Recruitment and retention are among the most pressing problems facing the NHS today.
In primary care, the proportion of GP practices in England experiencing high turnover almost doubled between 2009 and 2019, according to a major study by the University of Manchester.
The Additional Roles Reimbursement Scheme (ARRS), introduced in 2019, aimed to help PCNs with recruitment by providing funding for 26,000 new roles. But clinical directors have said the scheme is problematic because funds are needed not only for hiring staff but also for training and supervision, so new recruits and roles are fully integrated into a primary care environment.
This is one of several hurdles PCNs must overcome when looking to recruit. Others include having to hire from a diminishing pool of applicants, not being able to find employees with the right skills, and not being able to meet candidates’ pay expectations due to limited funding, inflation and rising costs. Then there’s the challenge of holding onto talented employees to create a stable and motivated workforce, and avoid a constant stream of staff leaving, which is costly and can affect morale.
When PCNs don’t get their recruitment strategy right, they risk getting caught up in a vicious cycle, warns Dr Sarit Ghosh, a clinical lead at one of the largest PCNs in the country, Enfield Unity.
‘If PCNs find it difficult to recruit, then their ARRS funding is left unused. This immediately puts them at a disadvantage compared with PCNs able to recruit successfully because the latter will have a stronger workforce for tackling incentive schemes like the Impact and Investment Fund (IIF). These programmes attract further funding if achievement thresholds are met. So, failing to recruit creates a vicious cycle where there is a widening resource gap between PCNs that can recruit well and those that struggle.’
On the other hand, managing to attract candidates but hiring the wrong people, is equally problematic. Dr Ghosh warns: ‘Almost as bad, if not worse, than being unable to fill positions is recruiting people who aren’t suitable or who don’t meet the desired role or person criteria. This leads to HR issues, underperformance, and becomes a situation that is difficult and time consuming to manage.’
Competition for the right candidates is fierce, with practices and PCNs trying to attract a small pool of qualified people. Dr Ghosh says that even hiring administrative staff is very challenging.
Despite all these pitfalls, however, Enfield Unity has enjoyed considerable success when it comes to recruitment. Since the inception of PCNs in 2019, the organisation has managed to retain the vast majority of its staff and use up nearly all its ARRS budget every year on recruitment.
Key to that, says Dr Ghosh, has been creating an attractive employer package that brings in the right candidates and keeps them motivated enough to stay with the organisation.
Here, he shares some tips that can help other PCNs do similar:
Seeking recruitment advice from an external agency may be helpful but Dr Ghosh says PCNs should also tap into internal resources. ‘Engage with your organisation,’ he suggests. ‘We often engage with staff either directly or via a staff survey to find out what benefits they find important, how they want to be involved in some of the decision-making, and how we can make them feel more valued. I think it’s very important to do this before you start to recruit.’
Offering applicants prospects for career progression and the ability to move from junior to senior roles is vital. Although Enfield Unity is limited in how much money it can spend on pay, the PCN makes the employer package more appealing by offering employees a clear route to scaling the career ladder. Being a larger PCN with 19 sites gives it an advantage in this respect because it has teams large enough to sustain posts with different levels of seniority and experience. Still, the PCN has proactively taken the decision to plough additional investment into senior roles, beyond the amount it is reimbursed for, in order to maintain career paths and create goals for staff to aim for.
‘This makes the overall package more attractive to applicants,’ says Dr Ghosh. ‘It also allows us to fill more entry level roles because employees know that there is an opportunity to progress.’
Another pull factor is provision of training and supervision. This helps both recruit and retain new hires, explains Dr Ghosh. Enfield Unity invests in training and support for all ARRS roles from GPs and training leads. This is provided through education sessions and written resource materials, with team members receiving training regularly depending on their requirements. Offering Protected Learning time is another feature of the PCN’s recruitment strategy.
‘Supervision, training and support for Protected Learning Time are, I think, the biggest and most valued benefits that we offer,’ Dr Ghosh says.
Enfield Unity has recently employed a mental health practitioner who was jointly recruited with the local community mental health trust. Dr Ghosh says working with hospitals and community trusts to recruit new staff is potentially an interesting idea, and as the Integrated Care System (ICS) develops, one that the PCN is likely to explore further.
The PCN has also worked with universities by, for example, hosting physician associates on placements during their training. This benefits PCN clinical staff because they become more familiar with taking on supervisory roles, but also gives students a taster of working in a primary care environment, and potentially sets up a pipeline of new candidates.
In Dr Ghosh’s experience, applicants are often less focused on achieving their salary expectations if it means having a shorter commute. Along with career progression candidates tend to value working close to home, so it’s a benefit that needs emphasising when creating an employment package.
‘A candidate who is close to their place of work is more likely to take that job even if it means accepting a slightly smaller salary compared with a location further away that may be eligible for a High Cost Area Supplement, for example. You’re also more likely to retain that person, once hired.’
Enfield Unity has many sites across the borough, which means it can be quite flexible in where employees work. Where possible, being similarly flexible – and explicitly stating this in your job advert and in interviews – could raise interest in the job and help you secure your first-choice candidate.
PCN should aim to interview interested applicants immediately instead of waiting for other interested candidates to come along. Any delay risks individuals being snapped up by other organisations and thr PCN losing out on top talent. Similarly, it’s advisable to avoid lengthy recruitment processes or taking too long to make a job offer. You need to act fast when the labour market is tight.
Dr Ghosh warns that PCNs need to stay ‘on the ball’ when it comes to hiring and ‘keep recruitment rolling because there’s always attrition, people leave.’ Keep in touch with candidates who may have narrowly missed out on getting the job for whom a new opening may be more suitable.
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