After a slow start last year, when PCNs displayed considerable reticence about taking up the additional role reimbursement scheme (ARRS), things have taken off this year.  There is a recruitment frenzy underway, with thousands of new roles being recruited across the country.  But could all this recruitment energy be being expended in vain?

The biggest challenge PCNs face is not recruiting to the roles in the first place (although one colleague described it to me as being like the “wild west” out there, as some PCNs do whatever is necessary to secure candidates – regardless of whether they have already accepted an offer elsewhere).  The biggest challenge will be keeping the ones they do manage to recruit.

For a start, PCNs are not actually organisations.  They are collections of practices, so when an occupational therapist or care coordinator is recruited by the PCN it is not 100% clear exactly who they are working for.  It is this sense of the new staff not belonging that is difficult for PCNs to overcome.

There are already plenty of stories of new staff arriving on their first day who discover they do not have a base (“could you work from home for now…”), a clinical space to operate out of, or any sort of induction.  It is not going to be long before those particular new recruits start looking elsewhere.

Even for those PCNs that have managed to put the basics in place, there is still the challenge for any new starter of working across multiple practices.  Each practice has its own systems, processes and way of doing things.  Will every practice make the new starter feel equally welcome?  Unlikely.  More likely is that very quickly they will start to dread Wednesdays and Thursdays when they have to go to practice X and practice Y.

Introducing new roles into general practice has never been easy.  It is not clear to many GPs and many GP practices exactly what value the new roles can bring to them.  The challenge pre-PCNs of introducing new roles was not a lack of availability of the staff, but a lack of belief amongst practices that they could make a significant difference to the workload.  This has not changed just because PCNs are providing the funding.

“What does the dietitian/physician associate/health coach (etc, delete as appropriate) actually do?” and “can’t we just use the money for an extra GP instead?” are not uncommon questions in practice meetings discussing the new starters.  And it is into this environment that PCNs send the new recruits, often without any real warning of what to expect or any support in overcoming known areas of resistance.

Even when all the practices understand the role, know how it is supposed to function, and are fully briefed and prepared for it to begin, it is still challenging for any individual to feel like they belong anywhere, when everyday they are in a different practice working with different people, and always feeling like an outsider.  When hostility is palpable in half of those practices, the experience goes from feeling like an outsider to more like an unwanted intruder.

Clearly the new roles will work better when they are in, and feel part of, a team.  But what should the team be?  Should they have a ‘host’ practice, and become part of that team? Or should they be part of the team of all the new roles working across the PCN?  Or should it be by professional group – so all the pharmacists form one team, maybe across multiple PCNs?  Or should it be a PCN project team working on something across the PCN, which includes members of existing practice staff as well as the new roles?  Or something else?

I am not sure it matters what the team is, but for the (lack of) ownership issue to be overcome I am sure it is vital that the new roles are part of a team, with a leader, clear objectives, and identified support.

I know some places have done this, and where they have many already have a waiting list of applicants disillusioned with their new life elsewhere who are keen to join.  Recruitment may have been very challenging over the last few months, but it will all have been for nothing if that effort is not at least matched with an equal effort to look after these new staff.  High turnover rates in these new roles is extremely likely in the coming months, and the winners will not be those that pay the most but those that provide the best support.