“The NHS is not great at team working”

This was a surprising statement from a non-NHS colleague who I really respect. Surely the NHS with all its different professions depends on good teamworking? Looking back on the year I reflect that there is a lot in that statement. Sometimes outsiders looking in can see what we miss. I'm pretty sure that building diverse teams, that share power and influence, is key to the future of the NHS.

I’ve just spent my 5th year as clinical director of a Primary Care Network. These organisations were set up to encourage GP practices to collaborate, and to embrace a wider range of roles. But we often butt up against resistance to change and the distrust towards new professional roles. I often see fierce defence of professional territory, or personal empire. The default position often seems to be resist and close ranks.

The kick back that Physician Associates have had this year is an example. I saw so many on social channels quick to jump on the bandwagon of scapegoating the role. There was a huge spotlight shone on mistakes of a few, that were used to build a narrative that the role in the NHS was dangerous and unwanted. From what I could see the main risk stems from the lack of protect time for supervision and mentoring. Too often staff are pressured into offering much more than they are comfortable with, too afraid to speak out, within a system that is over stretched, and all too happy to let the most junior staff stake the strain. The lack of willingness to offer, or to make time for supervision, has challenged many other new roles in networks I’ve observed.

Building teams has always been core to what we’ve tried to do in our Primary Care Network. But it’s not automatic and requires deliberate strategy. I’m a fan of Patrick Lencioni’s 5 dysfunctions of teams, as a guide to overcoming barriers to great team working.

At the base of his pyramid of good teamworking is trust. You must purposefully build trust as a team, make time for it, value it. In my experience the culture of trust is created by the leaders. Instead of heroically trying to be right about everything (a fruitless and exhausting pursuit), it helps build trust If leaders create a culture of sharing vulnerabilities. This also helps the next level up of ensuring it is safe to challenge each other. Teams that feel safe to actively encourage debate over differences, rather than avoid conflict, do much better.

Teams also need diversity. Diversity of views, backgrounds, thinking styles, and these are often best achieved through a wide range of roles. Great teams embrace new professions and approaches. Its why having a much wider range of roles in primary care should be a real strength. But too often I see those in traditional positions of power resisting diversity, and wanting to maintain autonomy and control. Often I see they do this to look after their own interests, rather than consider the wider staff pool, patients or local populations.

As we move into the next round of GP contract negotiations, I really hope those with the best interests of our populations are allowed to create conditions where new roles flourish, leaders show vulnerability and encourage dissemination of power and decision making. If we purposefully build diverse teams that function well in the NHS, I think we will be best placed to weather the tough times ahead.