Table 6. Recommendations for practice leaders to better support ‘support staff’, as guided by our theoretical framework displayed in table 1.

Concept	Recommendations for leaders
Staffing for quality	Ensure your no of full-time or part-time support staff is adequate for your practice’s requirements. Ensure staff have time to be trained in all tasks in case of staff shortages. Shift from a demand-led service to a capacity-led service. Team leads should regularly check on the fairness of workload distribution. Encourage informal skill development and intrateam support by expanding social opportunities for example, with group lunchtimes, break times and training. Be aware of the unequal burden faced by team members from underserved communities: ensure they are well supported and have a safe route for escalating disproportionate workloads.
Psychological safety, teamwork and speaking up	Model the behaviour you want to see in your practice: the conditions for psychological safety, teamwork and speaking up begin at the top and must be consistently reinforced at multiple levels (including formal and social leaders). Establish pathways for escalating staff issues safely and privately, so that all staff have a support route should they need it. Recognise that some people may not participate in the practice’s social network because of their own needs, caring responsibilities, backgrounds, or preferences. Care should be taken not to reinforce exclusion of such staff. Present a united team front to support better interteam and intrateam interactions. Be clear and consistent around managing patient expectations across teams: lack of clarity around what the standard care offer is can make equitable management of patients requests difficult. Develop or share multilingual patient education resources about your particular practice’s function to remove some of the translational burden from support staff.
Staff health and wellbeing at work	Ensure knowledge about mental health support services are shared and access is consistently supported. Develop peer-support systems. Ensure provision of resources is appropriate to the role, and be clear about why some roles might have access to different resources. Respond swiftly and appropriately when staff face abuse or discrimination from patients.
Lifeworld/system and lay translators	Know your staff, and know your patients: identify your generalist-lay and specialist-lay translators and their particular community (or lifeworld). Support and recognise their translational work. In mapping your lay translators, identify where you are missing bridges to communities that your practice serves. Think about how you can provide targeted support for them. Identify the occupational translators: those who work at the intersection of occupational groups, and therefore, have unique situated knowledge. Support and recognise their translational work. Ensure the practice does not take advantage of the unique skills that lay, specialist and occupational translators offer. Regularly check in to ensure that they feel their workload is fair and appropriately acknowledged/remunerated.