Collaboration for Academic Primary Care (APEx) Blog
Collaboration for Academic Primary Care (APEx) Blog
Posted by ma403
12 December 2023Rural primary care practices in England function as the backbone of healthcare service provision for individuals living in rural and remote communities. However, these practices face an enduring challenge – the recruitment and retention of staff. While much attention has been paid to the shortage of doctors in rural areas, we must also shine a light on the equally vital roles of the other multidisciplinary team members, such as dispensers, nurses, pharmacists and administrators, who support the practice in providing care for the local community.
The shortages of qualified staff in rural practice has far-reaching implications, affecting not only the delivery of practice services, but the quality of care delivered and overall patient experience. Among these essential healthcare services, the dispensing of medication at the primary care practice stands out as a lifeline for rural patients who would otherwise have to spend additional time and funds travelling to the nearest pharmacy. However, little is known about how staff members working in rural practices value dispensing services and how such services are linked to the recruitment and retention of staff.
Our team of researchers, working within the Exeter Collaboration for Academic Primary Care team,(https://medicine.exeter.ac.uk/health-community/research/apex/) were funded by the National Centre for Rural Health and Care (https://www.ncrhc.org/) to investigate the factors affecting recruitment and retention of primary care staff in rural practices where they dispense medication to patients. We also wanted to find out how rural primary care practices view and appreciate dispensing services.
Between June and November 2021, we interviewed and gathered the perspectives of 17 people working in various multidisciplinary roles (e.g. GPs, practice managers, nurses, dispensers, healthcare assistants, a social prescriber and a clinical coder) at 12 different rural dispensing primary care practices across England. After the team listened to the recordings and analysed the these interviews, we discovered that primary care staff chose to work in rural dispensing primary care practices for various reasons, including; the feeling of having control over their career, the chance to grow professionally, and genuinely enjoying living and working in the rural area. However, there’s a challenge when it comes to hiring new staff because practice managers need to balance the skills needed for roles such as dispensing medicine with the fact that these jobs may not pay rates commensurate to the workload and level of responsibility that accompanies the role. Nurses, in particular, have their own difficulties, with some potential recruits being unsure about the specifics of the nursing role in a rural dispensing practice.
When it came to practices retaining staff, we found that the money that the practice made from dispensing medication was a big factor in keeping the overall practice running. Unexpectedly, we found that having a dispensary within the practice also gave other (often administrative) staff the chance to train as dispensers and offered opportunities for career progression. Unsurprisingly, the positive work environment provided a sense of satisfaction for employees. Overall, making sure staff are satisfied with their jobs by providing chances to learn and grow and receive adequate remuneration, and creating a good work atmosphere were all important for retaining them in their rural primary care post.
But there were still some problems to solve. Those working in rural practices believed that people who didn’t want to work in rural areas were put off by travel difficulties experienced, especially in winter months. Plus, there weren’t always enough people applying for rural primary care jobs, meaning vacancies were open for months at a time, and sometimes the pay wasn’t enough to attract or keep staff in post.
Since we conducted our study, we have presented the findings at several national and international conferences including a workshop, which sparked some interesting discussions about further research and policy change that can support rural dispensing practices. The full findings have been published online and will be available in the BJGP Open in January 2024 https://bjgpopen.org/
We continue to explore staff retention in our SPCR funded project Well-being of the primary care workforce — NIHR School for Primary Care Research