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Partnerships

The NHS has long supported the idea of GPs working together and in the 1968 contract, which essentially put the specialty on the map, group practice was encouraged. Today's familiar GP partnership model has both advantages and disadvantages but in theory it does enable GPs to have clinical freedom, and to be independent contractors who cannot be accused of being in thrall to government initiatives or vested interests e.g. drug companies. To some, this remains the essential bedrock of what we do, although the landscape is changing. Many partnerships now include the practice manager or other key members of the team, and further changes are afoot with the advent of STPs and PCNs.

If a partnership is like a marriage, consider this section of the Safe House to be the nearest you will get to Relate! Harry Yoxall, the Somerset guru of the ups and downs of GP Partnerships, believes that all partnerships wax and wane in their "functionality" but he also has found that once a certain point of dysfunctionality is reached nothing can save a partnership.

Some early reflection may be no bad thing, as the state of partnership health can clearly make or break good patient care, not to mention professional satisfaction over many years. You might want to begin by exploring the health of your partnership by following this link How healthy is your partnership? or considering the different relating styles of Dr Chalk and Dr Cheese

The potential for difficulties in a partnership often results from:

  • Lack of clarity about the joint aims and ethos of the partnership.
  • Not appreciating the nature and importance of differing relational styles.
  • Perceived inequalities of workload.
  • Work-habits engendered by a certain working environment, which persist when that environment changes.
  • Individual doctors' partial or total unsuitedness to work as a GP

Solutions:

Lack of clarity about the joint aims and ethos of the partnership

More and more, partnerships are developing a 'vision statement' to give a flavour of the joint aims of their practice. This often takes the form of a snazzy, snappy statement posted somewhere on the practice website. It is important to have this; to give the partners, management team and wider staff some guiding principles of how they wish to work. However, it is even more important to have the exploratory, supportive and understanding conversation of each other's values in order to create said statement. This conversation should start with the partners and then be taken to the wider staff group and even the patients.

In healthcare, our values are often assumed or implied; it is easy to think that we are all in it for the same reasons. However, some GPs may put practice income at the top of their priorities, while others may put serving the diverse needs of their community. Both of these are perfectly valid, but for them to co-exist happily in day-to-day practice needs clarity and understanding on all sides. The development of a shared purpose for your partnership is key. Truly understanding and appreciating each other's values is a cornerstone for building a successful partnership. The happiest practices have addressed this issue. If you have not, the best way is to hold an away day led by an experienced independent facilitator.

Not appreciating the nature and importance of differing relational styles

GPs have different approaches to their work, ways of dealing with patients, and priorities in terms of what patients need. One of the fallacies of attempting to manage in detail the work of primary medical care is the notion that "one size fits all." The spectrum of patient needs and expectations is as wide as humanity itself. For this reason, it is well known that patients will often seek out a GP whose style is congruent with their needs. Arguably, a sophisticated country should support this level of medical care, and good Doctors have traditionally been patient-centred. Thus it is important for practices to be aware of the differing contributions of their doctors, and to support the best use of these in delivering holistic care for their populations. If you'd like to consider your own style, have a look at Dr. Chalk and Dr. Cheese

The above paragraph deals with differing GP approaches to consultation, but this is not the only form of communication evident within a practice. Where we are struggling with our interactions, it can be helpful to consider ourselves first. Sometimes when we feel challenged by another it is because they are completely opposite to us, because they remind us of someone we have historically struggled with, because they remind us of a characteristic within us that we are less keen on, or because we are conflicted in some way. So, if you find someone difficult or irritating, start by asking yourself what's going on for you?

The next step is to ask yourself what's going on for them? The reality is that, in the vast majority of cases, people behave in a way that they think will deliver them a positive outcome. The trouble is that this can be misperceived by others, depending on their own filters, and land negatively. Try and imagine what the positive intention of the other person might be.

Remember that everyone is different and that's OK. We are not all motivated by the same things, we don't all behave in the same ways, we all have our own personality traits and preferences. Successful partnership demands that we take some time becoming aware of what's going on for ourselves, understanding this and how it differs from our partners, gaining an acceptance of those differences, and appreciating the benefits that brings to the partnership as a whole, making us ultimately more cohesive and more effective.

Perceived inequalities of workload

Nothing beats evidence followed by facilitated discussion. Perception is not truth, data is key in establishing the facts of the matter. If the facts confirm the perception and your partnership is not set up for supportive conversation, an independent mediator or facilitator would be strongly recommended. Exploring the wider truth of the matter (what is going on for all involved? What stresses are they each under? Are there compromises to be made?) is part of the process - this is difficult to do if you are part of the fabric of the problem, no matter how expert a facilitator you are.

Work-habits engendered by a certain working environment, which persist when that environment changes.

Curiosity can work in your favour here. Asking open questions and listening carefully to the answers can help ascertain why certain habits have stuck and what purpose they continue to serve following a change in circumstance. Remaining non-judgemental is important; remember Steven Covey's 5th Habit (of the '7 Habits of Highly Effective People'): seek first to understand, then to be understood. Once you have a true understanding you can begin to explore the pros and cons (or helps and hinders) of the habit to the individual, the partnership, the practice and the patients. Your success in this will depend on your existing relationship with the partner in question and your skills as a coach. You might that signposting your colleague to an independent practitioner preserves your working relationship.

Individual doctors' partial or total unsuitedness to work as a GP

This scenario depends entirely on the circumstance, hence the possible solutions are myriad. If there are questions surrounding fitness to practice for a clinician, you are duty bound to report this to the appropriate authority (GMC, PAG). If you are concerned about stress, overwhelm or burnout in a colleague, a gentle, supportive nudge in the direction of the Safe House and an advocate would be appropriate. Coaching is also a valid option, but remember that we cannot change other people, we can only change ourselves. You cannot force someone to be something they are not, you cannot make them seek help if they do not wish to do so; you can only do your best and that's OK. Alongside that, it is worth remembering that a colleague who is struggling is also doing their best, and they deserve our support rather than our judgement.

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