Helen Salisbury: Patients lose out when practices competeBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l119 (Published 18 January 2019) Cite this as: BMJ 2019;364:l119
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Dr. Helen Salisbury is right to point out that practices that lose out in the rising competition for staff can put a strain on their existing staff and local health systems (Salisbury, 2019). But blaming competition for this unfortunate outcome skirts around the underlying issues. Some of the most important issues are external like rising demand in the face of stagnant funding (Baird, et al., 2016) and perennial failure to train sufficient health workforce in the UK (The Health Foundation, 2018). These are clearly beyond the control of individual practices. However, quite a few issues are within their control such as creating a supportive working environment, better staff engagement and providing inspiring leadership. Recognising and dealing with the latter issues are important because when badly treated staff leave their jobs, they may not just pitch up at the competing practice. Increasingly, they are moving into the private sector (Santry, 2016), retiring early (Moberly, 2018), or emigrating (Financial Times, 2017). They are therefore being lost to the entire health system. It is also likely that more talented and confident staff are the first to seek out opportunities elsewhere and make a move.
What can GP practices do? The first step is to recognise that their staff is the single most important asset they have and treating them well reflects in better patient care (NHS Wales, n.d.) (BMA, 2018). It is also important to appreciate the high cost of poor staff welfare, an expensive item that may be invisible in the practice balance sheet. This includes poor patient care, absenteeism, presenteeism, high staff turnover with attendant costs for training and on-boarding, disagreements, and litigation. A clear appreciation of the cost will help focus minds on the crucial importance of staff welfare. While most GP practices endeavor to treat their staff well, cases of staff maltreatment and poor employment practices are very common. This range from undermining and bullying to unfair contracts, and dumping work on a particular GP or staff. Very often, partners and managers may be unaware of exactly how their staff feel. Indeed, they may themselves be overwhelmed by the pressure of work. Perhaps being small organisations, they may not have developed the capacity to actively evaluate the wellbeing and engagement of their staff. In all scenarios, it is vital to understand that staff welfare is a core function of a GP practice and it would be difficult to deliver safe care when staff are not treated well (BMA, 2018).
The competition for staff means that practices would pay more attention to their welfare. They might become flexible enough to draw in staff who might otherwise not be able to work at all. It is also much more desirable that badly treated staff move from one practice to another within the local area or indeed anywhere in the UK than to have them move to the private sector or overseas for lack of a suitable employer. Whether we like it or not, UK general practices are already in competition with the private sector, the lure of early retirement for older staff, and more lucrative practices in far-flung places from Canada to New Zealand. Given the depressive effect monopsony power has had on doctors wages in particular, GP practices cannot compete with these other employers on pay. It is a good thing for them to compete on staff welfare. GPs and other practice staff are worth competing for.
Baird, B. et al., 2016. Understanding the pressures in general practice, London: The King's Fund.
BMA, 2018. Working in a system that is under Pressure, London: The BMA.
Financial Times, 2017. Britain pays dearly for the shortfall in doctors. Financial Times, 31 August.
Moberly, T., 2018. Rise in GPs taking early retirement. BMJ, p. 360.
NHS Wales, n.d. Caring for Staff: NHS Wales staff psychological health and well-being resource. [Online]
Available at: http://www.nwssp.wales.nhs.uk/sitesplus/documents/1178/Caring%20for%20St...
[Accessed 27 Jan 2019].
Salisbury, H., 2019. Helen Salisbury: Patients lose out when practices compete. BMJ, p. 363.
Santry, C., 2016. Scale of NHS staff transfer to private sector revealed. Health Services Journal, 23 May.
The Health Foundation, 2018. The health care workforce in England: Make or break?, London: Health Foundation, The King's Fund, Nuffield Trust.
Competing interests: No competing interests