (perhaps making it clear that this is not the practice’s doing). Practice websites can do all of this too – and at any time of the day or night, whether the practice is open or closed.
Lots of practices have established patient participation groups (PPGs). These patient representatives are a great positive resource – whether this is as a test bed for considering new ways of working that will save nurse and doctor time, eg, a telephone triage system, a blood pressure pod in the reception area or just to enlist their help to champion the practice’s services. If you are honest and can explain what the practice is trying to do and the reasons for this, your willingness to work with the local residents will be rewarded with trust and, importantly, loyalty. It might just make life a little easier for the reception staff on the front desk too.

Looking after the team
Talking of the practice team – how are they? Is everyone – receptionists, IT manager, data input clerks, the assistant practice manager and secretaries – coping with their individual workloads? Are they looking after each other, helping one another out? Is the atmosphere as friendly as usual or have there been a few more niggles of late?
Now, more than ever before, you must be alert to signs of staff feeling overloaded with work or demoralised by the media’s outpourings. Be ready to pick up on these immediately – sorting out as much you are able to, in a professional and compassionate way.
Perhaps it is time for a bit of team building. There’s no need to panic! Fundraising for local charities such as, sponsored walks, afternoon teas and raffles are great ways to boost morale and are (almost) free. Planning for such events can help to raise spirits and give everyone an alternative focus. Why not involve patients in these events too, asking for donations, sponsoring staff or even taking part.
You also need to keep an eye on the GPs and nurses – are they looking more stressed  than last week? Does anyone seem unreasonably irritable, a bit too quiet, maybe uncharacteristically moody or suddenly indecisive? Are there increased levels of absence or has punctuality become an issue for someone? Are you able to intervene, would a friendly, empathetic ear help – whether this is from you, a colleague or a peer support group? If you suspect that it is more serious than that, eg, self medicating in order to deal with workload, you must take action and report this, no matter how much you would prefer not to as your responsibility is to the team – and the patients.
And what about you – are you looking after yourself? Are you eating sensibly, do you take lunch breaks, are you sleeping well? I bet you rarely go home on time.
Please do not neglect yourself – you are the last person the practice can afford to have falter. Treat yourself – book a massage, see the latest film, go to a concert.
This applies to your local practice manager colleagues too. Attendance at practice manager (PM) meetings is dropping off everywhere, as managers find it increasingly difficult to justify a couple of hours out of the practice. But maybe this is exactly what everyone needs – a bit of thinking time, peer support and a chance to check that everyone is okay. Perhaps a quick call to a PM you haven’t seen for a while might be a good idea.

When things are really bad
If the practice is coming apart at the seams, make the earliest possible contact with your local area teams and clinical commissioning groups (CCGs) or, in Scotland, the local primary care contracting organisation and/or local health and social care partnership. In my experience, they will do their utmost to help.
If jobs are to be lost, staff have a legal right to be told and you have a moral responsibility to tell them. Conversations should cover the reasons for the redundancy and any alternative work that might be available. It is vital that you prepare for these meetings, to be certain of what you are legally required to do, to plan what you will say, to be au fait with the practice’s policies, and able to remain professional and in control throughout while affording the employee(s) dignity and respect.
Member(s) of staff should be offered advice, access to counselling and relevant information thereafter and up to the date the employment ends. Timelines will vary depending on the number of employees to be made redundant. Managing redundancy is difficult and upsetting for everyone involved; websites such as the Advisory, Conciliation and Arbitration (ACAS) and GOV.UK  are helpful and informative but is always advisable to seek specialist legal advice.
I am not sure that anyone really knows what will happen next but I do know that there are lots of us not ready to give up on the NHS just yet. We know we need to change the ways we work, our culture and yes, sometimes our attitude. But we do not need to make it any more difficult than it already is by alienating those most likely to help us – the public, the patients on our individual practice lists and our committed and hard working teams. Do the right thing – be honest, explain what is happening, accept any help you are offered, in whatever form and from whom ever, and see off those doom-mongers.

Anne Crandles, freelance practice management consultant in Edinburgh.

1 Health and Safety Executive.
Work related stress. (accessed 11 August).
2 ACAS. Redundancy. (accessed 12 August).
3 GOV.UK.  Redundancy – Your rights. (accessed 12 August).