Remote working toolkit for general practices and primary care networks

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How to use this toolkit

Building effective teams in general practice is difficult. But building effective teams when members of the team are not working in the same location can be even more challenging. Remote working is on the increase – not least because the Covid-19 pandemic has meant that over the past year many general practice staff have found themselves working at home, or in a practice but needing to work at a distance from other members of the team. And the introduction of primary care network (PCN) roles that cover multiple practices means teams are not always physically located together. The rapid implementation of remote consulting tools provides the ability to work more flexibly and from different locations, but primary care leaders need to learn how to build effective teams in a different way.

In the summer of 2020, The King’s Fund was commissioned by the Department of Health and Social Care to look into staff experiences of remote working in general practice. Using this work, and our previous research into effective teams, we’ve developed this short digital guide for practice and PCN leaders to help them adopt practices and techniques to ensure that their teams work as well as possible, even if all the members of the team can’t be physically together in one place.

What are the fundamentals of an effective virtual team?

Professor Michael West suggests that there are three fundamentals to effective teams:

  • a small number of meaningful objectives
  • clear roles and responsibilities among team members
  • time to reflect on how the team is working together.

These fundamental elements are underpinned by trust between team members. Developing and maintaining that trust is an ongoing task for leaders. Evidence from a wide range of organisations and sectors that have built successful virtual teams found that teams need to:

  • create clear and transparent objectives, where team members understand how each member will contribute
  • understand and share the range of skills in the team
  • explicitly talk about how they should collaborate when working together
  • hold team-building sessions to create strong relationships and clarify roles 
  • be clear about the values of their team.

For those working in new roles funded under the PCN contract, there is a danger that being split across multiple practices can mean they are expected to become part of multiple teams. As such, creating meaningful objectives for the PCN as a whole, with clear roles and responsibilities and time to reflect on how the wider PCN team is working, will be very important. This helps to ensure that even if some staff can’t fully feel part of individual practice-level teams, they have support and a sense of identity through the greater PCN team.

How can teams communicate effectively while working remotely?

Clear, consistent communication is critical for effective teamworking. There are particular challenges to building good communication in remote teams as existing staff groups tend to communicate with each other rather than across the entire team. Our research also found that staff who work across multiple practices find this particularly hard as they can often be excluded from a practice’s main communication channels, such as WhatsApp groups.

However, our research found that many approaches can support good communication in virtual teams.

‘Rules’ for communicating

We've got about eight channels now. We've got our training on [our digital project site] for all our trainees, so they can access stuff from home. And then the nurses, they've got their own channel, and they're having remote Zoom meetings regularly, and then they're saving the minutes on MS [Microsoft] Teams.

GP partner
  • Teams can develop ‘rules’ for how they’ll communicate including:
    • which information to communicate (or not) and when, for example, avoiding ‘reply-all’ emails to prevent information overload
    • which communication tools might be used for different purposes
    • etiquette for electronic communication (such as only using all capitals or bold typeface for critically urgent messages)
    • being clear about expected timeframes for responding.
  • Team members might need to communicate things that might otherwise be obvious when people are working in the same location, for example, individual working-patterns and availability and how they prefer to receive information.

Better meetings

We’ve put things in place… that are really nice, like semi-regular… catch-ups where the whole team get together. And we never used to do that and it’s lovely to see the wider team and all the different GPs and team members from other sites chipping in.

GP partner
  • Meetings are a key tool for inclusive communication and there are a number of steps to make meetings more effective for virtual teams: 
    • be clear about why a meeting is important (for discussion) and avoid using meetings solely for disseminating information
    • share material and resources or collect input in advance
    • use the start of the meeting to check in and pay attention to the emotional connectedness and team-building needs of the group
    • ensure all team members are engaged, perhaps sharing agenda items between team members, using voting tools or breakout rooms
    • think about recording meetings so all colleagues can hear the discussion
    • use meetings to set routines and rhythms for the team that may get lost if many people are working remotely.

Quality conversations 

There’s a lot of high-expressed emotion around, but I think that’s partly because you haven’t got that cup-of-tea time together, you haven’t got those quick conversations that happen. So it has been quite difficult.
 

Advanced nurse practitioner
  • Some communication channels might make it difficult to convey meaning, leading to misunderstandings or unproductive discussions. For example, it can be hard to judge tone of voice or warmth or to interpret silence on a video call, and so team members need to make concerted efforts to check in with one another.
  • The lack of spontaneous, informal face-to-face communication is a particular challenge for people working remotely and yet it is critical to building trust. Find ways to create opportunities for ‘corridor conversations’, to share jokes, support and advice, which are key to building empathy, trust and morale. This might include virtual social events, virtual coffee breaks, or ‘care calls’ that do not have a work-related agenda, particularly between team members working in different locations.

Staff working from different locations can present new personal and professional challenges for everyone in the team. Compassionate, authentic, inclusive and adaptive leadership styles become even more important. Leading teams working in this way also requires leaders to develop new skillsets, particularly around managing complexity and coping with the lack of immediate oversight and control.

Some things to bear in mind while either leading remotely yourself or leading others while they work remotely are outlined below.

Be accessible and present

Nothing was imposed on us… [change] was through a discussion. And that helped at each stage of discussion, telling us, basically, ‘This is what the plan is, it's not a hard-bound rule, you input, everyone inputs’.
 

Social prescribing link worker
  • Take steps to be visible and accessible for your team. This should not be confused with being unnecessarily intrusive or micromanaging, which can undermine trust. Instead, it is about prioritising being seen and being there for staff.
  • Be open to delegation and decentralising leadership while also being clear on roles in the team. Leaders need to empower and support other staff to be leaders, and to allow staff to work more independently and provide support to each other. This reduces the pressure on formal leadership to be everywhere at once – an impossible ask for remote working.

Create a strong sense of team

  • Celebrate success: as team success is often less visible when staff don’t see each other in person, celebrating the accomplishments and contributions of the team and individuals within it is vital. As well as being good for morale, it offers important opportunities for building relationships and reinforcing trust in the competence of fellow team members.
  • Ensure a sense of being a ‘whole’ team, being aware that teams can fragment into groups based on roles, who you work with most often, or seniority. Leaders across the team need to ensure that a strong sense of the ‘whole team’ is preserved. 

It doesn't matter who you are, we will tell you, socially distanced now, that you're doing a good job… If I didn't do that, it doesn't matter what I write down on a piece of paper about transformation, and about remote working, no one's going to do it.

GP partner

I’ve seen the strong team become more cohesive, move forward, loads of fresh ideas…the [other] team [is] struggling, I think the cracks are getting deeper. 
 

Musculoskeletal practitioner

Take care of yourself and each other

The way we approach situations… it’s never sort of a telling off, it’s a ‘let’s help, let’s encourage, let’s solve problems if there are problems’.

GP partner
  • Keep in mind the personal circumstances of staff. Taking the time to understand the personal pressures on staff is a key component of leading remote teams as the line between home and work life blurs and caring responsibilities have an impact on the working day. This is reinforced further with the extra impact of the Covid-19 pandemic.
  • Take care of yourself both for your own sake and for setting an example to the rest of the team. With remote working making it easier for people to work beyond their contracted hours and for other aspects of wellbeing to slip, this becomes more essential than ever.

How do you effectively use technology for your team?

Effective technology is essential for remote working but so is ensuring the right culture and leadership to support it are in place. Introducing new technology without making the organisational and teamworking changes needed to use it properly sets the team up for inefficient working at best and conflict, tension and burnout at worst. Some of the considerations for effective use of technology by a general practice team include are listed below.

Have the right tools

  • Make sure that remote-working options and technology are available as equitably as possible across the whole team (for both clinical and non-clinical team members). Unequal access can lead to resentment and conflict. There are good reasons why it might not be possible to provide equal access – if so, make those reasons transparent.
  • Choose the best tools for the team and the practice. There are lots of different options for technology solutions to support remote working, often with different features and pros and cons. While it may be tempting to go with either the most sophisticated or cost-minimising options, what is often most important is picking the technology that is a best match for the culture and working style of the team to get the best out it.

Support staff to use the tools

  • Empower all staff to engage with rapid technological change. This means investing time in training and coaching them to use new technologies for remote working as not everybody starts from the same place. Similarly, it is important to sit down with team members and explicitly create processes and workflows for remote working that can ideally accommodate the preferences and skills of different staff.
  • Pay attention to data governance and security, keeping it as a live item on everyone’s agenda, and invest in secure technology and the training to use it.
  • Make the space and time for iteration and evolution. Implementing technology for remote working is an ongoing process and this needs to be appreciated – changing direction, trying new ways of working and different technology are part and parcel of the process. What’s important is making time for this exploration, not seeing a need to change as a failure, and taking active steps to build consensus and bring the team along with ongoing change.
  • Stay aware of the effect remote working has on the wellbeing of staff, both immediately and in the long term. This includes emotional challenges such as loneliness, the tendency of some staff to work long hours or have difficulty ‘switching off’, and practical problems such as musculoskeletal issues from poor working environments.

I actually spent a good few hours sitting down with a couple of admin staff, going through actual requests… Through that I think they were able to gain the confidence of knowing where they needed to send various consultations. Now we’ve got a… very, very good, very, very strong digitally able workforce within the admin team, who deal with a huge amount of stuff for us.

GP partner

I hadn't realised how not seeing another human being had been having a negative effect on me.

GP partner

How do you manage day-to-day support, training and development for remote working staff?

Working remotely adds an extra layer of complexity to day-to-day management, supervision and support. Getting this right is particularly important for staff new to the practice, staff in training and staff working in new roles. It requires managers to support individuals and teams to work to the best of their ability without close supervision, but also means being adaptable in how teams might measure and think about performance. There are some practical steps managers can take to support staff.

Connect the team

We're making the effort to make [a new role in the team] feel included, and I think it's a win/win isn't it really if you can find out what they can offer, and they can find out what you need?

GP partner
  • Use shared-access platforms (such as shared drives or a channel in Microsoft Teams) to update the wider team so that individual members can see the work that others are doing. This will help with connectivity and show fair allocation of work.
  • Help each member of the team to understand fully how their role contributes to the overall goals of the team, particularly those who are in new roles. Discussing this in team meetings and creating workflows that staff can easily visualise helps create a shared understanding of how each member contributes to the team’s goals.

Provide individual support and guidance

  • Focus on individual’s quality of work as opposed to the hours that they have worked.
  • Keep in regular communication and work on building trust and rapport with new staff.
  • Have check-ins at the start of each meeting or conversation, to help build trust and understanding and give staff the confidence to raise issues or concerns with you early on.
  • Use one-to-one meetings to learn more about new staff members and their particular circumstances and needs to help create a joint-working agreement that brings the best for them and for the wider team.
  • Ensure that, in addition to management support, clinical professionals can receive supervision and support from within their own specialty. Facilitating peer support with others in new roles or in training positions can create a safe space to discuss cases and their common experiences.

It was really about the output of what they were delivering for me. I had two or three people come back and say, ‘Well, I finished half an hour early’… and I thought that was really lovely. I said ‘Well that's really great, but that will happen when you're at home, because you are able to focus more, you don't have the phone calls from the patients and you're able to really, really concentrate on that piece of work’.  So I said, ‘Please, don't worry about that extra half hour.'

Practice manager

Be clear about boundaries and expectations

You’re thinking just five more minutes, just five more minutes, and that’s when it kind of spirals…you don’t realise the time at home.

Practice nurse
  • Be clear about when and how you can be approached as a supervisor. This is very important in clinical sessions, especially if there is an emergency or safety risk.
  • Provide clear boundaries and expectations on working hours and practices, to help recreate the physical separation between home and work. This can help to avoid overwork and burn-out if staff are at risk of working extended hours and struggle to switch off.

Further reading and disclaimer

The research underpinning this toolkit was funded by the NIHR Policy Research Programme (grant number NIHR200702) as part of the Partnership for Responsive Policy Analysis and Research (PREPARE), a collaboration between the University of York and The King’s Fund for fast-response analysis and review to inform the Department of Health and Social Care’s policy development. Views expressed and any errors are those of the authors only and not those of the NIHR or the Department of Health and Social Care.

See also

Comments

Valentino Moretti

Position
private out patient Clinic,
Organisation
CORE srl Buja UD Italy
Comment date
09 October 2021

How can you overcome "privacy" limitations ?
What are the rules in U.K. in regard to sending by email "sensitive data" ?

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