Liam White offers a quick checklist to help you get the right team
Great things in business are never done by one person: they’re done by a team of people,’ said Steve Jobs, the visionary founder of Apple. Getting the right team is perhaps the most important part of making any organisation a success – and that’s as true in primary care as it is in the IPhone design team.
Like so many things in general practice, if you don’t want to end up fire-fighting, you will need a plan.
1. Make it clear
Any clear plan for the process of hiring and inducting new staff is a lot better than an ill-defined one, even if everyone interferes, or it needs adjusting when people aren’t available. Set dates and consider who you involve in the process – and have a back-up plan if their availability changes, rather than abandoning your timescales. Bear in mind that the more senior the colleague you involve, the longer they may take over the decision because of other commitments.
Take charge but be generous in sharing the decision with others – especially those who will be close colleagues to the new hire. Mercifully, partners will generally give practice managers a fairly free hand in hiring non-clinical staff – but on the other hand, beware of taking too many decisions alone. An applications sift should be conducted by at least twopeople in order to ensure it is done on the basis of presented evidence alone: it is very easy to read things into letters and CVs that aren’t there when you are ploughing through a whole pile. It is also true that all applications start to look the same after a while – and it’s easy to get a couple mixed up. Bear in mind that having to do a sift is the right problem to have, and sort out who’s who before you start contacting candidates.
2. Beware of discrimination
Keep the basics in mind while hiring. The process of hiring is about differentiating between those who are well suited to the role and those who are less so, but you need to make sure you are choosing on objective grounds, not making assumptions based on race, gender and so on. There are nine types of illegal discrimination that you need to avoid (see box, prohibited discrimination types).
If the candidate mentions, for instance, that they have children, that’s fine, but don’t assume childcare is a problem for female candidates if you wouldn’t discuss it with a man. Draw up a shortlist of questions you ask every candidate. You can let the interview become a conversation and range freely once you have gone through them – but you should be able to show that the selection process was fair, and a base of common questions is by far the easiest way to do this.
Explore the candidate’s ability to deal with common but difficult situations when dealing with ill or distressed people, and probe for detail about their experience. A strong candidate will be able to give you lots of detail if you push for it. Somebody who is making it up will struggle.
3. Review the job description and contract
Has the job description been reviewed in the last year? Does it deal with all the duties your new receptionist or admin person will have to perform? Is the practice providing new services they will need to know about?
Be sure to give the candidates a copy of the job description ahead of the interview if it is not included with the job advert. It is fair to let them know they should be prepared to demonstrate their adequacy for the post by reference to any of the required competencies.
If you think the job description is a bit lengthy and intimidating, keep it simple and put the details in the staff handbook. Make sure the contract refers to both. A staff handbook referred to as containing renewable terms is invaluable: if you update it and send an email to let everyone know, you have updated all your staff contracts at once, to reflect new duties or services.
4. Consider diversity
There is no general duty to promote diversity as long as you can show you are providing a fair, non-discriminatory process, but the benefits of a diverse workplace are of particular value in general practice. A diverse workforce will provide your surgery with views, perspectives and experiences that make it more effective. If you are not disabled, you will be unlikely to think of everything a wheelchair user or hearing-impaired person would spot that might help or hinder. Teams should aim to reflect the patient population in overall diversity, if not proportion.
Diversity in skills is also valuable. If you have an experienced team who are a bit jaded with the patients, consider a candidate who smiles a lot, even if they are a beginner. A popular colleague will get looked after and prosper – even if they need help to start.
5. Check entitlement to work in the UK
An eternity of pain awaits surgeries that fail to pay attention to this. The civil penalty for employing illegal workers was raised to £20,000 in 2014. In 2016, criminal penalties were upgraded to an unlimited fine and five years in prison. These offences are primarily designed to combat unscrupulous factory owners or gangmasters but all employers face the same steep penalties.
It is no longer necessary for prosecutors to show employers knew the person was working illegally to bring criminal charges. You should have a copy of colleagues’ current passports, whether UK-born or not. It indicates their entitlement to work.
6. Assess computer literacy
Test-driving new staff on the clinical system through the simple business of booking an appointment is highly recommended. Even if the candidate is completely new to the clinical system you are using, if they can’t make a booking quickly and confidently with a few minutes coaching, they are going to waste a lot of colleagues’ time. A strong candidate will not only achieve basic competence quickly, they will start asking intelligent questions about how to perform other admin tasks.
7. Carry out a DBS check
If you don’t have a disclosure and barring service (DBS) check on record as appropriate for each member of staff, you may regret it when the Care Quality Commission (CQC) comes to inspect. A DBS is not strictly required for staff who do not have unsupervised contact with members of vulnerable groups or do not act as a chaperone. But most surgeries require reception staff to handle confidential data for all patients.
Given that vulnerable groups are dealt with as a matter of course in general practice, it often makes sense to have everyone DBS checked to allow team flexibility. Chaperone requirements can be difficult to plan for, and the last thing you want to have to do is disturb another clinician.
Practices have complete discretion over when to renew the DBS certificate, though every two years is recommended. You cannot use a DBS certificate obtained while a member of staff worked elsewhere. Even if you pay for it, the certificate is always the property of its subject.
8. Follow up references
References are often bland these days, as employers are increasingly advised that breathing fire about former employees is not worth the risk of litigation. Larger organisations often churn out formulaic reports of an employee’s dates of service, contractual duties and pay without further comment, as a matter of policy. Many sensible people think references are not worth the paper they are written on, as they may just reflect a relationship between two people. Accordingly, it is all too easy to forget to chase them if a request does not succeed.
But while there is no general duty for an employer to provide a reference to leavers, the CQC expects current employers to provide them for everybody. So if you are drawing blanks, request references by email and keep a record to show you made reasonable enquiries. If you have no work references for a new staff member who is fitting in and doing well, get personal references, record your requests, and get a DBS.
Never assume somebody must be all right because of where they used to work – or even if they still work there part time.
9. Check certificates
While non-clinicians will not have the range of technical qualifications that clinicians do, they should be able to produce certificates for qualifications and courses attended. Few surgeries have strict academic requirements for non-clinicians, but achievement in learning is to be encouraged – so respect staff attainment and treat recent certificates seriously. If a new employee has been working in clinical services for a few years and attended courses, certificates should be kept on file, especially if they relate to an aspect of their work.
On the other hand, don’t worry too much about asking to see GCSE certificates for someone who graduated 10 years ago.
10. Look at risk assessment
We like practical people in general practice, and not the kinds of people who burst into tears at the sight of a risk assessment form. Why not give your job candidates a basic risk assessment form and send them to the kitchenette to evaluate it? If they have never filled one in before, explain that you want a careful examination of things that could cause harm to people in the workplace. Be generous with the results, as long as they show practical thinking.
If this seems over the top, remember that risk assessment will reduce staff anxiety ahead of CQC inspection and will help foster a safety culture. That, in turn, will help non-clinicians understand what a regulated business clinical services is.
It isn’t a big ask. Many teaching assistants are expected to do a risk assessment every day.
Liam White was practice manager at the St James Practice, Abbey Medical Centre, London, and is currently freelance.