In this feature, Christine Grey looks at effective ways practice managers can strengthen the work environment for staff working remotely.
The way in which general practice services are delivered has had to change rapidly during the Covid-19 pandemic to keep patients and staff safe, and allow staff to carry on delivering care should they need to self-isolate. Consequently, remote digital triage systems, whereby patients are remotely screened, including telephone and video consultations was introduced.
Many general practice staff have had to work from home, or work at the practice but at a distance from others, to stay safe. The implementation of new primary care network (PCN) roles covering different practices also means teams are no longer always in one physical place. Some practices have even had to consider creating more remote roles for salaried and locum GPs to help with recruitment and retention.
The new ways of working have been seen as a “positive” by many who have felt the benefits to working from home. But others have experienced the setbacks of being isolated from colleagues, not being able to work from home due to the requirements of their role or finding it a challenge building and managing effective teams when people are not working in the same location.
Furthermore, inequalities in access to GP services may be growing as remote consultations can exclude certain sections of the community.
The question is whether there is a risk that team work is compromised and inequalities increase with the rise in remote interactions in primary care, and whether this can be effectively managed in order to reap the benefits of the shift in work patterns.
Managing remote teams
Last year, NHS England (NHSE) said all staff working in GP practices should be enabled to work remotely “where possible” depending on their level of risk in the face of Covid-19. It comes with new complexities around supporting staff to work to the best of their ability without close supervision and adapting to different ways of thinking about training and performance measures, not least for new members of staff.
While there is a range of resources produced by organisations such as NHSE and the BMA to support the setup of secure IT systems for remote working in the NHS, The King’s Fund health and care think tank was commissioned in the summer of 2020 by the Department of Health and Social Care (DHSC) to look at how “real” staff were managing to work as well as possible when physically remote from each other.
The results of research
Research found the rapid implementation of digital tools was not enough on its own. In the face of a lack of immediate oversight and control, The King’s Fund found that leaders of remote teams needed to develop new skillsets and be trained in how to build effective teams in a different way. It developed a Remote Working Toolkit for General Practices and Primary Care Networks; a short guide on practices and techniques for getting the best out of teams in these circumstances.
The toolkit says that to be effective, teams need a few meaningful objectives; clear roles and individual responsibilities; and time to reflect on how the team is working together.
Consistent and transparent communication is crucial for effective remote team working. According to the research, staff who work across multiple practices often found themselves excluded from a practice’s main communication channel, such as WhatsApp groups. To encourage clarity and inclusion, “rules” can be developed for how the team communicates, such as agreeing which communication tools might be used for different purposes.
There are also ways to make virtual meetings more effective and inclusive, such as sharing materials and resources or gathering input in advance, and using tips in the toolkit to make sure all team members are engaged in the meeting.
The resource highlights how unequal access to remote working options and technology, for both clinical and non-clinical team members, can lead to resentment and conflict but, if there are good reasons why equal access might not be possible, those reasons should be made clear and transparent too.
The King’s Fund concluded that the technology “that is a best match for the culture and working style of the team” is an important consideration when designing solutions for remote working.
And, as some communication channels make it more difficult to convey meaning or to have spontaneous interactions, team members will need more than ever to make an extra effort to check in with one another.
Remote consultations and the effect on staff wellbeing
One consequence of GPs working away from practice premises is the shift towards remote patient consultations. The Royal College of General Practitioners’ (RCGP) report, Covid-19 Recovery: The Future Role of Remote Consultations and Patient ‘Triage’, said that by April 2021, around half of consultations in general practice were being delivered in person. However, at the peak of the pandemic, the ways in which patients accessed their GP reversed from around 70% in-person and 30% by phone, video or online pre-pandemic to around 30% in-person and 70% remote.
Team leaders need to be constantly aware of the effect remote working has on the wellbeing of staff in the short and long term, and not only of the more obvious problems when staff feel isolated.
The RCGP found GPs reported constant remote consulting “to be exhausting in a different way to seeing patients in person, and that it can make it harder to pick up on ‘softer’ cues, which can be helpful for making diagnoses.”
A poll of its members conducted in September 2020, with 622 GPs responding, found 88% of GP respondents felt face-to-face consultations were important for building and maintaining trusting patient relationships, and 63% said delivering all or mostly remote consultations reduced their job satisfaction.
There was also evidence that the new ways of working did not reduce GP workload. Data actually showed that digital triage resulted in an increase in consultation numbers, and remote consultations could take longer than in-person ones.
Furthermore, a British Medical Association (BMA) survey of more than 1900 UK doctors, conducted from March to April 2021, found that 75% of GP respondents had experienced “moral distress” at work as a result of not being able to deliver the care they felt they should. This came partly from not being able to see their patients in person, according to the report Moral Distress and Moral Injury.
Inequalities in patient access
Remote consultations in general practice are likely to be used more by younger, working people, non-immigrants, older patients and women, according to a British Journal of GPs (BJGP) report, Inequalities in General Practice Remote Consultations: A Systematic Review. It found that the internet-based consultations were used more by younger, affluent and educated groups, concluding: “Widespread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.”
The RCGP accepts that remote consultations have many advantages, not least in terms of convenience for patients and making access easier for some hard-to-reach patient groups. But its report said digital triage systems must not present a barrier to care.
It also anticipated the need to rebalance remote and in-person consultations as we come out of the public health emergency, saying there is a challenge ahead for the Government and health systems “to build upon the benefits that have emerged from new ways of working during the pandemic, whilst ensuring that relational care and health inequalities do not suffer in the longer-term.”