Never has wellbeing been more important

10 July 2020

Returning this week to my final two pandemic silver linings: a renewed focus on wellbeing, and on the importance of teamworking.

Improving practitioner wellbeing has been a focus for me during my time as Chair and was a key feature in our From the Frontline campaign (1.7 MB PDF) last year.

We know from our RCGP Scotland survey (318 KB PDF) in 2018 that wellbeing closely correlates with workload.

But of course, there are many other factors too:

  • dysfunctional interfaces of care
  • poor inter-professional relationships
  • inefficient systems
  • appraisal processes
  • rising public expectation and demand
  • the 'emotional labour' of being a GP.

Supporting wellbeing

During the pandemic, attention has turned to the importance of supporting wellbeing across the health and social care workforce in recognition of the very significant toll that the pandemic has taken on many of us, in our personal and professional lives.

Many of us are experiencing decision fatigue, physical fatigue, insomnia, anxiety, and uncertainty about the future.

Many have witnessed first-hand, or had shared with us, heartbreaking stories of loss and difficult grief, with restrictions on visiting at the end of life or attending a funeral.

Colleagues in health and social care have described compassion fatigue which if not addressed and supported can lead to burn out.

These are difficult times. In many ways, they are more difficult than the crisis-driven period at the start of the pandemic when we were united in our common aim of saving lives and protecting the NHS.

Now, more than ever, it is important that we take care of ourselves, that we recognise that these responses are normal, and that we give ourselves permission to take a break whenever we can.

Nurturing relationships

One of many difficult features of this crisis is the feeling of disconnection that it brings - from family, friends, colleagues and patients.

We have needed to find ways to nurture relationships and maintain healthy communication in different ways.

This is acutely felt by colleagues who have not been able to remain within the workplace, either because of shielding or illness.

Particular efforts need to be made to ensure that we find inclusive ways of connecting with all members of the team.

WhatsApp groups have proliferated, as have online meetings to replace face-to-face formats. Digital communication is efficient and inclusive, but it can also be tiring, with loss of social interaction and loss of non-verbal cues.

So again, there is learning around the new skills and etiquette needed.

What has made me happiest in recent weeks is the newfound ability to switch off my 'self-view' in a meeting. Others can see me, but I don’t have to! #nomorecovidhair

Working together to improve practitioner wellbeing

We have continued to prioritise our wellbeing work within RCGP Scotland, too.

A new doctor wellbeing stakeholder advisory group with RCGP, GMC, BMA and the Academy of Medical Royal Colleges and Faculties in Scotland has been formed to offer professional advice and support to the Wellbeing Division of Scottish Government.

As stakeholders, we have many areas of common ground and priority:

  • to improve the interfaces of care
  • to improve the experience and impact of appraisal
  • to establish a dedicated practitioner health programme in Scotland.

I am pleased to say that all three of these areas are gathering momentum and making progress.

I am also delighted to be part of the Royal College of Physicians and Surgeons of Glasgow Making Life Work Better virtual conference on 17 September 2020 when topics will include wellbeing, difficult conversations and trauma response.

If you’re interested, you can reserve a place now.

New ways of teamworking

New ways of working in teams has been another silver lining for me.

I have been aware of a real sense that everyone has wanted to play their part in whatever way they can.

At the start of the pandemic, the GMC, the Chief Medical Officer and the Chief Nursing Officer wrote out to the medical and nursing workforce to offer their support and give 'permission' to working in new and unfamiliar ways in these exceptional times, while also recognising that no one should be expected to work outside the limits of their expertise or competence.

For our multidisciplinary teams, some relaxation of the bureaucracy normally required to allow expansion of roles was a welcome approach and has allowed healthcare professionals to work in different ways, within safe limits for the greater good.

I hope that this pragmatism can continue in some form beyond COVID-19.

Our non-clinical colleagues have also adapted the way that they have worked during the pandemic, and I have shared in a previous blog an example of this in my own practice, where our care coordinators have made proactive outreach phone calls to the socially vulnerable.

These were hugely appreciated by our patients, many of whom felt forgotten, isolated and frightened, and 80% of the calls resulted in an onward referral to either a third sector service, such as food banks and welfare advisors, or a clinician. The whole team learned from their experiences. 

The need to adapt, build, protect and sustain teams moving forward will be so important as we work in these new ways and I’d like to share this excellent resource from the UK Academy of Medical Royal Colleges on developing professional identity in multi-professional teams (397 KB PDF), May 2020.

In general practices across Scotland, we now have regular daytime 'huddles' where we come together as a team to update on changes, share learning and troubleshoot the day.

This has been enormously important, both because of the rapidly changing landscape and guidance during the pandemic, and also the need for us to come together at a point in the day to touch base and offer support.

This is a change that I would love to see sustained.

Many of you will be aware of the new National Wellbeing Hub that was launched, with resources to support all those working in health and social care. It has a lot of great resources in it and includes a section on sustaining strong teams.

General practice has been truly exceptional in these last few months. It has adapted its ways of working, it has remained open throughout, it has staffed the COVID hubs, supported the care homes and offered palliative care to those dying at home.

We can’t do it without our teams, and we can’t do it unless we look after ourselves too. 

Post written by

Dr Carey Lunan, Chair RCGP Scotland

Dr Carey Lunan is a GP partner in one of Edinburgh's Deep End practices and is the current Chair of RCGP Scotland.

Prior to this, she held the role of Executive Officer for Patients and Public and Interface working. She also sits on the RCGP Ethics Committee.

Her priorities during her time as Chair include a focus on practitioner wellbeing, improving the interface between primary and secondary care, and growing and retaining the GP workforce.

She has made tackling health inequalities a high priority and has consistently called for the need to engage the public in a national conversation about the realistic role of the modern NHS and the importance of collective social responsibility.

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