Giving a voice to general practice staff

Since 2003, the NHS has measured its workforce experience through the NHS Staff Survey (NSS). However, this has always excluded those in primary care – a pool of around 140,000 general practice staff, pharmacists, optometrists, and dentists. The result? An overlooked opportunity to listen to and learn from the lived experience of staff who provide the first point of contact in the NHS.

This gap was finally addressed when, in July 2020, NHS England released the NHS People Plan. an ambitious workforce strategy promising to measure, understand, and improve NHS workforce experiences, including a commitment to implement a survey for primary care staff.

To see if the NSS could be extended to primary care, Picker completed a feasibility study for NHS England to look at its potential and demand. A phased approach to developing a primary care staff survey was recommended, starting with a pilot study of general practice staff. Between 2021 and 2022, Picker conducted the pilot Primary Care Staff Survey (PCSS) with general practices within Primary Care Networks (PCN). The pilot was based on the established NSS questionnaire, altering some survey questions to match the objectives and measurables of the NHS People Plan. It achieved a 47.4% response rate, comparable to the NSS, with positive feedback and good questionnaire performance, making it a success

Developing the survey

Stakeholder engagement was key. Picker kicked off the pilot with a series of stakeholder interviews, including healthcare organisations, public bodies, and specialities within NHS England, designed to ensure all decisions regarding survey approach, questionnaire content, and reporting were informed.

This process was followed by cognitive interviews with general practice staff, a crucial step in the pilot to further facilitate a robust, best-practice approach to survey design and identify any issues with the questionnaire.

Picker adopted an online-only approach, sending staff an email invitation containing a survey link. Those without an email address were sent a paper invitation containing details of the online survey. Post survey, reporting was produced at national, PCN, and occupational group level, with a one-slide summary using elements of the NHS People Promise to enable practices to review staff experience at an overall level.

Timing is everything

Despite the overall success, securing participation from general practices proved to be a challenge with several dropping out before reaching the fieldwork stage of the pilot. Reasons include:

• Survey fatigue, with many participating in localised surveys concurrently. It is suggested that localised surveys are limited, and if required the clear purpose and benefit of each survey should be highlighted.
• Low staff capacity caused by high workload in primary care due to the pilot running during the Covid-19 vaccine booster campaign and the Christmas holidays. Survey timing is essential, additional workload pressures need to be considered.
• Lack of access to general practice staff details. The feasibility of accessing staff data should be explored, with PCNs and general practices working together to compile an accurate staff list.

However, Picker identifies several solutions to overcome the challenge of participation.

Communication is key

For a successful national rollout of the PCSS, an extensive nationwide communications campaign within primary care will be required to drive awareness, grow engagement, and achieve buy-in amongst primary care staff. This includes:

• Coincide timing of the PCSS with the NSS to use its momentum and allow for comparability where possible.
• Plan communications prior to a national rollout to allow organisations to prepare in advance helping to discourage competing localised staff surveys.
• Highlight the purpose and benefits of the PCSS to encourage onboarding and staff participation.
• Increase communication with practice managers to ensure understanding of the survey process and provide guidance on compiling staff lists. 

Drive survey recruitment through NHS England’s internal and external channels.

Give them the why

A clear purpose, outlined benefits, and ease of process is needed to drive engagement and ensure full representation of PCNs and general practices in the survey. Spotlighting the NHS People Plan will play a crucial role in activating that all-important motivation.

The consistent message that, for the Plan to become a reality and meaningful change to occur, their voices and direct experiences must be heard.