Supporting workforce health and wellbeing: John Street Medical

According to Beyond Blue, healthcare workers exhibit higher rates of anxiety, depression and suicidal ideation when compared to the general population.

And the RACGP’s latest General Practice: Health of the Nation report says 71% of GPs experienced feelings of burnout in 2023.

We have profiled two Tasmanian primary care practices – John Street Medical (below) and Bodysystem physiotherapy (here) – who are making a conscious and significant effort to look after the health and wellbeing of their workforce – with great results for both staff and patients.

Dr Bailey Dunn’s bio on her practice website describes her main area of medical interest as the ‘science behind happiness’.

When asked about this, the former Canadian says she’s fascinated by the idea of what we can do to live happier, longer lives.

“It’s really understudied – there are centuries of research on depression, and very little on happiness,” Bailey says.

“I want to do what I can to create a positive energy for the people I interact with. I find that really rewarding. Why should we wait until there’s a problem to prioritise that?”

It’s a philosophy which – alongside a sharp business brain – led the GP to introduce new ways of working at her John Street Medical practice in Kingston, south of Hobart, which are reaping rewards for staff and patients alike.

Bailey and her husband Matt Grundy – a civil construction manager – bought John Street Medical in late 2019 from its retiring owners, who had been caring for the local community for more than 50 years.

She had been doing her final term as a registrar at the practice and – despite “never having owned anything more than a houseplant” – decided to take the plunge and buy the business from her employers. Only months later, the COVID pandemic hit.

“All of a sudden our doctors, our receptionists and nurses were really tired and calling in sick, (public health) policies were changing all the time, and the demand in the community to see a doctor was greater,” Bailey says.

She had been brewing some ideas to grow the business while creating a happier and healthier work environment for her staff, and COVID became the catalyst for putting these ideas in place.

At the heart of the new model is a burnout prevention (BOP) roster which staff have called life changing.

Bailey stopped weekend appointments and instead opened the practice from 7.30am until 7pm Monday to Friday, increasing the total number of appointments from 155 to 199 per week – making better use of the five consulting rooms. GPs don’t have the option of working full time at the practice.

Most work two or three days a week, and each 5.5-hour shift is 7.30am to 1pm or 1.30pm to 7pm.

This meant hiring more staff, which was tough to start with – until word got out that the practice was a great place to work.

It now has 17 GPs, five nurses and six admin staff, and every week Bailey gets calls from doctors wanting to work there.

“It took a bit of trial and error to get it all moving, but we’re lucky we’ve got a really young group of doctors who are open to try new things,” Bailey says.

“When we introduced BOP, we said we were going to try it for three months. At three months, everyone said ‘this is working so well’, so we said we’d do six months. And at six months, there was no one putting their hand up saying ‘I think this is a bad idea and we should go back to doing 9 to 5’. It just didn’t come up.”

And, importantly, the changes led to a 30% to 40% reduction in GPs calling in sick.

Dr Samantha Wyton started working two days a week at John Street Medical – which in 2022 was named RACGP General Practice of the Year for Tasmania – in March 2021, around the time the changes were being put in place.

“Patients love the flexibility of timing for the early morning and evening sessions so they can fit in around work,” Sam says.

“And I use the time before and after sessions to drop off or pick up the kids from school, meet my husband or friends for coffee or lunch, get any life admin jobs done and fit in a bit of exercise.

“It also gives me the opportunity to follow up on results, complete script requests, write letters, get advice from non-GP specialist colleagues or do home visits which I find helpful as it means I can be more present with my patients when I am consulting as I’m not interrupted as much.

“I believe Bailey’s style of recruitment and rostering can be rolled out to many practices across Tasmania.”

Part-time work doesn’t suit everyone; if GPs are seeking more hours, Bailey encourages them to have a ‘side hustle’ away from the practice.

Bailey lectures at the University of Tasmania and is training as a pilates instructor; Sam pursues her interest in perinatal mental health and breastfeeding medicine at a specialist women’s health clinic; other GPs work with the State Government’s COVID@homeplus program or as part of Primary Health Tasmania’s Tasmanian HealthPathways team.

“It’s just different enough that they don’t have that feeling when they walk into the building and go ohhhh, I’m here again,” Bailey says.

“We’ve had doctors say they want to work full time with us and we’ve had to say no, which is a really interesting place to be in in general practice – most practices are desperate to get doctors, but I’m not interested in quick solutions.

“We’ve got this wonderful team of clinically excellent doctors and if we don’t put some measures in place to protect them, that’s going to be short lived. We don’t want doctors who are burning the candle at both ends.”

As well as being better for staff, Bailey says the team has had good feedback from patients.

All appointments are for a minimum of 15 minutes, and patients value the long week-day opening hours.

“Also, I think our staff have more energy to be good doctors,” Bailey says.

“It requires an enormous amount of brain space to be switched on every 15 minutes for a new presentation, and sometimes it’s soul-destroying when it’s one bad news appointment after another.

“People reveal really heavy things to their GP – that’s quite a privileged position to be in and I don’t take it for granted, but I also need to be feeling clever and attentive and empathetic when that happens. And I can’t do that if I’m really tired.

“I want to have the opportunity to call a patient at the end of the day and not think ‘oh, I have to call this person when actually I really just want to get out of here because I’m so tired’.

“I don’t have those feelings anymore.”

John Street Medical’s staff-centred practices

• No weekend work
• No full-time work
• Shorter daily shifts
• Online booking system: “What our reception staff find most fatiguing is the phone calls – trying to engage in face-to-face interaction with a patient when the phone keeps ringing. So we use HotDoc now for online bookings, and that’s certainly relieving a lot of the reception work.”
• Get the right practice/office manager: John Street has landed on the model of a part-time office manager, Kyra Knighton, who focuses on the ‘people’ (staff and patients) side of the business and a full-time practice manager, Janine Harding, who is experienced in the ‘nitty gritty’ of Medicare, clinical software and public health policy. “Together they can achieve so much!”
• Encourage ‘restorative activities’ in non-work time: Such as swimming, hiking, yoga. One GP, Dr Nurman Noor, was a finalist in TV’s the Great Australian Bake Off!
• Social activities: “Kyra organises a staff social activity like yoga, painting, or a quiz night every 6-8 weeks. This helps build team morale and encourages staff to have fun.” Encourage autonomy among staff: “Our wonderful reception staff and nurses have a great sense of autonomy; we encourage them to sort the rosters amongst themselves because they get along well, they know the hours we want filled, and they know the preferences they each have for working hours.”

This story features in Issue 17 of our Primary Health Matters magazine. Click here to read the rest of the issue.