Practice managers reveal what assistance surgeries are providing for staff struggling to make ends meet and their tips for how best to put support in place
Report by Katherine Price
Three quarters of practice managers say GP staff have been negatively affected by the increasing cost of living over the past 12 months, according to a recent Management in Practice survey. And half of respondents said staff have left or indicated they may need to leave their job because of cost of living-related financial factors.
Ruth*, a practice manager in Lancashire, says the stress of financial pressures is having an impact on both morale and absence. ‘We support each other as best we can. We’ve had tears in some cases, obviously people are very stressed and even worried about losing their homes,’ she says. ‘There’s a limit as to how much people can deal with and it does increase sickness rates.’
‘That day-to-day struggle just seems so much harder,’ agrees Alex Kimber, managing partner at the Grove Medical Centre in Dorset.
While 70% of survey respondents said they had increased salaries to help staff manage soaring prices, in the face of practice funding pressures some practice managers have taken other proactive steps to support staff and ease their financial burden.
What are some of these, and how best can help be offered?
Providing interest-free loans
The Grove Medical Centre has provided interest-free loans to staff experiencing cash flow issues. While Mrs Kimber says this was something she may have seen once pre-Covid, the practice has now arranged four or five such loans post-Covid.
‘It’s certainly something that’s much more prevalent now,’ she says. ‘It’s usually small amounts, a few hundred pounds here or there. It’s a simple agreement so we all know where we stand.’
The practice deducts an agreed amount each month from the individual’s net pay. However, Mrs Kimber explains, ‘we have to be quite flexible about that because obviously some people are living paycheck to paycheck’.
Ruth’s practice has also provided two loans over the last two years to members of staff who were struggling with rent and mortgage payments via agreed wage deductions. This is support, she says, the practice is still committed to providing if and when staff need it.
‘It’s not just for employees on the national minimum wage,’ she explains. ‘A nurse has had that help too, for example. We’ve also managed to keep one person from losing their home [whose] husband was very ill and the loss of an income was what had caused an issue. She’s managed to stay in work throughout.’
Allowing flexible hours
When asked which roles survey respondents believed had been most affected by financial hardship in their practice, 89% said reception staff and 81% said administrative team members.
‘Unfortunately, it tends to be people who are integral to the business but are in those lower paid roles [who] feel the impact the most, like our reception staff and healthcare assistants,’ agrees Tim*, a practice manager in North Yorkshire.
Ruth highlights that these critical roles come with other challenges too. ‘Staff working in reception, in particular, can sometimes be dealing with very angry people. It makes it very difficult, however, if they start to think they’re not getting paid enough to deal with problems like that,’ she adds.
Tim is trying to support staff by offering flexibility both in the number of hours worked (for example, by providing additional hours if possible) and also in the scheduling of hours. ‘We’ve always tried to be flexible with it, however now the issue is cropping up more often, and probably started last winter when all the bills shot up,’ he says. ‘We also have people who work here who aren’t local, so they’ve really felt the pinch when it comes to the commute.’
Although working from home is not always an option, he has been able to arrange some team members’ hours to reduce their number of days in the office, saving them petrol or public transport costs without cutting their salaries. Where possible, the surgery offers rotas that fit around school hours, helping staff keep after-school childcare costs to a minimum.
Tim says this flexibility has been positively received: ‘For the past six months, we have been seeing some really good retention in those teams where normally there is quite a lot of attrition,’ he says.
Offering free provisions
Some practice managers have taken action by making some essential supplies, such as food or menstrual products, freely accessible, not just for team members who may be struggling financially, but any staff who may have simply been caught short.
‘Anyone and everyone dips in… there’s no shame in going to the basket,’ explains Mrs Kimber, whose practice started providing a free food basket about six months ago. ‘Those who can support it can bring something in the next day to replace it.’
Lorna* introduced a ‘breakfast basket’ at her South London practice around three years ago, which she says staff appreciate. ‘Although I never actually see anyone use it, it’s always gone, so it works,’ she says. ‘The items don’t have to be the best of everything – we get nine crumpets for £1, for example – but they’re always there, so there is something hot for someone to eat.’
Boosting mental wellbeing
The pastoral care aspect of the practice manager role has arguably become even more critical in recent years, and interviewees stressed the importance of not underestimating the everyday actions that cost nothing but show staff that you are available, ready to listen, and care about their wellbeing.
‘It’s about nurturing good relationships and being visible quite a lot of the time’,’ says Mrs Kimber.
‘It’s important to keep in contact with your staff and be available when they need you. That is just simple management really, but it’s hard to do when you’re so busy.’
Ruth agrees: ‘It’s mainly about communication, knowing your staff and being available so that they know they can come and talk to you and they’re not going to be judged.’
Cleona Jones, practice manager at the Practice of Health in the Vale of Glamorgan also says staff need to feel supported and appreciated but that this needs to be actively demonstrated.
They offer staff access to an Employee Assistance Programme (EAP), but it’s not just about a providing a formal benefit it’s also about actions such as taking over a rude or aggressive call when needed, providing refreshments or having an open door policy, she says. With this kind of culture in place, says, the practice has great retention.
At the Grove Medical Centre, emphasis is placed on relationship building and forging social connections to help address wellbeing.
It holds practice meetings every two to three months where mixed groups of doctors, nurses, receptionists and administrators are tasked with solving a problem. This encourages cross-departmental collaboration and interaction between colleagues who may not often come into contact, helping them understand each other’s roles, as well as empowering team members to improve their working environment, job satisfaction and mental wellbeing.
Mrs Kimber adds that staff are are more likely to approach more senior team members, if they have previously come into contact with them. ‘Once you have that interaction in a space other than work, it does make quite a difference,’ she says.
The practice also holds twice-yearly ‘away days’ where they may invite in a speaker, offer training or simply celebrate together. These are usually funded by the partners, with a small deposit or contribution sometimes requested for more expensive occasions.
In addition, team social events are organised that have ranged from bingo and pantomime shows to art classes. While nothing is compulsory, this can help at a time when people are tightening their belts, socialising less and possibly suffering from isolation.
Meanwhile, Lorna’s practice in South London has funded access to a staff wellbeing website service for the past two years that provides resources on topics ranging from nutrition and fitness to finance and mental wellbeing. Staff are also asked to fill out an anonymous wellbeing questionnaire two to three times a year, which helps her monitor any issues that may need addressing, including around financial wellbeing.
Be discreet when offering support
‘People can be very private. No-one really wants to put their hand up and admit to anything,’ says Lorna.
Practice managers point out that some team members may be embarassed to ask for support or struggle to see a way out of their situation. Which is why it’s important to raise awareness of support available in a discreet and inclusive way. This may include posters or information displayed in toilets, noticeboards or the staff intranet highlighting, for example, financial support, offers and vouchers for key workers, or links to resources such as an EAP.
Ruth says it’s possible to take a discreet but proactive approach: ‘The partners here have always been very good, they’ve always said, “if anybody is having financial difficulties, you should come and talk to us. Don’t get yourselves into a mess”.
‘If anybody is having problems, my door in particular is also always open,’ she adds.
Ruth also explains: ‘You tend to pick up who might be having difficulties. We always approach people quietly on the side and say, “how are you? Are things okay?” And if they admit that things are tough and they’re really struggling, that’s when we’d ask if they would like a a chat to see what we can do to help.’
Ensuring openness and transparency
Practices are committed to continuing to support staff manage their own financial pressures, however Lorna says that budgeting this year will be difficult. ‘It’s bills like heating that are astronomical,’ she says, while the practice’s National Insurance contributions are set to increase by £35,000 from April.
And while last winter, Tim’s practice made additional monthly winter payments to support staff, this has not been possible this year. ‘We’re making sure that we’re communicating about the challenges coming up, and that we’re on top of them and dealing with them,’ he says. ‘I think and hope that’s starting to fill people with confidence.’
*Some names have been changed in this article for anonymity.
