Human Resources Hot Topics - Our Guide for Primary Care Network Leaders

The role of the Primary Care Network Manager is a multi-faceted one.

You are continually (and continuously) stretched to take on more, in sometimes unfamiliar and highly specialist areas of management, such as Human Resources.

Which brings us to our latest THC / Best Practice webinar, featuring Orchard Employment CEO and HR Specialist Jemma Fairclough-Haynes.

For those of you who aren’t familiar with Jemma’s work, she is a seasoned HR professional, at the top of her game, who has worked directly with primary care senior leaders (and their teams) since the inception of PCNs in 2019. She is well versed in the complexities of people management and culture, when multiple parties co-exist within a network environment.

With this in mind, Jemma will share with us some common HR issues that PCN leaders become most commonly involved with to ensure you are better equipped to support your team more effectively.

In this blog, we cover:

1️⃣ Contracts and basic governance

2️⃣ Requests for salary uplifts

3️⃣ Transfer of services and TUPE considerations

4️⃣ Managing redundancy

5️⃣ Absence Management

6️⃣ Culture and people

As always, we have included lots of our own tips and learning, as well as providing links to further resources that offer more in-depth guidance on some of the themes we have covered.

Let’s jump in!

 To replay the webinar - please click here or keep reading for the summary.

1. Taking care of the basics.

Jemma cannot emphasise enough the importance of water-tight governance in your PCN.

This relates to a collective understanding of and compliance with, an agreed PCN vision, along with a set of shared values and documented key responsibilities which are collectively underpinned by local policies.

💡 On this point, it is a good idea to take time out of your schedule, once a year, to revisit and review all of your policies, to ensure they stay up to date and relevant to the operations of the business.

What policies should we have in place?

Policies across PCNs will vary and are based on size, makeup, and key drivers but at the very least, and as an organisation who employs a minimum of 5 staff members, the following are essential:

✅ Disciplinary policy

✅ Grievance policy

✅ Health and Safety policy

✅ GDPR policy

Other recommended policies to have in place are:

✅ Family friendly and / or flexible working policy

✅ Communication policy

You also need to keep your finger on the pulse when it comes to updates in employment law because, as Jemma acknowledges, this is one of the fastest evolving areas of law due to changes in government policy and as a result of court action or outcomes (case law).  

⬇️ Check out the resources list at the end of the blog for all the links you need to stay on top of employment law changes!

2. Managing requests for salary increases

With the rising costs of living and staff awareness of additional healthcare funding (and competitive rates of pay elsewhere), requests for pay uplifts are becoming increasingly more common. It‘s a really tricky situation though for PCNs who will be keen to invest in their staff but also need to be mindful of balancing the books.

Jemma advises PCNs to think beyond the pay scales and consider other ways to add value as an employer:

💭 Have you thought about progression routes for your staff?

💭 Can you offer additional training / opportunities to upskill your teams?

💭 As an organisation, is there a strong and supportive culture where there might not be elsewhere?

💭 Are there opportunities to work flexibly / to support a family friendly working arrangement?

💭 Could you be more generous with your annual leave allowance?

💭 Ask; what makes us a great employer?

As with any specific requests from staff, explore what’s possible first and if you can’t say “yes” explain clearly why you are saying “no”. Keep it simple, to the point and evidence your response.

For example:

“Unfortunately, we can’t get you to £… at the moment because we need you to be able to demonstrate that you can do XYZ…”

“We can’t reach the figure you’ve asked for because, as an organisation, our funding has been re-allocated to XYZ…..”

Finally, if there really isn’t room for further progression, be honest about your inability to expand the role or the employee further. Accept that, as an organisation, you may have already fulfilled your obligations - and you have probably given them a great launch pad to move on elsewhere.

3. Transfer of services and TUPE

The Transfer of Undertakings (Protection of Employment) or TUPE, sets out the legal and ethical requirements to protect employees in the event of a change of lead employer or provider.

These are a person-centric set of laws which must be adhered to when managing staff through any TUPE process, with a view to keeping employees in the same roles, on the same contractual basis.

Due to the nature of PCNs and the widespread use of third-party providers to supplement staffing (particularly where the Additional Roles Reimbursement Scheme staff are concerned), management of the TUPE process commonly lands on the shoulders of PCN leaders, and this can feel incredibly daunting.

A high level overview of the TUPE process...

An example of where TUPE may be necessary is when a PCN decides to terminate the contract with their external ARRS provider and employ the same staff in-house.

✅ The first step is to check the agreed notice period for termination of the contract with your provider.

✅ Then notify the provider of your intention to terminate.

✅ Ask your provider for a full disclosure of all information relating to the employee/s. You can ask for information relating to previous maternity periods, pay, any outstanding tribunals or grievances, etc. (and want to know everything).

✅ Once you are in receipt of the information, review the employee's associated contract/s or policies by which they are currently bound.

✅ Always attempt to maintain the same terms but be aware that you can make changes should there be an economical, technological, or organisational reason for doing so.

⚠️ Always consult with staff if you intend on making changes to the existing contract / policies relating to their work.

✅ If you need to reduce staffing numbers, the TUPE process still applies but redundancy will have to be offered and you will need to discuss who is responsible for management and payment of redundancy with your provider.

Read the small print.

⚠️ Be aware that most PCNs realise too late that they are ultimately responsible for management of the redundancy process and the payout.

Many provider contracts will state something along the lines of: “we [as the provider] are the employer but you [the PCN] agree to meet the associated costs of employment”. Recognise that redundancy may well be included as an ‘associated cost’. If possible, check all agreements / contracts in advance and negotiate / get clarity on these terms.

That said, associated costs can be re-negotiated even after a contract has been signed. You can absolutely state that you’re giving notice however you would like to re-negotiate the terms of the contract based on evolution of the business and its needs.

⚠️ Be wary also that, in some instances, PCNs have given notice to their provider but the provider has failed to inform the employee, which will skew the agreed notice period.

4. The Rules of Redundancy

Redundancy may become necessary when there is a downturn in the business and when:

• There is a lack of funding

• There is no longer a need for the role/s in question (or the role no longer adds value)

• There are changes in staffing structure

⚠️ An employee’s continuous length of service and their age must be taken into consideration, and the period of consultation is dependent on how many staff are affected and your redundancy timeline.

The process…explained.

Before you sit down with your staff, make sure you are prepared and well-versed in the process. Seek external advice if necessary and refer to related local policies and procedures.

✅ Map out the roles as they stand and work out who is doing what, when, where and how, to identify so that you can evidence where there is no longer a need.

✅ Prepare your ‘at risk’ letters and identify your redundancy pools.

✅ Agree on timelines and notice periods, including identified milestones for communicating with staff at each stage.

Don't be scared to use the law as a reference point if you need to. That’s what it’s there for.

5. Absence Management

Long term sickness and repeated absence is not a problem that’s unique to primary care however, it does appear to be more prolific in primary care because of the nature of the health service in general:

➡️ We are working through, arguably, one of the most stressful periods in the history of primary care; stress levels are through the roof and morale is through the floor.

➡️ Many of our staff are long-standing NHS workers who are ingrained in a more sympathetic culture when it comes to promoting good health and providing compassionate care – perhaps where the needs of the person, rather than that of the business, are prioritised.

Some tips for managing repeated absence...

💡 High rates of absence can be indicative of poor organisational culture. When dealing with repeat offenders, always consider whether the issue stems from the person, or the organisation and its environment.

💡 Don’t put off back to work interviews – these are vital in engaging and better understanding the reasons for absence, supporting staff to improve their sickness record, making clear your expectations, and holding staff to account in future, should you need to.

As with all of the management scenarios covered within this blog, the operational needs of the business should always take priority. It is not personal.

6. Working within a culture of fear (and how to reverse it).

No-one sets out to create a culture of fear (or you’d hope not anyway) but nonetheless, poor relations within practices and PCNs are sadly commonplace.

An example of this is where there may be one practice that is not aligned to the same values and behaviours as everyone else within their network. It may not be financially viable for the practice to leave so mediation and resolution is required.

Let’s take a step back.

Recognising that a culture of fear exists within your organisation is the first and most crucial point in tackling a culture of fear – closely seconded by speaking up. If no-one calls it, nothing can be done, and everyone is complicit in the problem.

From there, it is helpful to identify where the fear stems from; is it within one practice, between members of staff, or is it felt across the network?

Once you have acknowledged that the working environment is a negative one, a deep dive is required. This can take the form of:

• Anonymous staff surveys

• A ‘speak up’ box

• Leadership audit

• Management survey

• Use any related data to evidence the problems (exit interviews, sickness absence meetings, wider staff surveys, leader etc).

At this point, you might also want to consider:

➡️ Reviewing your PCN vision and values – and related policies (and ensuring everyone is signed up to these).

➡️ Consulting with a relevant in-house specialist such as a Trust adviser, solicitor, HR representative.

➡️ Employing an external professional to manage the issues.

In the case of a clash of cultures between an individual practice and the wider network, sanctions can be put in place such as issuing them with an ultimatum and / or applying financial penalties where there is likely to be a direct impact on revenue or costs as a result of poor behaviours.

No matter the circumstances, here are six key pointers:

⭐ Speak up

⭐ Do not accept the situation, or put off taking action

⭐ Stand firm

⭐ Don’t deal with a culture of fear alone – get support and take advice

⭐ Use your data

⭐ Never prioritise one person’s (or one practice’s) needs above those of others

And if it’s really bad and you cannot foresee a positive outcome, leave.

Are there anymore, more general tips for managing difficult conversations?

Of course! Here are our key recommendations to support you in handling tricky management situations:

➡️ Don’t put off difficult discussions. The issue won’t go away and may get worse as a result of inaction.

➡️ Maintain your dignity and professionalism at all times. This is business, it’s not personal.

➡️ Use key documents (such as your business case) as a basis for negotiation.

➡️ Always follow the agreed processes and procedures in place.

➡️ Use your experience and any previous training – and go with your gut.

➡️ Ensure you communicate clearly and effectively.

➡️ Consider using external consultants / independent representatives if necessary as they are wholly unbiased with no ties to the organisation.

Don’t become emotionally invested.

pay

Keen to find out more?

There are lots of resources available to PCN leaders and managers, which can support you to get the best from your growing team 😊

• Sign up to a trusted HR consultancy mailing - check out Jemma’s Orchard Employment newsletter here!

• Take a look at the ACAS website which contains a wealth of inexpensive / free resources on employment law

• Add “HR and employment law” to your Google Alerts

• Check out the Practice Index website which will cover you for all things HR, finance, learning and compliance

• Prioritise equality and diversity training within your network and practices

• Subscribe to solicitors’ mailing lists who will also cover updates and changes

• Watch out for updates from your LMC board

• If you are interested in taking on a more HR-specific role in primary care, consider an HR / CIPD accreditation.

We hope this helps! 😊

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About the Author

I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast.

I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 120 PCNs by providing interim management, training and consultancy.

I have managed teams across multiple sites and countries; I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care, and I am the author of over 250 blogs.  

I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.

Find out more about THC Primary Care and follow us on Linkedin. 

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