Deirdre Walsh, Post-CCT GP Fellow, Haxby Group; Clinical Educational Facilitator, Hull York Medical School, York.
The concept of embracing change has been at the forefront of my mind since I qualified as a GP last month. Overnight, my professional role, working pattern, and area changed.
In parallel to this, change within my profession is occurring at a rapid pace since the inception of the Primary Care Networks (PCNs) and also, not forgetting, the unprecedented pandemic challenges in recent months.
It has become clear to me that change is inevitable and, at times, outside of our control; however, whether we embrace that change is either helped or hindered by certain key factors.
… change within my profession is occurring at a rapid pace since the inception of the Primary Care Networks and … pandemic challenges …
Personally, the key factors that have enabled me to embrace change in the last month have been that of scheduled time, support, and clear communication.
I have been lucky enough to have a supportive induction (something that I know peers in other practices have not been as fortunate to receive). This induction has provided invaluable time to form new relationships with colleagues and learn about different ways of working.
My new working pattern, with the mix of clinical and non-clinical research days, has further enabled me to have the time to understand the changes within my profession and appreciate what the PCNs are actually all about.
Prior to this varied work, attempting to understand fast-paced organisational changes after a long clinical day was challenging to say the least and I, unsurprisingly, found myself disengaged at times.
Having time to make sense of these rapid changes has created feelings of belonging in me. I feel valued. As they are investing in me, I wish to invest in them. It has reduced previous feelings within me of being on the periphery and instead nurtured feelings of excitement about acting as an instrument of change.
It is no surprise that I feel this way when one considers the American systems scientist, Peter Senge’s quote: ‘People don’t resist change. They resist being changed’.1
Reading this quote has helped me to make sense of my previous disengagement. At times, I felt resistant to change as there was no time to understand the reasons behind the change nor opportunity to be part of the solution.
… an under-resourced primary care workforce is not going to change unless the foundations are laid to enable staff … to feel valued and an integral part of the solution.
During my research days, I have noticed a similar thread of key factors enabling primary care staff to embrace organisational change. Indeed, national bodies have stressed the importance of creating time, support (both psychological and financial), and clarity in ensuring the success of PCNs.2,3
One recent example of local organisational change that has impressed me is the change to care home care in York. This change was driven by NHS England’s rapid response to the pandemic to bring about the service specifications for enhanced care home care ahead of the Directed Enhanced Service (DES) specification this October.
The team has clearly understood the rationale for the change and worked tirelessly to revolutionise care home care in a matter of a few weeks, with several positive outcomes.
However, to embrace and drive such change, teams require financial support and time to implement and evaluate services. Time to ask questions like: Does delivery of care home care via PCN allocation improve patient care? What problems still exist? Should there be inter-PCN collaboration to improve equality of care?
… in order for primary care staff to embrace change and embody the visions of the organisation, they need to be given time to understand the ‘why’ driving change …
I fully appreciate that time is a precious commodity in general practice, however, an under-resourced primary care workforce is not going to change unless the foundations are laid to enable staff, including newly qualified GPs, to feel valued and an integral part of the solution.
Sadly, I have heard many stories of peers not being offered these key factors to embrace change and it is therefore no wonder that they struggle to adjust and become disillusioned.
I was therefore pleased to read the recently published NHS: Our People Plan 2020/21.4 This plan recognises the need to look after staff and embrace new ways of working. The Post-CCT Fellowship Scheme is one such way of working differently and looking after GPs so that they feel in control of their working lives.
My experience over the last month has taught me that, in order for primary care staff to embrace change and embody the visions of the organisation, they need to be given time to understand the ‘why’ driving change, be supported to make that change, and communicated with effectively. Actions such as ensuring a robust induction and creating innovative working patterns that promote wellbeing go a long way to driving positive change for the future, to everyone’s benefit.
1. Strategies for Influence. Peter Senge — learning organizations. 2019. https://strategiesforinfluence.com/peter-senge-learning-organization (accessed 6 Oct 2020).
2. The King’s Fund. The updated GP contract explained. 2020. https://www.kingsfund.org.uk/publications/updated-gp-contract-explained (accessed 6 Oct 2020).
3. Fisher R, Thorlby R, Alderwick H. Understanding primary care networks: context, benefits and risk. 2019. https://www.health.org.uk/publications/reports/understanding-primary-care-networks (accessed 6 Oct 2020).
4. NHS Digital. We are the NHS: People Plan for 2020/2021 — action for us all. 2020. https://www.england.nhs.uk/ournhspeople (accessed 6 Oct 2020).