A key plank of the government’s manifesto commitment to deliver 50 million more appointments in general practice is providing funding towards the cost of 26,000 new clinical roles. From pharmacists and physiotherapists to mental health practitioners and paramedics, these new roles will extend the workforce in primary care networks (PCN) and help to turn general practice into a truly team sport.
Our research and leadership development work with primary care networks across England suggests that major challenges are emerging in both recruiting and retaining these new clinical staff. There is a risk not only that the government’s commitment will not be achieved, but also that investment will potentially go unspent and patients will not benefit from improved access and quality of care.
'Building effective teams is really challenging at the best of times but building teams when members of the team are not working in the same location is even more complex.'
There are a number of reasons for this, some related to supply — shortages in particular roles and difficulties in recruitment in some areas, particularly more deprived areas. But there are also issues about how the roles are being implemented within PCNs which are affecting the ability to retain staff in these roles and which risk undermining the investment.
Fundamentally there is often a lack of clarity and shared understanding across PCNs about what these new roles can offer and how they might be embedded into existing teams. The National Association of Link Workers has previously reported on the difficulties experienced in embedding these roles in general practice and in our research we have found that remote working in response to the pandemic had exacerbated those issues.
Building effective teams is really challenging at the best of times but building teams when members of the team are not working in the same location is even more complex. Staff working in these new roles generally have their time split across the different practices within a network which can leave them feeling part of no team at all.
'At the heart of all of this lies the need for each primary care network to have a cohesive vision and a sense of team and team purpose shared across the whole network, not just within individual practices'
During the Covid-19 pandemic, many teams in all kinds of industries have found themselves working remotely from each other, and learning from these experiences should help to inform how to develop inclusive teams so that these new roles might be supported better. In the summer of 2020, The King’s Fund was commissioned by the Department of Health and Social Care to research staff experiences of remote working in general practice. We found that while there were benefits to remote working, such as increased flexibility and the ability to more easily participate in off-site meetings, staff reported feeling isolated from peers and sometimes found it challenging to access appropriate professional support when working remotely from each other. A striking finding from our interviews, particularly but not exclusively from those in larger practices, was the tendency for professional groups to form (or sometimes reinforce) siloes with insufficient communication as a whole general practice or PCN team. This can leave staff in network-wide roles even more isolated, and without attention this will continue to be an issue after the pandemic.
I think that at the heart of all of this lies the need for each primary care network to have a cohesive vision and a sense of team and team purpose shared across the whole network, not just within individual practices. I have heard from many network staff that working together on delivering the local vaccination programmes has been incredibly helpful for developing this sense of team —those in new roles and existing staff have been deployed to work together towards a common goal, and have had the opportunity to get to know each other and to build trust. Capitalising on that is now critical, but PCNs will likely need access to expert support to do this. General practices don’t have easy access to the kind of organisational development support that would be available to an NHS trust trying to introduce new staff roles and ways of working and are often left to try to work it out for themselves. With an increase in network and remote working, primary care leaders need support to build effective teams if the benefits of these new roles are to be realised.