Health and wellbeing guardians in primary care

This appendix document sets out guidance to how the function of health and wellbeing guardians can be implemented in primary care, as a deliverable within the NHS people plan and supportive of the NHS people promise we are safe and healthy.

This implementation guidance should be adapted to the local organisation’s need and used as a starting point and be applied flexibly, rather than seen as a fixed mandate or set of requirements.

Context of primary care

Primary care, including general practice, dentistry, optometry, and pharmacy, is a diverse and complex landscape with varying models of delivery. Therefore, the position of a health and wellbeing guardian within primary care will vary, and in some instances may not even be suitable where alternative models such as health and wellbeing champions may be better placed.

Local knowledge, information and engagement with leaders should be used to inform how the principles of a health and wellbeing guardian function could best be adapted and adopted into each local primary healthcare context.

Recommendations for health and wellbeing guardians in primary care

Appreciating that the adoption of the health and wellbeing guardian function in primary care will be driven by local context, the following models are offered to be considered and flexibly adapted based on local need. These models have been developed based on consultation and engagement with a variety of primary care sector leaders and practitioner engagement.

Large primary care organisations (for example, federations)

• For larger primary care organisations like federations, who have a senior management team/board in place, the health and wellbeing guardian function is likely to work well as part of an existing senior management team/board member portfolio. This would replicate the similar approach adopted by the larger healthcare organisations including integrated care boards (ICBs) and NHS trusts.
• Ideally, this should be a non-executive director (NED) or a lay member role or equivalent, to enable them to hold the senior management team to account for improving the health and wellbeing of all employees in their organisation.
• When appointing a NED health and wellbeing guardian, the NHS fit and proper person test framework for board members requirements should be adhered to.
• Responsibility for appointing a health and wellbeing guardian, and who the health and wellbeing guardian is ultimately responsible to, should be informed by what is most appropriate for the local context.

Primary care networks

• All primary care networks (PCNs) will be working closely with their local committees (medical, dental, optometry and pharmacy) and trade union representation to support the local needs of network organisational members.
• A PCN might wish to consider asking a member or local committee representative to adopt the health and wellbeing guardian function as part of their existing role, advocating the health and wellbeing needs of either the entire primary care workforce they represent or for the section of general practice, dentistry, optometry, and pharmacy to which they belong.
• Responsibility for appointing a health and wellbeing guardian, and who the health and wellbeing guardian is ultimately responsible to, should be informed by what is most appropriate for the local context.

Smaller independent practices

• Independent practices, including dentistry, optometry, and pharmacy, are likely to be too small to benefit from a having a health and wellbeing guardian in place.
• Instead, it is recommended that they consider rolling out health and wellbeing champions across their practice, where named colleagues are invited to champion and support the health and wellbeing of all team members at a team-based level. These champions can be supported by regional and national support and development.

Primary care health and wellbeing guardian purpose, remit, and support

Large primary care federations are likely to follow a similar approach to health and wellbeing guardians as those in integrated care boards (ICBs) and NHS provider organisations. For primary care networks (PCNs), they are likely to follow a similar approach, yet must be cognisant of being able to link in with and represent the health and wellbeing needs across their system of practices.

Purpose of health and wellbeing guardian in primary care

To seek assurance, independently challenge, and hold to account the senior leadership team of their federation/practice(s) and/or members of the PCN for developing a compassionate and inclusive culture of health and wellbeing, to ensure that all employees are cared for and enabled to deliver high quality of care to patients and service users.

Remit of health and wellbeing guardians in primary care

To champion the improvement of employee health and wellbeing, directly working with senior leaders across primary care practices/organisations to achieve this.

Primary care organisation infrastructure and support for health and wellbeing guardians

As this is an assurance function and not an operational doing role, health and wellbeing guardians require a team to support them with the operational aspects of improving employee health and wellbeing. Key support relationships are likely with:

• PCN members, partners, practice managers etc.
• Engaging with staff networks including a network of health and wellbeing champions.
• Working with peer health and wellbeing guardians across the local primary care landscape to support each other and collaboratively champion improving employee health and wellbeing across their local footprint.
• Supported by the regional and national health and wellbeing guardian networks and community resources.

Who should take on the function of a health and wellbeing guardian in primary care?

A nominated organisational/PCN representative who has competency, authority, impartiality, and confidence to challenge primary care leaders to ensure that employee health and wellbeing is a priority and is continually improving.

Key skills of a health and wellbeing guardian in primary care

• Is competent and confident to act as a critical friend to challenge the senior leadership team to take action to improve health and wellbeing.
• Ability to actively listen, appreciatively enquire, and robustly question the organisations leadership team.
  • By doing so, helping them to explore and mitigate the impact of their decisions on employee health and wellbeing and enact their corporate responsibility to improve the health and wellbeing of their employees.

Responsibilities of the health and wellbeing guardian

The health and wellbeing guardian achieves their responsibilities for advocating improving employee health and wellbeing by championing a health and wellbeing culture, seeking assurance, and holding the organisation to account, as follows. To achieve this, they will likely:

• attend the appropriate meetings with the senior leadership team/primary care network (PCN)/staff networks to champion health and wellbeing and hold organisational leaders to account.
• work in collaboration with and be supported by leaders for the organisation who represent practice managers, partners, and those responsible for human resource and organisational development and occupational health and wellbeing, or equivalent functions to discharge their assurance role effectively.
• participate in regional and national health and wellbeing guardian networks to offer peer support, share best practice, and influence the health and wellbeing agenda across their system.

These responsibilities will likely need adaptation to the local primary care context, appreciating the diversity and complexity of the primary care landscape. A detailed overview of the key responsibilities for health and wellbeing guardians is provided as follows.

1. Championing a health and wellbeing culture

1.1 Creating a proactive and preventative health and wellbeing culture: Using their senior leadership position and influence to advocate for a preventive and inclusive health and wellbeing culture based on organisational interventions, that recognises how good employee health and wellbeing leads to high quality patient care.

1.2 A role model for health and wellbeing: Role modelling when advocating for improving employee health and wellbeing the leadership behaviours as defined in the NHS our leadership way. These behaviours of we are compassionate, we are curious and we are collaborative are underpinned by key principles expected of all leaders to demonstrate compassionate and inclusive behaviour towards our people.

1.3 Networking and influencing across boundaries: Network with peer health and wellbeing guardians and leaders through regional and national networks, to learn from each other and to influence NHS employee health and wellbeing strategy and policy as levers for improvement.

2. Seeking assurance

2.1 The organisation understands the diverse health and wellbeing needs of its employees: Ensure that the needs of all employees are inclusively and regularly reviewed using a variety of workforce, occupational health, engagement data and metrics.

This may take the form of:

• seeking assurance that the organisation is regularly reviewing its NHS health and wellbeing framework diagnostic tool/assessment and workforce data (for example, the Wellbeing dashboard in model healthcare system)
• actively seeking out staff feedback/engagement through diverse networks that reach all employees, including adoption of an engaged network of health and wellbeing champions and where applicable professional nurse advocates.

2.2 There is a holistic strategy for improving occupational health and wellbeing for all employees: Ensure that a holistic occupational health and wellbeing strategy is adopted across the organisation whereby employees receive proactive, preventative and compassionate support for their mental, psychological, physical, financial, cultural, and social health and wellbeing.

This is as outlined within the NHS health and wellbeing framework’s seven elements of health and wellbeing and supported through the NHS growing occupational health and wellbeing together strategy.

2.3 Senior leaders continually review and act on employee health and wellbeing data and metrics: Ensure that the senior leadership team has access to, monitors, regularly discusses and acts upon findings from workforce health and wellbeing data and metrics, to demonstrate that the health and wellbeing strategy and services provided are improving employee health and wellbeing.

2.4 There is an inclusive approach to providing occupational health and wellbeing services and support for all employees: Ensure that supportive occupational health and wellbeing services, initiatives and interventions are addressing and improving the health and wellbeing needs of employees.

Through effective analysis of relevant data, the organisation should be able to demonstrate that the different needs of various staff groups are being met and ensure that necessary support is provided with particular consideration to the nine protected groups under the Equality Act 2010.

3. Holding to account

3.1 All senior leadership decisions consider the impact on employee health and wellbeing: Ensure that employee health and wellbeing is proactively considered in all organisational decisions and actions at senior leader/board level. Ensure that every decision made by the senior leadership team considers and mitigates impact on the health and wellbeing of all employees.

3.2 Occupational health and wellbeing are considered alongside other workforce, performance, quality and financial demands: Challenge the senior leadership team to ensure that the organisation is working with system leaders and regulators, to ensure that employee health and wellbeing is given equivalent weight to other key measures of organisational performance such as quality, finance and operations.

3.3 Work does not compromise the health and wellbeing of employees: Hold senior leaders to account to ensure that employees are not being compromised by the work they do and the environment they work in.

Ensure that when a never event, or event that causes unexpected trauma/adversity, happens to an individual or team, the organisation is taking action to ensure that the people affected are supported and learning is captured and acted upon.

In relation to the death by suicide of any member of staff, new national guidance for organisations is available in the NHS employee suicide: a postvention toolkit to help manage the impact and provide support document. The health and wellbeing guardian is entitled to hold senior leaders to account to ensure they are implementing this guidance, but the health and wellbeing guardian is not expected to lead or report on any investigation findings.

3.4 There is an adequately funded/resourced occupational health and wellbeing service/offer: Drawing on the NHS growing occupational health and wellbeing together strategy, ensure that the organisation is providing adequate investment, resource, infrastructure, capacity, and capability in an integrated and multi-professional occupational health and wellbeing support service that covers proactive and preventative interventions, through to responsive diagnostic and treatment services (for example, rapid access to physiotherapy and mental health services). Leaders of this function should be working with and operationally supporting the health and wellbeing guardians to discharge their duties.

3.5 All leaders and managers are responsible for improving the health and wellbeing of their employees: Ensure the organisation empowers managers and leaders to look after the health and wellbeing of their teams to create a culture of wellbeing through wellbeing conversations, manager training, and team wellbeing development.

Managers and leaders are held to account to role model healthy leadership behaviours, to keep their teams safe and healthy, appreciating that a wellbeing culture is dependent upon good organisational leadership and management.