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Wednesday 26 October 2016
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Pulling together

Working in general practice has never been an easy option but during the last few years it has become even harder for everyone, from GPs to receptionists. What can practice managers do to strengthen their teams?

Many practice managers see it as part of their role to do what they can to keep up morale and sort out problems. But how do they go about this?

Jayne Tabor, an experienced practice manager and business partner, says: “There are quite a few morale issues around at the moment. Workload is going up and everyone one is hard pressed.

“As managers we try to do what we can in the practice. Communication is key – it is often the answer to everything. We understand both sides.”

Gary Hughes, a practice business manager in Bracknell, says it is important to have a supportive atmosphere within a practice and be open about the bad times as well as the good. He says practice managers need to have a ‘paternalistic’ role.

In some cases this will involve getting staff together for a social event. Many practice managers will look to something low cost and fun – a night out at the local pub, a quiz evening or a meal together, perhaps with the practice footing the bill as a ‘thank you’ to the staff. Even a meal together with everyone contributing a dish of food can make a difference. One practice ran a successful Ten pin bowling team.

A few practices will manage to organise something more ambitious – a fun day out to help the different members of the team bond together, perhaps held at the weekend to overcome the perennial issue of how to get staff members together and still provide a service to patients.

And some practices are going for the option of using outside experts to help teams bond over activities such as circus skills and art sessions – and helping get problems aired and problems addressed into the bargain.

There are a confusing array of ‘teambuilding’ activities on offer from professional providers – ranging from James Bond style treasure hunts, drumming workshops and even cocktail mixing. But many of the firms that operate in this area are not specialists and only a handful of operators offer an experience tailored to the particular needs and pressures of general practice, which may be very different to those of the normal corporate client.

So what is wrong with a ‘do it yourself’ option of social events? Nothing – and practice teams often do go out together. But meeting for a meal or a drink can’t be compulsory for staff if it is outside worktime and may not be something all of them choose to do. Where there are problems which involve specific members of staff, they may be the ones who choose not to attend an event.

And there is always a danger some staff members feel excluded by the activity chosen – a trip to the local steakhouse may leave vegetarians cold; the pub may not be the favourite option for those who don’t drink; and getting everyone to agree on an activity is mission impossible. Out of working hours events can be difficult for those with caring responsibilities or other commitments to attend. Getting GPs engaged is crucial to create the ‘we are all in it together’ spirit.

But, perhaps more importantly, these social events may not offer the opportunity to air problems in a neutral atmosphere – something many of those running teambuilding courses believe is vital if progress is to be made. “A social gathering can be great for people to get to know each other but probably won’t resolve specific issues within the practice,” points out David Harrison, who runs which has worked with a number of practices. 

He suggests practices should consider taking time out together, preferably away from the surgery. ‘It breaks the spell of the hurly burly of the day-to-day issues within the practice. The team can then come into the day with a fresh mind set and the distractions of a busy surgery can be put to one side.’

But if practices are paying for the input of a facilitator and a venue, they are likely to want to get their money’s worth. Key to achieving that is knowing what the objective of the session is – even if it is as simple as understanding each other’s views and problems.

Some facilitators will gather views in advance of the day, from both practice managers and GPs (who are likely to have taken the decision to employ them) and from other members of staff. This allows them to adjust the activities and guide discussions to ensure that the right issues are raised. Communication issues – particularly between different parts of the practice - tend to be high up on many practice’s agendas

All hierarchies disappear in many of these exercises: a GP may be no better at spinning plates than a receptionist and even the most senior member of staff may need the assistance of those around them to succeed. A hidden lesson is that communication is often key to working together.

One game Sheila Wells, who specialises in receptionist training and writes the blog, has encouraged groups to play is Chinese whispers – an effective way of showing the difficulties in passing accurate messages around a practice. Another focuses on non-verbal communication with teams having to sort themselves by age and birthday without speaking. 

Wells says such sessions can be particularly helpful with receptionists who often feel a little distant from the healthcare professionals within a practice but have a stressful frontline role. Mr Harrison agrees: “Sometimes it seems there can be very little understanding between the three groups – clinical team, admin team and receptionist team – about the demands and problems each face and I believe an essential part of an away day should address these issues.” But he stresses the fun factor is also essential.

Practicalities for practice managers can include getting the funding to put on an event. Although some practice managers may control a training budget, others will have to get the agreement of partners – who can be sceptical about the value of such exercises. Their support and active engagement in the exercise is crucial to its success and they normally have a veto on involvement. An outside venue and refreshments will add to the cost (although can sometimes be negotiated down). However, the greater part of the cost is likely to be locum cover for staff and GPs. An alternative might be looking at a day when the practice already closes for the afternoon and uses out-of-hours cover – although this might mean employing some staff for additional hours and it will make it harder to enforce attendance.

Sarah Day, a practice manager in Chesham, Buckinghamshire, was able to arrange a teambuilding day with Mr Harrison’s company using ‘headroom’ money from the clinical commissioning group. This enabled the practice to use a half day set aside for training, keeping a skeleton staff at the practice for the morning who then joined the others at lunchtime.

She says the day was very successful and the team left with pages of suggestions for improvements which could be made within the practice. She says that while generally these were not dealing with fundamental issues they were ones which concerned staff and where changes could be made to enhance the working environment.

The fun activities broke down barriers and meant that when it came to talking about issues in the practice, everyone was very relaxed and willing to say what they thought – including people who were often very quiet in other settings.  For example, one practical issue which came out was email access for receptionists – something which she had thought they did not want but they felt would be useful but had not raised back in the surgery.  “Most of the changes we have now implemented – and I have learnt how to juggle!” she says.

Mr Hughes welcomes the idea of away days but adds just a note of caution. Support for staff and keeping up morale is a continuous process not a one off, he says, and is about the ongoing culture of the practice. And practice management consultant Fiona Dalziel adds:  ‘One of the things that motivates people the most is feeling listened to and involved in decisions. It costs absolutely nothing for anyone to say thanks very much – you really helped.’