Our panel of expert PMs discuss how to look after your team’s wellbeing this winter. Kaye McIntosh listens in.

The experts:

• Stacey Chapman, Head of Business Operations, Practice Managers Association
• Kay Keane, PM, Alvaney Family Practice, Stockport, Greater Manchester
• Michelle Barksby, PM Sherwood Medical Partnership, Mansfield, Nottinghamshire

Stacey Chapman

It is sadly not surprising that, in a survey of almost 2,500 NHS staff, 69% say Covid19 has had a severe impact on their mental health.

Even before the pandemic, research by the mental health organisation MIND revealed that 88% of primary care workers find their work life stressful, significantly higher than the wider UK workforce (56%).

We have to recognise that mental illness and stress in particular in the NHS is here to stay – and addressing it is imperative.

Jenny Firth-Cozens wrote: ‘Stress is here to stay and the sooner we accept that tackling it is a normal part of management, and an essential part of patient safety, the sooner the lives of doctors and their patients will improve.’ (BMJ 2003)

Stress accounts for 37% of work-related ill health. The PMA has shifted workshops on stress management and resilience online to make them accessible to healthcare workers during the pandemic. It’s more important than ever to learn the tools to support yourself and your team.

Mental wellbeing is dynamic and changeable, but it is possible to maintain stability by improving emotional resilience; enhancing the ability to bounce back and capacity to adapt in the face of challenging circumstances.

One of my favourite quotes that can be forgotten in the chaos of everyday life is: ‘Accept the things I cannot change, change the things I can, and have the wisdom to know the difference’ (The Serenity Prayer, Reinhold Niebuhr)

The PMA’s top tips for managing change are:

Recognise uncertainty

Try not to worry about things that haven’t happened – or might never happen! Recognising these thoughts as worries, not reality, is the first step to feeling less anxious.

Accept the things you cannot change and change the things you can

The pandemic – and how long it will go on for – is beyond our control. Think about the areas of your life that you can control. Who can you talk to, what are you eating? Make time to do less.

Delegate!

Be honest – is there anything you can ask a colleague to do? Perhaps there’s something you can do a bit less of to help create some breathing space.

Make time to relax

It’s exhausting going at 100mph. Try mindful breathing, go outside for a blast of fresh air, have a bath. Switch devices off for a while. This can give you some respite when feeling overwhelmed.

The 7 characteristics of resilience

•          Awareness

•          An understanding that setbacks are part of life

•          An internal locus of control – a sense that events in your own life are the result of your actions

•          Strong problem-solving skills

•          Having strong social connections

•          Being a survivor, not a victim

•          The ability to ask for help

Kay Keane

As if life as a PM isn’t hard enough, we now have the additional pressure of managing a group of staff who themselves may have to isolate because of contact with someone with symptoms; they might get symptoms themselves; or they may be in one of the at risk groups that means they are again isolating. With a workforce that has no slack, there is no easy cover for staff.

I write this having got three staff isolating tomorrow and one off who is in a severely vulnerable category. We do not offer full sick pay to staff until they have been employed for two years, so the prospect of statutory sick pay for these people is a real threat to their home life and income.

Tomorrow my HCA needs to isolate as she has been in contact with another mum at football who tested positive. I’ve gone through her clinic, moved her patients and got a list of things that she can do; first off, fill our remaining flu clinics. As much as we wanted that to be done by November there are still patients who haven’t been for their jab yet, so actually protected time for her to do that would be useful. At least we should get everyone booked in!

Supporting staff who are spread across sites has always been difficult but supporting them when they are at home is more so. They can be isolated, and of course there are health and safety issues which may come into play. The only thing that I can do is be consistent, so treat everyone equally, and keep in touch. I do this on a team WhatsApp group, and lots of screen messages to check on their progress. Not ideal but something.

I also know it’s important to trust people and give expectations of what their role will be at home. Telling our HCA to phone flu patients may not be guidance enough; telling her I’d like her to book 50 patients in would be a more measurable target, and as we are quite a competitive bunch, one that might just fire her up.

It is undeniably hard on PMs as well as their teams. I  have never seen so many of my colleagues struggle, I have never seen so many messages on PM forums saying “I’ve had enough”, “Today is my last day” or “I’ve handed my notice in”.  It’s a serious problem, and one I am starting to look at in my Board role with the NAPC www.napc.com.  I hope we can come up with a way to support each other and offer some leadership and really get the recognition for the profession that we are.

This time round we have the addition of the winter pressures; in the first wave we could hold routine work but now must complete it; its going to be a tough winter.  You will all be digesting information about the Covid vaccines, and a new DES to deliver them.  The winter pressure is beyond anything we imagined. The only comfort I find is that I am not on my own; PMs are great at sharing skills, information and supporting each other. 

You really can’t pour from an empty cup. Rest, eat well, take exercise, get outside and find what brings you some joy in this horrible time. That’s the only way that we really can support our team and, of course, ensure that patient care doesn’t suffer.

Michelle Barksby, PM, Sherwood Medical Partnership, Mansfield, Nottinghamshire

Every year, throughout the NHS, winter workforce sickness is challenging. COVID presents significant additional uncertainty, which can swing daily from a position of stability to fragility with little warning.

In recent weeks the impact of the long months of pandemic response, and the uncertainty of what the coming months hold, on staff wellbeing and mental health is starting to become apparent. The additional impact this could have on staff sickness on top of COVID sickness absence is concerning.

It’s important right now to recognise the effect that the pandemic is having on our workforce. By acknowledging and verbalising these collective challenges and feelings with our teams, it can help aid realisation and recognition that they are not alone in feeling the way they do. Creating a collective support group within the workforce can help.

There are national and local support services available for staff wellbeing so practices shouldn’t feel they have to take the entire responsibility for delivering this assistance. Provide support numbers for staff and other suggestions for boosting mental health and wellbeing through intranet message boards or wellbeing notice boards in practice. You can offer staff counselling services where available and support with 1-2-1s and informal catch-ups.

Encourage staff to meet with each other virtually during working hours for team catch-ups and check-ins, especially when staff are working from home. Emphasise these don’t have to be all about work but to support each other with virtual tea breaks. Encourage individual staff members to seek support from their own GP services where appropriate.

Make time during your day or week to check in with your team too both for their wellbeing and your own. Encourage staff to take their days off and leave wherever it’s possible to do so, as the time away is important.

Most practices would be planning for their festive season celebrations now, which can’t go ahead this year. But it doesn’t have to be forgotten entirely. Planning a virtual quiz, bingo or team building event can boost interaction and team mental health and wellbeing. Focus on the fun and don’t let it turn into a work session; set staff a challenge – the craziest background decoration or the most tinsel in a teams meeting.

It’s also important not to forget about your own wellbeing as a manager and leader.  You’re only human and will share many of the worries and concerns you’re seeing in your team whilst trying to also reassure others. Taking your own downtime and head space to reset and energise is key. Separating your time, and not allowing work to blend into your own time, can be critical. Try to allocate at least one day a week where you do not log on, switch off your phone and take time to rest. Your ability to motivate and support your team will be much better for it.