Creating a Workplace that Works with Dr. Sonali Kinra

Dr Rachel Morris: Welcome to another episode of You Are Not A Frog: How to Keep Good People. In this episode, I’m chatting with Dr Sonali Kinra. She’s a GP and a clinical associate for NHSE&I. She’s also the workforce retention lead for Nottingham ICS. We’re asking the question, just how do we stop people from leaving a job that they’ve worked for for many years, but maybe overwhelming, stressful and getting more and more unmanageable by the day? You may have asked this question yourself. And the good news is that there are things that make a difference.

So listen to find out the impact that culture has on job satisfaction. The motivation factors that really count, and why diversifying your career may be the best thing that you can do.

Introduction: Welcome to You Are Not A Frog. The podcast for GPs, doctors, and other busy professionals in high stress jobs. Even before the coronavirus crisis, many of us were feeling stressed and one crisis away from not coping. We felt like frogs in boiling water—overwhelmed and exhausted. But this has crept up on a slowly so we hardly noticed the extra-long days becoming the norm. And let’s face it, frogs generally only have two choices, stay and be boiled alive, or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. You have many more options than you think you do. It is possible to be master of your own destiny, and to craft your life so that you can thrive even in the most difficult of circumstances.

I’m your host, Dr Rachel Morris, GP and executive coach and specialist in resilience at work. I work with doctors and other organizations all over the country to help professionals and their teams beat stress and take control of their work. I’ll be talking to friends, colleagues and experts all who have an interesting take on this. So that together, we can take back control to survive and thrive in our work and lives.

Rachel: The Christmas season is traditionally a time of overeating, too much TV, and perhaps a bit of reflection before we set loads of resolutions for January that we probably won’t keep. Now it’s fair to say for many of us, 2020 has been a total car crash. You may be feeling a bit disillusioned, soft and lacking in joy this year. But now more than ever, we need to take back control of our lives, feel better, beat stress, and start to design a life in which we’ll thrive.

Now I know what it’s like to feel overwhelmed and exhausted and one crisis away from not coping. That’s why I created the Shape Toolkit programme for professionals in high stress jobs. And I’m delighted that it’s now available to all healthcare professionals as an e-learning course consisting of four modules with five videos each. It contains activities and exercises for reflection with up to six hours of CPT and it will help you take control of your workload, maximize your wellbeing, change your response to stressful events, and design a working week that you’re going to love.

Now I love to help you get ahead of the game. And I’m offering the course a special discounted price. And as a Christmas bonus, I’m including my brand-new eBook all about well-being. The stress less dashboard. So why don’t you treat yourself this Christmas? Give yourself a present of the course and I’m offering 100% no quibbles money back guarantee. So if you don’t find it of any value, we’ll give you your money back. So, do take advantage of this special Christmas reduced price offer, which is only available until the 31st of December.

Here’s this week’s episode.

It’s brilliant to have with me on the podcast today Dr Sonali Kinra. Now Sonali is a GP, living and working in London. She’s also the GP retention lead for Nottingham ICS and she’s just been appointed the interim clinical associate for the primary care team for NHSE&I. So it’s brilliant to have you with me, Sonali. Thank you so much for joining us in your busy schedule.

Dr Sonali Kinra: Thank you, Rachel, for inviting me. I’m looking forward to this.

Rachel: So I wanted to talk to Sonali because she’s got a really good perspective on workforce retention. And we had a really great chat the other day just about what we can do to keep the people that we want to keep, to keep our good people. And I thought that this is a huge problem in general practice and primary care and has been over the last few years. But I know that it’s also a big problem in other professions such as law, where they really struggle to keep, particularly women actually, particularly women with families, and other professional areas where they really sometimes do have a shortage of staff and turnover seems to be high. And people seem to leave after training for donkey’s years to achieve the position that they’ve achieved. And people are just upping and leaving.

So, I thought it’d be really good to just explore a little bit about why that happens. And how we can prevent that happening. Is there anything we can do to not only to prevent our colleagues from leaving, but to prevent ourselves from leaving. Right? Because I’m a big fan of the fact that there are small changes that we can make and it shouldn’t have to be a choice between staying sane, and thriving, and working. You shouldn’t have to leave your job in order to thrive at work. And presumably, that’s the sort of thing that you feel as well, Sonali. Am I right?

Sonali: Absolutely, Rachel. To be able to retain people, I mean—I go back to the report that was done by Michael West, who talks about the ABC of well-being, which is A which stands for autonomy, B is for belonging, and C is for competence.

But what is there? What is it that we are doing or not doing, perhaps, that people are leaving us? Like I said about the attrition, and we are seeing attrition that happens at probably those transition periods that are there. So if you’re looking at general practice, when you’ve been a trainee, and you are protected, given perhaps that protection, given that sense of belonging, and then suddenly you now then the training finishes, and you feel you’re at that cliff edge, isn’t it? And you’re out into the big world, which has been much harder during the COVID time, certainly.

Then what happens at that transition period, when you’re going from being somebody who’s been in their first five years of their career, and then they go on to that transition phase from going from the five to 10 years?

And then what happens at the other end of the spectrum, even what we call as the ‘wise five’. — how do we make sure that we keep those people who are—who’ve absolutely given it everything to their profession? Given their time, given all that brain space that they had? How is it that we can—how do we make sure that we can keep them slightly longer in the profession, not just for themselves, but for us, for them to be able to pass on their experience to us. You need the experience that they’ve gained, the relational memory, the organizational memory that they have built over the years? We absolutely need that. So, for me, I think it’s about what culture are we building in the place that would keep people happy in their workplace.

Rachel: I think that’s so right, isn’t it? Culture is such an important part of feeling happy at work. And I guess no two general practices are the same, are there? and you can work in one place and then go to another place, and it’s so much better than the other place. The work is sort of the same, isn’t it? You’re still seeing the same patients with the same problems. But I guess it’s how the partnership chooses to handle the patients and handle the workload makes a big difference but also the ethos of the partnership.

I’m interested in this interplay between the actual job and the culture. Because I think with the best in the world, if the job is awful, can you create a culture that’s so nice that people will stay and do a really awful job?

Sonali: Job’s tough wherever you go. I mean, I would say certainly, with general practice, having had exposure to that. But also having family members who have been lawyers, so both my sister and my sister-in-law are lawyers, they’ve got a tough job. My father has been in the finance world. And he’s now 72 and still date, he is not coming back home. And he likes to work from his workplace. He’s not here, he’s in India. He wants to go into his workplace. And still, he’s pulling those long hours, and he’s coming back home at 8:39 pm.

So the job is tough, the job is challenging, whichever sector you work in. But the culture, the fact that it makes the job doable, enjoyable, is going to be by the people who are there in that place. And I think what is going to—what makes that culture is the communication, the engagement, the transparency, the feeling that we are in it together. This is not about them and us. This is about that, if we’ve got something a problem at hand, or even if you tried to solve something, we’re going to be doing it together.

And I think for me, certainly, through the course of my career, tried to keep those lines of communication open. We used to have an open door. And if you’re not seeing patients, then the days are only when we were going to practise and only offering face to face, or even now, they’ll be doing a mixture of remote and face to face, keeping that open door so that my colleagues are able to speak to me.

I was leaving on the HR aspect for our practice. And all the staff, the receptionist, the secretaries knew that if they had an idea, if they had a problem, they were going to come and speak to me about it, and we are going to try to solve this.

Rachel: I think that’s really important that feeling that somebody else in your organization has got your back. And I remember the most sort of releasing thing that was ever said to me in a practice, just an offhand comment in a practice meeting. We were talking about some complaints that were going on and or someone had put in a very unreasonable complaint about—I can’t remember what it was and then the GP had followed the guidelines and whatever. And one of the managing partners said, ‘You know what? If you get complaints for following guidelines or even if you just make a mistake, we’ve got your back, we’re here for you. We don’t mind’. And it’s like, ‘Wow, that’s so releasing. It means that you’re not going to be so worried the whole time. That was really helpful’.

So I think a lot of professionals, one of the big worries, isn’t it? It’s doing something wrong, it’s making a mistake. And it’s—I mean, it just constantly astounds me that we expect ourselves to be 100% accurate. I mean, not even machines are 100% accurate. And then we absolutely beat ourselves up when we do something wrong or make a mistake. And it doesn’t help by the general public expecting us to be 100% accurate and have an absolute witch hunt, when we do just make a common mistake as if we’re meant to do it.

But just having an organization that you know is going to get your back, I think makes a huge, huge difference. Well, certainly GPs, in my experience—and I know GPs have left when they just felt how to complain or felt completely unsupported by their practice, it makes a big difference, isn’t it?

Sonali: So I think you’re right, we do beat up ourselves, beat ourselves over it. We are specialists in generalism. And certainly, I think our job is harder, we are supposed to know a lot or a little bit about everything.

So I think the organisation or the senior leaders, I would say. And when I say senior leaders, I know there’s sometimes a little bit that has to do with, ‘Should really be having a senior partner or a junior partner whichever way’? but it is the role of people who are perhaps more experienced to have the back of those people who are new into their careers. We should be providing that for our trainees.

Rachel: So I’m particularly interested in people that are leaving the workforce because of the workload, because they feel they just can’t cope with the workload. And I’m just wondering, in my head, how does culture help with that? Because actually, bottom line, if you’ve got too much work, you’ve got too much work to do. And if there isn’t anyone else to do it, you’ve just got to do it. So how can an employer or a practice—how can you help with that and stop people leaving because of that?

Sonali: I think, and I hear that, Rachel, I hear that a lot in terms of that. If you’ve got the workload, who is going to ensure that the workload from 8 till 6:30, which is the in hours, the encode hours that you’ve got in general practice, you have to make sure that everything that comes through the door or digitally gets dealt with within the day? So, does culture impact that? Absolutely. It does.

Who is communicating within your workplace as to what, how much workload is coming through? What discussion has taken place how we share that workload? Sometimes people feel that okay, perhaps maybe, there is not equitable share of the workload. And then that immediately impacts your morale, isn’t it? Because then you’re feeling that what I’m doing is more than what the other person is doing is less. And then that just widens the gap, your motivation to be able to do the work also goes down, because you feel that there is a dem.

And that’s so is that communication, that engagement taking place, so that you’re able to share with the workload has been. And I think the discussion is not just about as to what those discussions are happening internally. Feedbacking—doing the feedback as well, that there is an increase in workload, you gradually increase your sphere of influence so that you’re able to impact the bureaucracy that has come in which impacts our workload.

I think also within what else impacts the culture certainly would be, if you are sharing that you’re struggling with your workload, maybe get people into the discussion as to is there a more effective way of doing this? Is there a more efficient way of doing this? Simple examples, again, I know my examples are perhaps more general practice related, given my knowledge expertise is at, there is when our blood results come into the system, or the way our letters from the hospitals come in into the system. That would be practices perhaps that have been able to streamline that process, whereas in the other places, they haven’t. And because they are in that vicious cycle or a spiral of the fact that there is too much workload, there is no headspace, you are not able to put your head above the parapet. See what else new innovative techniques are coming out that and not able to bring that then into your workplace, you’re just going down that spiral.

So if you’ve got perhaps like a trainee or a new person who joined your team, who may be buzzing with ideas, but then if you’re drowned in the workload, your head is down, they’re not going to necessarily be able to approach you with that idea. And you’re not necessarily going to be able to reduce that share that workload, which they may have actually brilliant ideas for.

Rachel: Yes, and you see them as the problem that they’re just moaning about the work. Rather than actually—they’re coming in with some solutions. And I think sometimes they might be a little bit of a culture gap between the old guard and the new people coming in. These old sort of cradle to grave GPs that we’re on call every—I mean, I still remember, my dad was a GP, in the sort of 70s 80s, well 90s, and 90s, actually. But we couldn’t go out for a weekend because my mum had to stay in to take calls from patients. And then she’d have to bleep my dad wherever he was. So yes, he was just on call all the time.

And, but then the workload is much less sort of during the day. So it’s a completely different way of working. And I have experienced, when we’ve said, we fed back to maybe all departments saying, ‘Actually, it’s probably not fair that you’re just piling extra and extras and extras. Can you do anything about it’? And the responses will, we’ve always said it like this, ‘So you just have to suck it up’. And that’s an incredibly demoralizing, demoralising place to be. And I think people have experienced that sort of reaction and just get completely fed up with it.

Sonali: Absolutely. I think. And COVID has that way been? It’s been interesting, isn’t it? Because we’ve all had to adapt to change overnight. And perhaps some, if not all of the professions have beautifully, have we adapted and look at our patient population, how they have adapted to all of this stuff.

So change is possible. I mean, unfortunately, it had to be a pandemic for us to move towards that change. Change is hard, isn’t it? It’s hard for anyone and everyone. There’s some people who are—there’s a beautiful curve again for changes, you’ve got the laggards. And then you’ve got the—divide always the world in two thirds, is to those people who are going to be running happily with seeing anything that is new and shiny. And there’s some people who are sitting on the edge just trying to see what’s happening. Let’s watch and wait and watch whether these people are going to still be happy and shiny, and then they’re going to be the laggards.

But keep those doors of communication open, keeping those channels open so that you could perhaps be having an—you know, somebody coming to you with an idea to say that would actually make your life better, and much more effective. And then you would be able to get home in time and not really be burning the midnight oil.

Rachel: That’s funny. I’ve heard from someone that during COVID, their senior partner that has just blocked any sort of triage, blocked telephone triages, blocks online triages. Literally, overnight, was forced to do online consultations. And then they said. ‘Oh, actually, it’s quite good, isn’t it? It’s actually working’. So a lot of people have been forced to make some quite big changes. So I think Coronavirus has been obviously devastating that there have been some processes that are coming out of it, that we will take and we will run with. And I’m hoping that that will help the retention crisis. It will help keep the people who would otherwise be leaving because it’s forced us to address the issues that we’ve got.

We needed to change to help with workload but I am hearing that the workload is just going up and up and up. Now it’s pretty exponential for GPs. And I was just wondering, what else you would be advising practices to do, in order to keep their GPs or to keep their people?

Sonali: I’ll put culture always at the top of it. There are lots of national incentives and schemes as well that have come through, certainly for people who are at the start of their career. So you have the new practice scheme. We also want to encourage people to get into partnership. So, there’s the New to Partnership Scheme. And then we’ve also got the senior mentor scheme that people who are there in the wise five or others can become mentors.

And locally, within Nottingham, it’s tough. It’s our mid-careers that we worry a lot about, where people have not had—people like you and me perhaps who have not had the opportunity because these schemes weren’t there when we had just come out of training and the mid-careers really do. And I would say not just GPs, I would say actually, across the profession, our GP nurses, mid-careers really hold the place together. And so what is it that we can offer them to be able to keep them?

And I think more and more, I have been aware what we haven’t had is coaching and the use of coaching in our personal and professional life, and the benefit of it being different from mentoring. And I really think we have to see if you’re able to create ways where people have access to coaching.

So during Coronavirus, the people’s direct rate within NHS England certainly made coaching available callers looking after you too available to anybody who was working within the NHS and I utilised that. I did about three or four sessions with it. And just the perspective of—the lens with which you look at certain problems absolutely changes, and you’re given some time to reflect where you’ve been but equally how you really worked through some of those really have problems at times, and where you’re still taking the lead. So it’s not somebody else solving the problem for you, but you’re still taking the lead to be able to do that.

So I think that is certainly something that would be beneficial to consider for any profession. Sports people that have coaches, you know, throughout their life, isn’t it? And that there’s a nice article written by a surgeon, Atul Gawande, who talks about surgeons having coaches. So have a coach in your theatre room? Why do we stop doing that when once you finished your training and the merit that is in it?

I certainly think—I think that would be quite helpful. I think one of the other things that I’ve noticed more recently, has been about the salaried or sessional GPs and the partnerships. And it’s perhaps worth exploring as to this dual role that we have now got within general practice where you’re a partner GP, or you’re a sessional GP, and where does the ownership of a business or the lack of ownership of a business amounts to non-belonging to the practice. And I just wanted to actually explore that a bit further. What has led to that gap between people who are owners of a business and people who aren’t?

Rachel: Yes, and I think this is something that is really badly done in general practice because sort of traditionally, everyone just became partners. Even being a partner because it was almost like a career decision, I want to be a partner, not I want to run a business. And it was almost to do with seniority and all that sort of stuff. And then you’ve got the people who came along with salary GPs, portfolio GPs because they didn’t want the responsibility of having to run the practice, but they were still clinically just as good.

And now you’ve got this sort of weird two tier system. You’ve got partners who are supposed to be running the business, but most of them don’t run the business or some of them do, some of them don’t, it really, really varies. Expecting that the salary doctors will have just have the same commitment to the practice as they do. Even though it’s not their business and almost expecting the salary doctors to take the same amount of business responsibility. It’s a very weird system, where I don’t think the expectations on either of them are very clear. I’ve done lots of team coaching and practices. And there’s some partners that just completely abdicate all responsibility for any of it and just wants to see patients and they think, ‘Well, why are you a partner, then, if you don’t want to do that’?

Sonali: And perhaps something for us to learn from other professions here, isn’t it nice and neat? I think the law world has perhaps—is perhaps, ahead of us in that journey, because they’ve had some kind of equity Partners, non-equity Partners. So really, I mean, what I’ve only seen a little bit from my sisters and sister-in-law’s, it still keeps that sense of ownership. It keeps that sense of—sorry, the sense of belonging, where you can impact change, and work together.

So I think it is something worthwhile exploring and I think something you said there about portfolio roles. Also how it—salary became synonymous with or the portfolio role became synonymous just with sessional, or salary. Well, it’s not true. Partners also do portfolio roles. I have been—I think, I have been a pathology before now majority of my career. And enjoyed it because it is hard to do only clinical work, doing that for eight sessions or nine sessions. You want to—you’ve had Surina in your previous podcast—to be able to actually do work flexibly do other things as well just keeps various parts of your brain active.

So I encourage people that you should look at exploring progressing your career. It’s not just about vertical progression, number of years that you gain in the clinical side. It’s about horizontal as well. You know, it’s you want to look at you could have interest in education, you could have interest in leadership, in management, in people development. And we do have, we do have these options available.

So just look at—think one of the other things I would say that you asked about retention was also kind of look in the broader sense. What is it? Clinical practice is giving you joy, which is brilliant, but broaden your horizon, as well. I know people will then say, ‘Well then, but we do need people to be doing the clinical work’. I get that. But that’s how we will also attract people into our profession that ‘Come and join us because it’s enjoyable and it’s valuable’.

Rachel: Yes, it’s that fine balance between we need bums on fixing patients, but we want to keep people and with the best one in the world doing 10 surgeries a week is not a way to stay sane. I think this comes all the way back to what you said just now about coaching. And I think coaching is so simple, so not on my own sort of career change, or whatever. And I did that through having coaching. And I got further in three months and I would have done in 18 months just because I was looking at what I really enjoyed and what I loved. And I then found a way of staying and staying and doing bits and pieces of this. But also diversifying and doing other stuff. And I’m such a big fan of diversifying. And I really feel that if you diversify, and you encourage people to do other things, they will then stay in general practice because uses other bits of your brain gives you a different type of team, it allows you to be maybe more creative. I think doctors are very creative people. They can’t necessarily get that creative when you’re sort of churning through your 20 patients.

But designing and planning and doing all this. And it helps you what’s your strengths as well. I think that’s something we don’t talk about as doctors. What are your actual strengths? And there are all these sort of online Strengthsfinder surveys and things you can do. And they’re absolutely fascinating. I did one and I went, ‘That’s why I like doing that’. One of mine is communicating ideas, that’s one of my top strengths. And like, ‘Oh, oh, that’s why I sort of liked in podcast’. And that’s why I like speaking at conferences because it’s communicating.

But actually, if I’d just stayed exactly in the role I was in, I wasn’t doing any of that, it allows you to develop. And actually, it’s not about making a massive career change, often just small changes. And that’s what this podcast about I guess, is small changes and people call it job crafting. And I think we probably need a bit more help in crafting our jobs, said it makes us want one to stay.

Sonali: Absolutely. So interesting. You said about strength finders. So, one of the things within next generation GP, which is a leadership program started a few years—a couple of years ago, three years ago. We do use a Strengthsfinder approach in that, and they have a session on Strengthsfinder, which is absolutely marvelous. Because one, you get to see your strengths individually. But when—I remember the last time we did it, you also see your strengths as a team. So you’re just people sitting around the table, and seeing what you can really bring out in each other. So it’s kind of building that peer network, as well. So you get to know each other as to what you play to each other’s strengths.

And then something you said there about the job crafting. So one of the things again that could help, and I’m sure will help with retention is where we ask our people what matters to them most. We’re always now being told, ‘Ask your patient, what matters to you’? Why are we not asking the same question to our workforce? Let’s try to make a job around them. And so make the job fit the person and not the person fit the job.

And then they feel that they’ve created something together, and that’ll evolve, that’ll change. So when they’ve got perhaps little kids, the job will look very different. When the kids come into their teenage years, and when they may not want you at all to be breathing down their neck, the job will look different. And then when you know when they fly the nest, it’ll look different.

And again, finally, why are we not talking to our own to say, ‘What really matters to them’? And I think there are some people who are doing this and they’re doing an absolute marvelous job at it. And then they will retain those GPs. Another I would say, and people say, ‘Oh, it’s just probably the areas which have got enough resources. It all comes down to funding’. No, so we have a fantastic project which is called as the Deep End project, which was started in Scotland. But they’ve also—from that they’ve developed something called as a trailblazer fellowships. And this was initially done in Yorkshire and Humberside.

So the trainees—and these are in those areas, which are very deprived. So they had trainees they were given the support, the trainees were given the support and a fellowship in that area. And 95% of these trainees are retained in the same practices where they have done their treaties of fellowship. Isn’t that amazing?

Rachel: Yes, that’s really wow, that is amazing.

Sonali: So these are technically meant to be quite hard areas. And what is it that we are doing to support them? They’re actually then they want to stay. So we’ve addressed some of the retention problem there, isn’t it? And how to mirror that to make sure it happens the same for our mid-careers?

Rachel: Yes, what factors do you think did keep them in there?

Sonali: The support, valuing, going back to the purpose, the peer network, learning from each other. And also, some of the other things out around that multi discipline team approach. It’s not always the general practitioner who is going to solve everything. We think that we can. So you need to look at the wider team. And it’s not just the health team, it’s the care team as well. So what’s happening with our volunteer sector? What is happening with our social care team?

I had the opportunity when I was in Nottingham to go and sit with our council in our city council, just to see how they deal with the same people. I just see them in my clinical room, they’re there seeing them at their triage and all on discharge. And a lot of things we were trying to do the same things. But in some things, they are so creative, that really crafting that around what the patient’s needs are. But just if each spoke a little bit more to each other. I think I was told I was probably perhaps the first GP who had ever gone and sat in the city council to see what was happening at their triage and then how did they see a patient journey, what services they needed at home. And then at the discharge point when they were getting discharged from the hospital that transition again. So yes, so I think I think what probably perhaps does help in that retention is to have that wider team approach.

Rachel: Yes, yes. So have a wider team approach, help make someone feel supported and valued in their jobs, help them craft their job search, you say more of what they’re good at, rather than just say, ‘You’re a salaried GP, this is what our salary GPS do blah, blah, blah, blah’. But you will do exactly the same, actually craft it to the person and get them doing different things. And then anything else that strikes you as really important, if you want to keep your people?

Sonali: I would say so again, and I keep going on about the culture, but having that inclusive culture. You had—you covered in your last podcast, it was brilliant. I don’t even know the last podcast, but with one of your podcasts on how to be actively anti-racist. And simple things in terms of some of the things that you said about saying the name properly per person who works with you. How much difference it makes where people are not having to use their short names or nicknames just so that they can have their name pronounced properly. Truly building that. We’ve got a richness in general practice, I mean, in London, if I look at the diversity that is there. But are people truly feeling included? Are you really giving them that space that they can do some quality improvement?

So yes, I think inclusive not just for the sake of it, but because of the richness that it will bring to your life.

Rachel: Yes. And that goes right back to what you said at the beginning about the three things that the GMC report talks about autonomy, belonging, and competence. Give autonomy, give them choice over their careers. These are professional people, but trained for a very long time just treating them like shift workers is not good. Help them feel that they belong, that they are valued members, even if they are not the business owner. They’re not partners, they are a valued member of staff, they can contribute stuff to the running of the practice.

And then the C is for sort of competence, giving them the resources and the skills that they need to do the jobs. That’s very stressful, isn’t it? Feeling you’re out of your competence zone, being asked to do stuff that you don’t know — I guess, in general practice, is quite a lot, anything can come in. But if you have the support and the resources, and even if the workload is high, actually, that’s okay, you can sort of cope.

Then I think, finally, there is that thing about the workload. And it’s like you say, we can’t just use that as an excuse. We can’t just say, ‘Right, it’s workload, and it’s just never going to get any better’, because actually, some practices managed to nail it and some don’t. And some practices have made some decisions not to earn as much money in order to have more people covering the workload in order to—they’ve made this decision to be flexible to really nail down and hammer their processes, so their GPs aren’t just under it all the time. And I’m sure you’ve seen a massive variety of the way different practices do handle that.

Sonali: Yes and there is something in there about the regulatory bodies as well to help out. Because there has been over the years we’ve seen, isn’t it a bit of a mission creep with the bureaucracy? So where is it that we can change the processes? So, the appraisal process, we’ve seen how it needs to go through that evolution? Is it really fit for purpose, we keep now. There is a great article in BMG about is it fit for purpose. Is it achieving what it was meant to achieve? What’s happening with CQC? I mean, yes, there are regulatory body, but again, what is the purpose? Is the practice—are they being supportive to the practice so that they are able to provide the services to the patient or is it—we know that there’ll be a domino effect if a practice gets shut down, isn’t it?

So what are the regulatory bodies that are doing that can actually support the general practice. And we try to remove those, those bureaucracy things were really—that during the COVID times, there was a huge reduction in the reports that we have to do, or the insurance reports or the other reports that have to do and just not having that overload actually made it enjoyable, didn’t it?

Rachel: That’s interesting. It makes me think about Herzberg motivation-hygiene theory. From the 1960s, Herzberg says, ‘Forget pay, forget rewards, you just need to make their jobs more interesting’. And it’s about the fact that you’ve got these things that motivate you. There are motivation factors, and you’ve got things that demotivate you, there are hygiene factors. And they’re not the same. So you need to remove unnecessary bureaucracy, you need to pay people properly, you need to make the processes okay, you need to give them a good working environment. And if those are all there, that’s great, people won’t be demotivated, but it won’t motivate them.

In order to motivate them, you need to have purpose. You need to be recognized for doing a good job. You need to feel that you’re doing a good job. You need to have relationships. You need to have opportunities to grow and to develop within your work rather than just being so stuck in a dead end job doing the same thing day in, day out. And I think sometimes we think that just getting the pay, right, or just maybe getting the processes right is all there is without remembering the other half of that.

Sonali: Yes, it’s about growing as a person, isn’t it? You have to make your life exciting, interesting, just like in your personal life. How do you keep your relationships exciting, interesting? So just like what you do in your personal life where you go those changes, I think the same should be given to professional life. And diversify. Yes, diversify. Take people along with you, don’t leave people behind. Keep those channels of communication open. But also—and reach out to some because not everybody would perhaps be able to come and speak to you very easily. There are some people who may not have had those opportunities, or may have put their head above the parapet and only to be shot down. So look out for each other.

I think I go back again to having someone’s back. So look out for those people within your teams who will not be the ones to put their hands up, give them a nudge. Have that discussion with them before your Zoom meeting for five minutes or 10 minutes to say, ‘How are you doing? Are things okay? Is there anything that you want to talk about? How is life? Where do you want, which way do you think you’re going’?

Rachel: So we’re nearly at the end of our time, Sonali. I’m just interested, if you had three top tips, both for the employers, the practices, but also three top tips for the professionals themselves, to keep themselves in a job that they’re going to love? What would those tips be?

Sonali: Wow, three top tips. So, for the organisation, I would say communication, communication, communication, really—in any shape, way and form. Use digital, use knocking the doors, talking to people, whichever method works. Keeping that transparency so that they don’t feel that they’re being left behind. So, communication would be certainly my top thing with regards to from the organisation.

From the staff point of view, I think I would certainly ask people to consider coaching. You’ve got the offer available through the NHS, it’s free. So no reason why people at least—but certainly, and I would imagine in the other professions, if anything, perhaps people have more access to it. We are still catching up in the NHS. I think the other professions are perhaps ahead of us. So as an individual, I would say certainly, coaching. I would say having some sort of kind of reaching out, if you think you feel okay with it, is to reach out to others for just general chat about your career. ‘Where do you think I should be going? Where do you think I am going’?

And then third, I would say is also asking about building a job around you. We’re not in a sausage factory. We’re not just having an—going around in the conveyor belt. We are humans. We’re people. We all bring some emotional baggage with us that whatever happens at home impacts your work life. So, have those discussions as to how can that job be built around you.

And I think and perhaps that goes both ways. Because it’s not just for the individual to be able to ask that, the organization has to have an open mind to be able to actually do that. But if they do that for everyone, then one, nobody feels left behind. Two, everybody feels that you know they’re pulling their weight in whatever needs to be delivered, which is your bums on the seat from 8 to 6:30. And three, you will fill those gaps as well. Because if you put a problem to an organisation that this is what we need to cover, then you work out between yourselves how we will cover that period.

Rachel: Yes, yes, great advice. And I think that that thing about take charge of your own career. Make sure you are reaching out, you’re doing stuff, you’re diversifying. So I think the worst thing I’ve ever experienced is to be stressed and bored in work at the same time, really stressed and really bored. Like, ‘What’s going on, I’m not getting anything from this’. We human beings need to grow and learn and develop. And if you’re feeling bored, even if you’re stressed, just do something that’s going to challenge you or learn a new skill or learn something different, or reach out and go and find those opportunities. But there’s opportunities, they are out there, but they’re not necessarily either advertised and they don’t necessarily land in your lap. So you need to be a little bit proactive about going out and finding that out.

And like you said, I’m a huge fan of coaching. So, get some coaching. What is it you actually love to do anyway? And how are you going to go find out? How are you going to progress and just try different things? I think most people I know in the NHS who’ve got really interest in varied careers didn’t go, ‘Right, I want to do X. And here’s my career journey through 10 years’. It’s like, Oh, I’ll try that. And that has led to this and that’. So I’m sure that it’s exactly the same for you. Sonali.

Sonali: Absolutely. It’s actually been that and yes, interesting you say about those opportunities aren’t always available. Join social media, I would say. So Twitter. So the way it is I look at Facebook or Twitter. Facebook helps me connect me to my past life. So to my friends in schools and college, but Twitter helps me to connect to my future.

So join those places, because—and you have a huge medical Twitter family that is there. And people are welcoming that. Yes, I completely get it. There are some good days and bad days that you will have. But I would certainly say, at least for me, personally, the good outweighs the bad that has been. So try it.

Rachel: Try it. Good advice. Well, thank you. And I know you’re very active on Twitter. Say, if people wanted to contact you find out more about you. How could they do that, Sonali?

Sonali: Absolutely. Yes. I’m on Twitter @SonaliKinra. Happy for people to send me a message. And anybody who—I’m not saying that I’m a career counselor, or a career advisor but always always, I’m happy to have a discussion or help you put you in touch with others who may be able to guide you better. But so yes, message me through Twitter or send me an email. Quite easy, sonali.kinra@nhs.net. Or any trainee who is going through a transition phase or somebody in the mid-career, who just wants to—feeling stressed and bored in their workplace and yes wants something that makes it more exciting, more enjoyable, and more belonging to where they are.

Rachel: Great, thank you so much. So yes, and I just encourage people to access, access all these opportunities available. And if you can get some coaching, it’s just, it’s transformational. It’s not just for people who aren’t performing. It’s for people who want to do their best—you never get a professional athlete without a coach. And I strongly believe that if you want to do well in life and career, it’s good to get some coaching. So, thank you so much for being on the podcast. That’s been fantastic. And hopefully we’ll get to speak again soon.

Sonali: Thanks so much, Rachel. This has been interesting.

Rachel: Thanks. Okay, bye.

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