One presentation within the session, led by Megan Brown, focused on public and staff involvement in workforce research, and the role of co-production in shaping work that is relevant, and grounded in lived experience. Megan presented our approach to community inclusion and engagement with patients and staff, describing our approach to co-production. Discussion in the room reflected the recognition that workforce challenges cannot be understood, or addressed, without creating spaces where different forms of expertise are taken seriously.
Following this, we asked participants about which staff groups are hardest to engage meaningfully in workforce research and education. Alongside familiar groups such as busy clinicians and survey-fatigued staff, receptionists and other non-clinical roles featured prominently. This connected closely with discussion in the session, led by panel member Eleanor Hoverd, on our realist review exploring the work of receptionists in general practice. As Eleanor reflected, conversations with the audience quickly moved beyond individual roles and into questions of power, hierarchy, and control within practices. Who gets “released” for training, whose learning is seen as legitimate, and how these decisions affect wellbeing, job satisfaction, and patient experience were recurring threads. These are important issues, as how busy clinical staff are supported or constrained shapes how patients experience care and how services function under pressure.
Panel member Sameena Hassan presented work from the Deep End North East and North Cumbria network, grounding the conversation firmly in place. Discussion about neighbourhood health and the realities of working in the most deprived communities prompted questions about scalability, funding, and national implementation. Sameena reflected that there was clear alignment between the challenges being raised at DEMEC and the day-to-day realities faced within Deep End practices. While there was strong commitment among educators and leaders to drive change, there was also visible frustration about the difficulty of engaging staff and trainees in improvement work when time, funding, and flexibility are limited.
Audience members asked directly how initiatives developed through specific funding streams could be sustained or spread in a context where time and money are already stretched. There was no sense that these questions had easy answers, but there was a shared recognition that learning from Deep End work, including its emphasis on relationships, advocacy, and co-production, has wider relevance as the NHS navigates major structural change.
Additional questions, answered
As often happens, the session ended with thoughtful questions we didn’t have time to fully explore. We promised to return to those in this blog.
- What is a realist review, and why does it take time?
Realist reviews are used when the issue you are trying to understand is complex – for example, workforce roles, systems change, or interventions that play out differently in different places. Rather than asking simply “does this work?”, realist reviews ask: what works, for whom, in what circumstances, and why?
They do this by looking at how context shapes outcomes. A change that works well in one setting may fall flat in another, not because it is “bad”, but because the conditions around it are different. Realist reviews try to make those conditions visible.
Because of this, realist reviews are iterative and relational. They often take longer than traditional systematic reviews – sometimes up to 18 months – as they may involve more than one search and ongoing discussion with content experts. Content experts are people whose professional or lived experience helps test whether emerging explanations make sense in the real world.
The process we follow is based on five broad stages: shaping the scope of the review, searching for evidence, selecting and appraising documents, extracting data, and synthesising findings into explanations that link context, mechanisms, and outcomes. It requires a particular way of thinking, and it’s usually recommended that teams undertaking realist work have some training and methodological support.
What seemed to resonate at DEMEC was that realist approaches are well suited to workforce questions precisely because they do not promise simple answers. They help explain why “one-size-fits-all” solutions so often struggle once they meet real systems.
- What are we learning so far about retaining receptionists?
There is no single answer yet – and no magic fix. Our understanding is still developing, particularly in relation to receptionists working in under-served areas.
What is already clear is that many receptionists report feeling under-valued and excluded from opportunities that could support their development. Being empowered, having access to training, and being recognised as part of the wider practice team matter. So do relationships – both with other receptionists and with clinical colleagues.
Creating space for receptionists to talk, share experiences, and be listened to is not a “soft” extra. It has real implications for wellbeing, retention, and how patients experience care. These early insights are shaping how the realist review is unfolding, and there will be more to share as the work progresses.
Our take home messages from DEMEC 2025
For the Workforce Voices team, DEMEC 2025 reinforced several things. There is a strong desire across the education and workforce community to move beyond surface solutions and engage with the realities of power, culture, and constraint. There is recognition that non-clinical staff are central to workforce sustainability, yet often structurally marginalised. And there is growing interest in approaches that can handle complexity without flattening it.
The conversations we had – in the room, through the online polls, and afterwards – will feed directly into our ongoing realist reviews, co-design work, and engagement with staff, patients, and communities. They also sharpened our sense of how much this work depends on relationships, trust, and having time to think together.
We’re grateful to everyone who joined the session, challenged us, and shared their experiences so openly.
