One legacy from the pandemic is the emerging trauma and moral injury experienced by colleagues alongside those who, in the course of their work, have been left with the debilitating symptoms of long covid. We know anecdotally that this has led to many people leaving their professions as they can no longer give the treatment and care to the standard they have previously delivered.
We acknowledge that following the pandemic wellbeing has been brought into sharper focus and rightly so. Many organisations have pledged a commitment towards a healthy happy workforce by independently offering a suite of resources.
The issue is that wellbeing isn’t seen as “business as usual” everywhere. We have started to understand what it is we need to do but we’re probably only really scratching the surface in terms of putting meaningful and effective interventions in place.
We know that many PCNs, for example, are operating under enormous strain and struggling to invest in providing time for breaks, a supportive and caring culture and normalising a focus on the importance of wellbeing and the tools that support it. Many of them are experiencing significant challenges with retention and recruitment of GPs and other staff to enable them to have adequate time for patient care. The result is colleagues having to work extra-long days and poorer patient satisfaction.
A major challenge for promoting wellbeing in healthcare is that any provision by commissioners can come across as well-meaning solutions with a perceived lack of understanding about the realities of the chronic problems of demand outstripping supply with underfunding and under-resourcing. This can serve to reinforce a feeling of being done unto, driven by tick box incentives without addressing the underlying causes of the problem and invariably results in primary care colleagues feeling undervalued.
At a time where there is a difficult dichotomy around the importance of wellbeing, we are seeing a slight shift towards an understanding of its importance but at this time there is no allocated budget which leaves organisations with the issue of what and how to put something in place to give practical support.
Dr Rachel Morris – a former GP who hosts the You Are Not a Frog podcast and curates the ‘Work Well Webinars’ evening webinars for staff in primary care - has noticed that many teams in General Practice still haven’t got the basics of wellbeing right (for example, taking regular breaks, connecting with each other and being active). When GPs are asked what the biggest barrier to self-care is, the answers invariably include lack of time due to demand, excessive workload due to lack of resources and the inability to say no or set boundaries around their work. One of Rachel’s most popular recent podcast episodes amongst GPs was about how perfectionism and shame can lead to stress and burnout in healthcare https://youarenotafrog.com/episodes/152/
The issues of demand, workload and staff recruitment aren’t going to go away any time soon, and so healthcare professionals are looking for training and content which help them think differently, manage their teams better, engage in challenging conversations, set boundaries and be more productive as a more holistic way of addressing their wellbeing at work.
Given that lack of time is impacting on wellbeing, senior healthcare professionals seem to engage in wellbeing content in those ‘slivers’ of time when they are doing other stuff such as driving to or from work, walking the dog or cooking a meal. So, people are engaging with podcasts and webinars that are available at any time as well as short ‘bitesize’ videos (for example the You Are Not A Frog YouTube channel which has bitesize videos about all aspects of wellbeing and resilience). https://www.youtube.com/@youarenotafrog/videos
A coaching approach is also known to be effective, and evidence around restorative group sessions is good but needs time investment though which is not always available as described above. There is some good work emerging from Schwarz rounds but mainly from those who participate and not everyone can. They tend to be popular in secondary care where it is possibly easier to co-ordinate because of the issue regarding difficulty in protecting time during the working day.
Organisational culture has a considerable impact on how the wellbeing ‘agenda’ is viewed. There are organisations who have funding and foresight and are making local investments. They are working with psychologically trained teams and offering a positive approach to psychological wellbeing, but this does not seem to have impacted positively on primary care colleagues who, to date, have not been served well. This then moves down in grades through organisations with just one junior banded person with no specialist training to support the health and well-being agenda and with no current funding from NHSE, the future is not a joined up one. The British Psychological Society have joined the call from the Association of Clinical Psychologists that we need to do more. The Kings Fund’s position is the need to focus on recovery if we stand any chance of achieving the three R’s – Retain, Retrain and Reform, from NHS England’s Workforce Plan.
The issue remains that there are pockets of good practice and there is a suite of resources available but many people either don’t know what is available or don’t engage with them, possibly because they are overwhelmed by the operational demands placed on them.
Alongside directly supporting wellbeing of NHS colleagues where they are currently, we also need to address the underlying conditions that are causing them moral injury.
In a person-centred NHS this requires that health and care services are designed and delivered in keeping with the needs of individuals and communities. By understanding the health & wellbeing needs within our communities alongside them we can develop new models of support and care. This includes supporting people becoming greater advocates for their own health and wellbeing with all the benefits that brings to people’s health and the reduced need of formal NHS services.
NHS colleagues will be pivotal to designing and delivering such an approach in partnership with their communities. Supporting their wellbeing now despite the challenging environment in which they are working is therefore more important than ever. Enabling them to actively participate in positive change encompassing a sense of common purpose, self-direction and mastering their role within the change will deliver huge benefits for all through greater purpose, joy and meaning throughout the workforce.
It’s also important to establish how we keep learning and ask ourselves if we need a more nuanced understanding of what is effective in terms of wellbeing interventions for people. It’s evident from feedback that NAPC has received from our support programmes that we need to include much more about difficult conversations, boundary setting and what good leadership looks like.
Then there is the question of when the best time is to provide support and resources to those who are activated and keen to access those resources given the increased demands on their working time.
At the National Association Primary Care (NAPC), our vision for wellbeing within the NHS revolves around cultivating a workplace where everyone feels genuinely valued and supported. One of NAPC’s core values centres around colleagues experiencing joy and meaning at work as a prerequisite for a highly performing NHS. Creating meaning and fulfilment by empowering healthcare professionals to improve the health and wellbeing of their community in addition to taking care of themselves is vital. It involves creating an environment where getting the help you need is not just okay but positively encouraged. This approach is reflected in all our support programmes.
One example is our CARE programme (Connected, Authentic, Resilient and Empowered) that we have been delivering for the past 4 years. The programme has been nationally commissioned and supports Integrated Care Systems across the country. Connecting and empowering the workforce to improve population health, the syllabus incorporates support for wellbeing, building and harnessing resilience. It is important to note that there is a stage beyond resilience called ‘antifragility’ where people respond to challenges not by tolerating them better (resilience) but rather respond positively by innovating and implementing new solutions to challenges. The overwhelmingly positive feedback from participants has reinforced our conviction that positive ideas for change can and must come from the front line.
Historically, NAPC has also delivered focussed Wellbeing courses nationally that have been evaluated as excellent at sharing selfcare skills to improve wellbeing.
At the NAPC we promote the need to make things simple, reduce the bureaucracy, increase trust and can demonstrate that where there is a positive culture that recognises the importance of good health and wellbeing it results in the green shoots of recovery.
A joyful workplace across the NHS is not a luxury we cannot afford but an essential element that underpins increased productivity and better performance.
NAPC will continue to support people and provide programmes with the aim of supporting colleagues to care for themselves and their communities at a challenging time. The future success of the NHS is dependent on everyone recognising this and investing wisely accordingly. If you are interested in greater productivity and better performance across the NHS, we encourage you to join us in increasing the health and happiness of NHS colleagues.
This article is the result of a meeting ran by the NAPC exploring Wellbeing for the future where we were joined by the following experts. We would like to thank them all for their time and their valuable input.
Dr Rachel Morris. Rachel is former GP who now helps doctors and other professionals in high stress, high stakes jobs beat burnout and work happier. Rachel is the host of the Apple Top 100 UK Business Chart podcast ‘You Are Not a Frog’ and creator of the Shapes Toolkit Resilience Training Programme. https://youarenotafrog.com/ https://www.shapestoolkit.com/
Dr John Simmons. GP. Also studied homeopathy, acupuncture, functional medicine and Heart Math. John has always worked on a multi-level approach to health alongside his conventional training and, because of this integrative view, established the 4 Wellbeing Principles: Eat, Move, Breathe, Love, which underpin our vitality and sense of health and wellbeing. He believes that attending to these parts of our lives, with curiosity and courage, would enable us to live with the best health and vitality whatever our circumstances.
Dr Clare Boultby. GP. Leadership fellowship on staff wellbeing and mental health. Interest and experience in thinking environments, health coaching, reflective supervision and coaching and mentoring. Clare has a drive to help improve the culture around wellbeing in staff within the NHS. Wanting to help it to become part of a normal day for staff to have time to think, reflect and look after themselves and feels this would improve a sense of belonging at work and long term improve patient care.
Andrea Svecova. GMBPsS. CARE Alumni, currently fulfilling the role of a Health & Wellbeing Coach, with a specialisation in cultivating positive work environments, mindfulness and promoting work-life balance. Ealing GP Federation.
We also had input into the discussion from Dr Sonya Wallbank. The Kings Fund.
Sonya is a consultant clinical psychologist and specialises in workforce resilience and restorative approaches to wellbeing. She has worked in the NHS as a director of service delivery and workforce, leading complex change and improvement programmes for NHS England and NHS Improvement, including the delivery of the health and wellbeing response for NHS staff during the Covid-19 pandemic.
The following colleagues from the NAPC were also present and part of the discussion:
Dr Caroline Taylor. GP. Chair. National Association of Primary Care
Liz Howarth. Programme Director. National Association of Primary Care
Caroline Rollings. RGN, MBA. NAPC Wellbeing Lead. NAPC Board & Council. Meeting chair
Catherine Laverty. MA, Dip HE, RMN, NAPC Faculty and Council Member
Victoria Parker. Communications lead. NAPC
Cathie Sammon. RGN NAPC Faculty, Mental Health.
