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Practices to reduce burnout among staff under new QOF rules

by Rima Evans
31 March 2023

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Reducing the risk of GP and practice staff burnout as well as shoring up resilience and wellbeing will form part of QOF activity for practices from April.

Practices will also have to take steps to create a compassionate and inclusive culture, under the Quality Improvement workforce and wellbeing indicators, which are a new addition this year.

Latest QOF guidance published yesterday says practices should first conduct a review of all work-related factors that affect wellbeing focusing, in particular, on workforce planning, including access to flexible working, reasons for absence, and the support provided to different staff and new starters.

Surgeries will then have to draw up and put in place a plan to improve outcomes. What HR measures that includes will be up to individual practices to decide though the guidance does include suggestions.

To address wellbeing, resilience and burnout, the guidance says, practices should ensure stress risk assessments are carried out for each role (as required by the Health and Safety at Work Act 1974). But they could also offer support on mental wellbeing by, for example, introducing a mental health champion and encourage staff to engage with support programmes such as the free, confidential Looking After You too scheme or Practitioner Health, it is suggested.

To create a compassionate and inclusive culture, practices are advised to consider all flexible working requests; ensure staff in a leadership role have access to training on compassionate leadership and how to lead a team; create a ‘buddy’ system for new starters; make sure all general practice staff have an annual appraisal that looks at training and development needs; take action to prevent discrimination, and more.

To gain another 10 QOF points, practices will also have to participate in at least two PCN peer review meetings to ‘regularly share and discuss learning from quality improvement activity focused on workforce and wellbeing’.

The guidance says: ‘There is a clear need to focus on supporting and improving the wellbeing of the general practice workforce. The pandemic put a significant additional strain on the workforce and the demands on general practice remain high. This module aims to provide practices with the means and resources to evaluate how they currently support their staff and aims to enable the introduction of processes and initiatives that will provide structure and support to staff on a long-term basis.’

It adds that: ‘We know that practices will be at different points in relation to supporting the wellbeing of their workforce therefore these resources are designed to be used in a flexible way to meet individual organisational needs.’

Tony Brown, managing partner at Alnwick Medical Group in Northumberland said he agreed that a positive culture and team ethos not only helps with general wellbeing among the team, but helps to provide better patient care and further enable local recruitment.

However, he added: ‘The best welfare we can give to the team is to pay them at a rate commensurate with their roles elsewhere in the NHS and what they deserve, but practices can’t afford to do that.

‘I don’t see how government can say all of this about staff welfare when they have only given an uplift to the GP contract of 2.1%. It’s another example of NHS leaders being so far removed from general practice that they don’t understand the real issues. I look forward to a funding review in the near future.’

President of RCGP Professor Dame Clare Gerada said while it is good that at last someone is focusing on GP wellbeing, forcing practices to implement audits like this is not going to sort out the real issues, which are workload – especially the workload of GP partners – and a lack of workforce.

‘It is akin to resilience training for hospital doctors. In other words, the response to intolerable workload pressures and lack of compassion in the workplace is to put the locus of disturbance into the individual, who is then made to do resilience training. I am also not sure how we are going to translate this work into something that actually increases wellbeing, when we have so desperately to fill workforce gaps,’ she added.

Professor Gerada, who is also chair of Doctors in Distress, said a better option for GPs would be to ensure they have access at practice level to ‘space for reflection’.

‘This should be protected time and fully remunerated and would ensure doctors can work together to explore the emotional impact of particular cases and general workload. This should be in place of all the mandatory and statutory training NHS England requires us to do.’

It was announced by NHS England earlier in the month, that the current QOF system is to be reviewed during 2023/24, so it becomes more ‘streamlined and focused’.

What are the indicators for the workforce and wellbeing QI module?

A total of 37 points are available

QI013 – The contractor can demonstrate continuous quality improvement activity focused upon workforce and wellbeing as specified in current QOF guidance.  Points value: 27

QI014 – The contractor has participated in network activity to regularly share and discuss learning from quality improvement activity focused on workforce and wellbeing as specified in current QOF guidance. This would entail attending two primary care network meetings, at the start and towards the end of QI activity. If a practice is not within a PCN, the expectation is that two meetings would be held locally with other practices. Points value: 10