One of my favourite questions for guests in the current series we are running in the General Practice podcast on the additional roles in general practice is where do they belong?  Do those in the roles feel like they belong to a specific practice, or to the PCN as a whole?

Many PCNs have already experienced turnover in the additional roles, despite the scheme only having just completed two years (and for the first year only pharmacists and social prescribing link workers could be recruited).  One of the most common reasons cited by those leaving is that they did not feel like they belonged anywhere.

It is a difficult conundrum.  The PCN is a collection of practices, and is not really an entity of itself.  It does not exist in a specific place, and is defined as much by a series of meetings and actions as by any physical reality.  So when an individual is appointed to work for the PCN it is not surprising that they can lack this sense of belonging to something.

This issue is then exacerbated because these roles in many places are very new.  Most practices are not used to working directly with social prescribing link workers or health and wellbeing coaches or physician associates (etc).  Making something new work involves change, and change inevitably leads to resistance.  So those taking up post in one of these new roles is working for the less-than-tangible PCN, and at the same time encountering push back from the individual practices within the PCN.

Those taking on these roles need somewhere safe they can retreat to, somewhere they can feel supported, somewhere they can regroup and work out a plan to win over those who have not yet understood the value they can add.  They need to feel like they belong somewhere.

What is really interesting about the responses that I have had to the question from those in roles that are clearly working extremely well is that they are not consistent about where they feel they belong.  Some respond quite emphatically that they feel like they belong to their host practice.  They feel part of the practice team, welcome in the practice, supported by the practice, but at the same time enjoy working with patients from across all the practices in the PCN.

Conversely others feel part of a PCN team.  This is particularly true where there are a number of roles working together, for example social prescribing link workers, care coordinators and health and wellbeing coaches.  They feel like they belong to the PCN team, and that this is where they get the support they need.  The team often has a number of key individuals (clinical supervisors, line managers etc) from across the practices, who enable this team to feel an integral and valued part of the PCN.

Where it doesn’t work, and where more commonly we see turnover in the additional roles, is when those in the role does not feel like they belong to either a practice or a PCN team.  Problems occur when roles are isolated, and left to try and work with each PCN practice without really being a part of any of those practices and without any peer support to speak of.

As long as the new roles feel like they belong to either one of the practices or the PCN then which is not really important.  What is important is they feel like they belong somewhere.