Managing your practice staff through the COVID-19 pandemic

Dr Pipin Singh offers tips on keeping your practice team running as a tight unit while keeping up staff morale

The COVID-19 pandemic has created rapid and evolving new ways of working for both clinical and non-clinical teams within a practice. These new models have had to be adopted quickly. Clinical and non-clinical leadership is crucial at this current time.

Firstly, make sure all staff know what to do if they or family members have symptoms of Covid-19 themselves. The health of you, your family and your team remain paramount.

Consider the following:

• Setting up surgery WhatsApp groups for all staff, your GPs , nurses group and other team groups. Set up some clear ‘house rules’ to avoid overuse
• Encouraging daily or weekly briefings from your team leads via email, a socially distanced meeting or remote meeting on video conference call
• How you will separate your suspected COVID-19 patients from non-COVID-19 patients
• Upping the telephone triage skills within your clinical team.

Leadership

Ensure you have appointed a clinical lead and a non-clinical lead during this pandemic. This will allow clinical matters to be dealt with safely and in conjunction with developing national recommendations.

Similarly you will need a non-clinical lead to ensure administrative changes can be implemented in a timely manner, particularly as new processes develop.

Clinical lead role

You may wish to share this role among partners or salaried colleagues, to help with continuity.

The clinical lead should be responsible for:

• Making sure the practice has a safe total remote consultation system in place that fits with your surgery processes – offering both telephone and video consultations.
• Putting in place training for the clinical team, both GPs and Nurses, in telephone and video consulting. Online resources are available to help training those inexperienced in telephone or video work.^1,2  
• Ensuring your surgery communication is up to date, eg, SMS texts and email, as well as website and social media.
• Ensuring new protocols are developed to allow assessment of patients in accordance with latest guidance, including face-to-face assessments in ‘hot’ and ‘cold’ areas.
• Putting protocols in place for managing routine referrals in line with your local trust.
• Prioritising clinical work so that only essential work is carried out at the present time, eg, DMARD bloods. Refer to the RCGP guidance on prioritising work for support on this.
• Acting as a bridge between the GPs, nursing staff, allied health care colleagues and administrative staff all of whom will have concerns and queries as the situation continues to evolve.
• Keeping up to date with national recommendations on COVID-19
• Ensuring PPE is adequate for your clinical team in line with guidance and staff understand and adhere to donning and doffing guidance.  
• Ensuring 2 metre social distancing is adhered to within your surgery.
• Keeping staff up to date on practice team progress via weekly email or remote team meeting. This may require just your clinical lead, non-clinical lead and sub-leads.
• Acting on any problems that arise with your in-house processes and feeding this back to your team via email.
• Ensuring COVID-19 templates are completed adequately and data around suspected cases of COVID-19 are completed accordingly
• Ensuring shielding searches and letters are completed by either a GP or delegated to an appropriate team member.

Non-clinical lead roles

This will vary on how your surgery is set up. Your practice manager is likely to take on the overarching non-clinical lead role, but may wish to delegate various roles to different team members and appoint sub leads.

Reception sub-lead

The reception lead will need to be responsible for:

• Ensuring the whole receptionist team knows how to manage patients presenting with suspected COVID-19, whether over the telephone or presenting to the surgery.
• Briefing all reception staff on any new booking procedures and ways of working.
• Providing clear guidance and lines of communication so they can raise concerns regarding patients or any issues they identify with your new processes.

Prescriptions team lead

Your clinical lead can direct the key messages here for the prescriptions lead to follow and quote. Alternatively, a clinical pharmacist could oversee this, if your practice has one. 

The role will involve:

• Reassuring patients that repeat prescriptions will not be interrupted.
• Preventing patients stockpiling, eg, paracetamol / inhalers – and ensuring all team members are providing a consistent and clear message around this.
• Guiding the team on how to manage patients who you suspect may be stockpiling drugs.
• Changing stable patients over to repeat dispensing prescriptions.
• Ensuring prescribers adhere to guidance not to issue prescription durations of over 1 month of medications.

Secretarial team lead

Your secretarial team will likely be involved with your referrals, requests for advice and guidance, medical reports and 2-week-wait referrals. Ensure you appoint a team lead.

Duties for a secretarial team lead to consider include:

• Creating an electronic referral bank to log referrals that trusts are not accepting, so these can be sent promptly when the appropriate time comes.
• Making sure referrals are re-triaged at the appropriate time.
• Managing requests for advice and guidance from secondary care.

Dealing with staff sickness or self-isolation

If your administrative staff develop COVID-19 or need to self-isolate or shield, decide on how this will impact that team. How will you provide not only cover for that role but also provide optimal support for that team?

You may need to consider appointing extra temporary staff. These are likely to be funded by the CCG for pandemic purposes – keep a detailed record of what cover you need due to the pandemic. The BMA has produced a useful template for tracking additional COVID-19 staff and other costs.

Consider moving team members around within the surgery. You may have staff who have previously worked across another team that is affected by staff absences. This could be more productive than securing outside temporary cover.

Ensure you put any necessary training in place if you need to pull someone in from another department. This is likely to be rapid training – some rapid shadowing followed by brief supervised working may be appropriate. Also ensure the staff member feels supported at all times if queries crop up.

Ask team leaders to write a summarised A4-side job description for each role, covering the bare minimum required for safe working within that role. This will avoid overburdening a new team member who is unlikely to need to take on the full duties while covering temporarily.

Remote working

Remote working should be available to both clinical and non-clinical staff. You should be able to access laptops from your CCG for remote working, or instructions on how to access your clinical system from your own desktop or laptop.

If you are remote working, ensure you feel comfortable in any decisions you make and pre-empt any issues that may arise. Your practice should have a clear protocol for clinicians to follow, if they are on call from home and need to see someone face to face – whether to assess suspected COVID-19 or non-COVID-19 patients.

Always ensure anyone remote working can speak to someone within the surgery quickly if needed.

Keeping up staff morale

Practice team morale has never been so important and my top tips are:

• Speak to each other regularly
• Continue to meet for coffee – keeping physically distanced
• Consider keeping an annual QOF bonus this year
• Offer support to unwell or shielding staff, and those with unwell relatives   
• Bring any home bakes into the surgery
• Remain calm.

It is also important to make sure your team members are aware of organisations offering dedicated support for healthcare staff during the pandemic, including the Our NHS People Wellbeing Support resources from Health Education England and the new Looking after you too initiative for practice staff, developed by NHS England and the RCGP.

Dr Pipin Singh is a GP partner and trainer in Wallsend, Tyne and Wear

Reference

1. Greenhalgh T, Choo Huat Ko G and Car J. Covid-19: a remote assessment in primary care. BMJ 2020; 368: m1182  Published online 25 March 2020
2. How to use video consultations in general practice. Pulse Intelligence 07 April 2020. Taken from: Video consultations: a guide for practice by Trisha Greenhalgh, on behalf of the IRIHS research group at the University of Oxford, with input from Clare Morrison of Scottish Government Technology Enabled Care Programme and Professor Gerald Koh Choon Huat from National University of Singapore.  NB Please note that the Roth score referred to in the Covid-19 assessment template included in this resource is no longer recommended.