What Should Practice Managers Do When Staff Wellbeing Results Deteriorate?
When staff wellbeing results deteriorate, Practice Managers should establish what has changed, assess whether any concerns require immediate attention and investigate the working conditions contributing to the findings. The priority is to understand the reasons behind the decline before deciding what action is appropriate.
A lower survey score does not automatically indicate poor management or prove that employees are experiencing work-related stress. Changes in staffing, workload, participation or organisational arrangements may influence the results.
However, a consistent decline should not be dismissed as an inevitable consequence of working in general practice.
Practice leaders should examine the findings alongside relevant operational information, involve employees in understanding the concerns and agree realistic improvements.
Where significant workforce risks are identified, these should be considered through the practice's existing risk management and governance arrangements.
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A decline in staff wellbeing results should prompt further examination, but its significance depends on what has changed and the circumstances surrounding the survey.
For example, a practice may report lower satisfaction with workload following a period of unexpected sickness absence or the introduction of a new clinical system.
That does not necessarily indicate a long-term organisational problem.
However, if employees have reported increasing workload pressure across several survey periods, the findings may suggest that existing arrangements need reviewing.
Practice Managers should begin by comparing the results carefully.
Useful questions include:
Have the same questions and response scales been used in previous surveys?
Has the number or composition of respondents changed?
Are particular areas deteriorating more than others?
Do written comments explain why employees responded negatively?
Have there been significant operational or staffing changes?
Are similar concerns appearing through other management channels?
A fall in an overall wellbeing score may conceal very different experiences.
Employees might continue to report positive relationships with colleagues while becoming less satisfied with management communication or available staffing support.
These differences matter because they point towards different possible responses.
Managers should also avoid treating small numerical changes as definitive evidence of deterioration, particularly when only a limited number of employees have completed the survey.
The purpose of the initial review is to establish whether the results reveal a meaningful concern that warrants further attention.
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Some survey findings require prompt management consideration regardless of whether the overall results have deteriorated significantly.
Concerns suggesting unsafe working arrangements, threatening behaviour, bullying, serious misconduct or potential risks to patients should not be postponed until a general workforce improvement plan has been agreed.
A survey may identify that employees feel unable to complete essential responsibilities safely, for example.
In that situation, managers should consider what work is affected, whether immediate controls are necessary and which individuals have responsibility for the relevant decisions.
The appropriate response will depend on the nature of the concern.
A reported difficulty with administrative capacity may require a review of workload and task allocation.
A potential patient safety incident should be considered through the practice's established clinical governance and incident reporting processes.
An allegation involving an individual employee or manager may require confidential handling under an appropriate employment procedure.
Potential priorities include:
Concerns about completing essential tasks safely.
Reports of threatening or abusive behaviour towards staff.
Persistent inability to take necessary breaks.
Allegations of bullying, harassment or other serious workplace misconduct.
Employees reporting that they cannot raise safety concerns.
Evidence suggesting foreseeable risks from excessive work demands.
Anonymous survey comments may not contain enough information to establish what happened.
Managers should avoid making assumptions about individuals or attempting to identify respondents. Nevertheless, credible concerns should be considered using the information available and the relevant procedures.
The absence of a named complainant does not mean a potentially serious risk can simply be ignored.
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Understanding the causes of deteriorating results is more useful than responding immediately with a general wellbeing initiative.
Different areas of staff experience may decline for different reasons.
A lower score relating to workload could reflect increased demand, staffing vacancies, poorly organised processes or unclear priorities.
Reduced confidence in management communication might be associated with recent procedural changes or inconsistent instructions between teams.
Concerns about working relationships could involve individual disagreements, wider team difficulties or problems with how workplace concerns are handled.
Practice Managers should therefore examine the specific areas where responses have become less positive.
The Health and Safety Executive's Management Standards provide a useful structure for considering working conditions.
They cover six areas associated with work-related stress:
Demands: Workload, working patterns and the working environment.
Control: The influence employees have over how they carry out their work.
Support: Assistance, resources and guidance from managers and colleagues.
Relationships: Positive working relationships and appropriate handling of unacceptable behaviour.
Role: Whether employees understand their responsibilities.
Change: How organisational changes are managed and communicated.
For general practice, these areas can help distinguish between the amount of work being undertaken and difficulties arising from the way work is organised.
For example, administrative employees may report that their workload has become less manageable despite no significant increase in task volumes.
Further discussion could identify repeated interruptions, changes in responsibilities or inconsistent prioritisation.
The survey alone cannot establish which explanation is correct.
Managers should use it to identify the questions requiring investigation.
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Workforce survey results should be reviewed alongside relevant information about the practice's operations.
This helps establish whether employee concerns correspond with observable changes in working conditions.
For example, declining feedback about workload may coincide with persistent vacancies, increased overtime or an administrative backlog.
These patterns may justify a more detailed examination of staffing capacity and working arrangements.
Other information may include sickness absence, staff turnover, incident reports, previous risk assessments and relevant discussions from team meetings.
However, none of these measures should be interpreted in isolation.
Sickness absence may increase for reasons unrelated to work. Staff turnover may reflect career progression or personal circumstances.
Similarly, a backlog may arise from a temporary technical problem rather than a persistent mismatch between staffing and demand.
Practice Managers should look for connections without assuming that one indicator explains another.
The HSE's approach to assessing work-related stress encourages employers to consider several sources of information and discuss the findings with employees.
This is particularly useful when survey results identify a concern but offer limited explanation.
For example:
If reception employees report worsening support during difficult patient interactions, management could examine incident reporting arrangements, access to senior assistance and whether existing procedures are understood.
If clinical staff report difficulties managing workload, the practice may need to consider appointment arrangements, clinical responsibilities, staffing and appropriate professional support.
The objective is to obtain enough information to make a proportionate decision, not to create an unnecessarily extensive investigation.
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Practice Managers should acknowledge deteriorating findings without becoming defensive or suggesting that employees are responsible for the results.
Staff may be reluctant to provide further feedback if they believe negative responses will be challenged or dismissed.
A constructive approach involves explaining what the survey identified, recognising any limitations in the data and inviting employees to help clarify the concerns.
For example, management might explain that responses concerning workload have deteriorated and that the practice intends to examine whether recent operational changes are contributing.
This provides a clear subject for discussion.
Simply asking why staff are unhappy may be less productive, particularly where the concerns relate to specific working arrangements.
Managers should also avoid presenting the survey as a judgement on individual employees or departments.
Where findings relate to a small team, confidentiality risks need careful consideration.
Detailed departmental results or free-text comments could identify respondents even where names were not collected.
Appropriate discussion should focus on the issue rather than who may have raised it.
Useful approaches include:
Sharing the principal findings in a balanced way.
Explaining which matters management considers most significant.
Inviting staff to clarify operational difficulties.
Providing private routes for sensitive concerns.
Making clear which decisions require GP partner or clinical lead involvement.
Explaining when employees can expect an update.
Not every concern will lead to the change employees would prefer.
However, providing a reasoned explanation helps demonstrate that their views have been considered.
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The response should address the working conditions contributing to the decline, with actions proportionate to the concerns identified.
A practice does not necessarily need to introduce a new wellbeing programme.
If survey results suggest that administrative staff cannot complete routine responsibilities within contracted hours, the most useful response may involve reviewing workload allocation, staffing capacity or established processes.
Where the issue concerns management communication, a clearer system for sharing operational decisions may be more appropriate.
Individual support services, such as occupational health or employee assistance programmes, can also be valuable where relevant.
However, providing personal wellbeing resources should not replace action to manage avoidable workplace risks.
The HSE distinguishes between interventions that address causes of work-related stress and those that help employees manage its effects.
Both may have a role, depending on the circumstances.
A practical improvement plan should identify:
The concern being addressed.
What further information has been considered.
The agreed management response.
The person responsible for implementation.
Any resource or approval requirements.
A realistic timescale.
How effectiveness will be reviewed.
Practice Managers should involve GP partners where action requires decisions about staffing, expenditure or service arrangements.
Some difficulties cannot be resolved immediately because of recruitment constraints, funding limitations or wider NHS pressures.
Where this is the case, management should consider what temporary measures are appropriate, whether risks are being adequately controlled and how unresolved concerns will be escalated.
The aim is to make meaningful improvements without promising changes the practice cannot deliver.
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The effectiveness of management action should be assessed against the original concern rather than simply whether an agreed task has been completed.
For example, introducing a new administrative workflow does not necessarily mean workload has become manageable.
Practice Managers should establish whether employees are experiencing a practical improvement and whether relevant operational information supports that assessment.
A short follow-up discussion may be sufficient for a relatively straightforward change.
More substantial workforce issues may require a targeted survey, review of staffing information or additional management assessment.
The most suitable method depends on what the practice is trying to establish.
For example:
Following changes to task allocation, managers could review outstanding work and obtain feedback from the affected employees.
After introducing a new communication procedure, staff could be asked whether important information now reaches them appropriately.
Following additional training, managers could establish whether employees feel adequately prepared for their responsibilities.
Where staffing concerns remain unresolved, management should continue reviewing workload and relevant risks.
The HSE recommends monitoring whether agreed actions are implemented and evaluating whether they have addressed the original problem.
It also advises organisations not to wait for a scheduled review where it becomes apparent that the measures introduced are ineffective.
A practice should therefore avoid repeating a comprehensive survey immediately simply to obtain a better score.
Employees need sufficient opportunity to experience any improvements before meaningful comparisons can be made.
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A deteriorating wellbeing score can create pressure to demonstrate a rapid management response.
However, acting too quickly without understanding the cause may result in changes that do little to address the problem.
Potential mistakes include:
Treating every reduction in survey scores as evidence of poor management.
Focusing on the overall score while overlooking specific concerns.
Assuming worsening results must be caused by increased workload.
Introducing generic wellbeing activities without examining working conditions.
Dismissing negative findings because participation was limited.
Responding defensively when employees raise concerns.
Promising improvements without establishing whether they are achievable.
Repeating the survey before previous actions have had time to take effect.
Another risk is placing the entire responsibility for improvement on the Practice Manager.
Some workforce concerns require decisions from GP partners, clinical leads or wider organisational arrangements.
A Practice Manager may identify a staffing problem and manage the immediate consequences without having the authority to approve recruitment.
Effective leadership involves recognising those limitations and ensuring that matters requiring wider decisions are appropriately escalated.
Deteriorating findings should prompt informed management consideration, not an expectation that one individual can resolve every organisational pressure.
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Deteriorating workforce feedback may be relevant to CQC where it identifies concerns affecting staff support, safe working, organisational culture or service delivery.
CQC's assessment framework includes the quality statement Workforce wellbeing and enablement under the caring key question.
The framework also considers areas relating to staffing, leadership and the ability of employees to raise concerns.
However, there is no prescribed staff wellbeing survey score that automatically determines a CQC rating.
A decline in results does not itself establish regulatory non-compliance.
The important consideration is whether the findings identify relevant risks and how the practice responds.
For example, a practice may recognise that employees are experiencing increased workload pressure following staffing changes.
Appropriate management evidence could include a review of capacity, consideration of relevant risks, decisions made by GP partners and subsequent monitoring.
Employers also have legal responsibilities to assess and manage work-related stress risks.
Where deteriorating wellbeing results suggest risks associated with working conditions, management should consider whether existing risk assessments remain suitable or require review.
The existence of a survey is not a substitute for meeting these responsibilities.
For Practice Managers, workforce feedback should contribute to routine governance rather than being treated solely as documentation for inspection.
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When staff wellbeing results deteriorate, the following questions can help establish a proportionate response:
Have the results been compared fairly with previous surveys?
Are changes in participation or survey design affecting the comparison?
Which specific areas of staff experience have deteriorated?
Do any findings suggest an immediate safety or employment concern?
Have relevant operational circumstances been considered?
Do employees have opportunities to explain the issues raised?
Are existing risk assessments still appropriate?
Have the relevant managers, GP partners or clinical leads been involved?
Are agreed improvements realistic and clearly allocated?
Is there a plan to assess whether the original concerns have improved?
These questions are intended as practical management prompts, not a formal scoring tool.
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Does a lower wellbeing score mean a GP practice is poorly managed?
Not necessarily. Results can be affected by workforce changes, operational pressures, survey participation and employee expectations. The practice should examine the specific findings and relevant circumstances before drawing conclusions.
Should Practice Managers investigate every negative response?
Every response should be considered appropriately, but not every negative comment requires a separate investigation. Recurring themes may warrant wider management attention, while serious concerns may require prompt consideration regardless of how many employees raised them.
Should a practice repeat the survey immediately?
Usually, the first step should be to understand the findings and determine whether action is necessary. A follow-up survey may be useful after appropriate improvements have been introduced, but the timing should reflect the issue being addressed.
What if wellbeing results deteriorate despite previous improvements?
Management should assess whether the actions were implemented effectively, whether they addressed the underlying causes and whether circumstances have changed. Further action may be required where the original difficulties remain.
Can deteriorating wellbeing results affect CQC assessments?
They may provide relevant information about workforce experience and organisational arrangements. However, a lower survey score does not automatically determine a CQC rating or establish a regulatory breach.
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A decline in staff wellbeing results is an opportunity to understand whether existing working arrangements remain appropriate.
For many practices, the most useful response is a focused review rather than a large new initiative.
Practice leaders could begin by:
Identify what has changed. Review the specific findings, participation patterns and operational circumstances affecting the results.
Address urgent concerns. Consider potential safety risks and serious workplace issues through appropriate management and reporting procedures.
Investigate the underlying causes. Use relevant workforce information and employee discussions to understand why particular areas have deteriorated.
Agree realistic improvements. Allocate responsibility, involve relevant decision-makers and ensure actions reflect the concerns identified.
Review the outcome. Establish whether working conditions have improved and whether further action is necessary.
Staff wellbeing results will not always improve consistently from one assessment to the next.
General practice faces changing demands, and employee experiences may vary as the organisation develops.
The important management responsibility is to recognise when those changes indicate a concern, understand the underlying circumstances and respond appropriately.
For Practice Managers, a considered response to deteriorating wellbeing results can provide valuable insight into the workforce and support better decisions about how the practice is organised and managed.