For over a year, NHS staff have been challenged by the response to COVID-19 on a scale and at a pace not previously seen. These pressures have, overall, brought out the best of NHS leaders and practice managers with compassionate and inclusive leadership behaviours coming to the fore.
Not least because it has been a particularly hard winter, with the usual winter pressures, the increased targets for Flu vaccine uptake, the roll out of the Covid Vaccine, the continuation of the Covid assessment hubs, and expectations of service delivery driving back to business as usual (adapting to new norms) and striving for business as usual, in very unusual circumstance.
While employee wellbeing has been moving up the NHS agenda, with the developments of the NHS People Plan and the NHS Health and wellbeing framework, the last 12 months have really demonstrated the importance of this being thrust to centre stage and remind us all how critical it is to look after the employees within the NHS, because at some stage we will have dialogue with them about our own care.
The GP Partners that continue to value their staff and treat them fairly, even under enormous pressure, are much more likely to retain the skills and people they need to bounce back once the crisis is over. As a new virus, it is still unclear how long the threat will last, and Practice managers have been working diligently through a plethora of cascaded documentation, ever changing operating procedures in a bid to ensure that they have business continuity to see practices through the many months and a continued period of disruption, at the same time as managing patients expectations in relation to a service provider which has adopted new service delivery models to facilitate patient care continuing in an alternative mode. It will be a crucial test of GP Partners agility and people support capability.
There have been many high priority considerations for practice managers in the last 12 months, which have added to their pre-existing workload, including but not limited to.
·Covid Guidelines, Localised SOPs
·Workplace Health and Safety
·Employee health and risks
·Hybrid working models.
· Management of Bereavement
· Long terms sick leave
· Managing Covid related leave (sickness, isolation, quarantine, shielding)
· Capacity management, in covering sickness absence, along with supporting the staffing other joint ventures such as Covid assessment hubs and Covid vaccine clinics.
· PCN developments, and ARRS role
· Service provisions
· Patient relations and communications.
According to the CIPD Health and Wellbeing at Work Survey 2021, conducted in partnership with simply health there has been an increase in the proportion of managers that buy into the importance of wellbeing (67% of those surveyed) although many (46% of those surveyed) lack formal strategy or approach and tend to manage workforce well-bring on an ad hoc basis. Covid-19 had prompted an increased focus on mental health, and 57% of employers that were surveyed are making strides in their commitment to their employees in this area.
Most NHS employer’s provider basic health promotions such as free eye tests, flu vaccines, links to advise for health eating/lifestyle though private health insurance, discounted vouchers for entrance to health and fitness facilities, and the provisions of counselling services. There are lots of options out there, though many examples of such services rarely reach the right people such as practice managers, whose role it is to continually monitor NHS staff well-being.
The most common triggers for staff reporting mental health in the workplace is stress at work, this is overwhelmingly related to workloads, followed by management styles and the new demands placed upon staff due to Covid-19. More staff are noting the effects of Covid-19 related anxiety (for example fear of contagion in the workplace or on the commute), other effects of Covid-19 related anxiety include personal factors such as personal illness and health concerns, or that of family members, and poor work life balance due to the volume and intensity of the work being carried out over the period of Covid-19.
In November 2020, mental health charity Mind revealed that more people had experienced a mental health crisis during the COVID-19 pandemic than ever previously recorded. Many people are experiencing a range of mental health issues, including stress, anxiety, depression, post-traumatic stress symptoms and burnout, and the effects are anticipated to be long-lasting for some.
This has a real impact on Practice Managers because they bring a sustained and motivated leadership quality and are the ones who are genuinely and extremely concerned for their practice staff well-being. This responsibly is likely to be apportioned to them on behalf of GP partners, to conduct staff engagement, to provider support and training, to implement systems and analyse the data, all in a bid to understand the problems effecting the practice staff and what solutions are to be implemented in a time/cost-effective manner.
There is a current workplace concern relating to the impact of Covid-19, 70% of managers reported signs of ‘Leaveism’ meaning they are allocating their time off such as annual leave and sick leave, to try to remain in control of their workloads. Only 28% of managers surveyed said they were confident in their knowledge and ability to manage staff with disabilities or long-term conditions and mental health, of which only 24% of managers confirmed they have received training on mental health at work, which is a likely reflection on the 39% of organisations who have a policy or process in place to support employees with mental health at work.
Many practice managers have conducted the workforce health risk assessments in the last 12 months, and many confess to having to revisit this with their staff owing to the impact of covid, not least if their staff have been symptomatic or been off on long term sick leave due to long covid, but also recognising the workplace stress, chronic stress and the pandemic fatigue which has set in.
In recent surveys conducted with practice managers during covid training sessions 75% of them noting that they wish to focus on stress management while 64% also cited they had to start to focus on self-protection. With a common theme arising when they describe the last 12 months in primary care as: demanding, challenging, overwhelming, exhausting, frustrating, pressured, fast paced, being everything to everyone, and undervalued.
When we consider the Trauma curve as utilised by professionals who work with patients who display symptoms of PTSD, is a tool that can help Practice Managers to visualise the journey taken both individually and collectively with colleagues. This trauma curve will have triggered stress at work for many NHS employees; Stress being state of mental or emotional strain resulting from adverse or demanding circumstances.
This trauma curve when compared to Maslow’s Hierarchy of Needs, gives insight to Practice Managers that their NHS staff have been looking to their leaders and their employers in ensuring that their psychological and safety needs are met as a priority, little focus in the last 12 months has been on sense of belonging, or self-actualisation/esteem.
Practice Managers are in a position whereby the demands they can cope with are superseded with the demand’s others place upon them, this can be consuming on both time and energy, with many being described as able or resilient because they can live tumultuously and learn from it or overcome it. Practice Managers present as the voice of reason or a process of positive adaption in a time of ambiguity or uncertainty.
It is important for Practice Managers to assess themselves against Yerkes-Dodson Law performance curve model, because if they are experiencing pandemic fatigue, chronic stress, or burnout they are likely to feel that the workload pressure has become too much and are likely to fall ill or leave.
Some closing tips to help Practice Managers with managing their own mental health as they continue to lead their teams through the restorative phase to business-as-usual primary care.
Key signs to look out for are:
· Lower productivity
· Change in personality.
· Lacking in energy
· Poor decision making
· Poor time keeping
· Increased sickness absence
Considerations for a Practice Manager:
· Who do you turn to when you are feeling unwell?
· Who supports you when you are feeling stressed, pressured, or overwhelmed?
Self Help tips
· Manage unrealistic expectations; it is ok to say NO at times.
· Manage your own expectations of yourself.
· Practice self-care and compassion and attend to your own needs.
· Get downtime form work, you are not paid to be on-call so switch off the phone and emails.
· Connect and network with your colleagues because they may prove invaluable in their support.
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