Conflicts Within Primary Care Networks Are On The Rise – Is Arbitration The Answer?

Disputes are on the rise within the NHS, and we should not be surprised by that.

Working under indescribable pressure, crippling staff shortages and ever-increasing workloads are not ingredients usually found within harmonious professional relationships. 

And there’s no sign of an immediate improvement. The latest data shows GP appointments are still way above pre-pandemic levels, and the British Medical Association has just announced that England’s full-time equivalent GP workforce has fallen more than 2,000 below the level of 2015. GP Online cover more on this topic here. 

In my work supporting the practice management of PCNs and GP Federations, I am often called on to help with dispute resolution at practice, network and federation levels, sometimes acting as an outright arbiter between warring factions. I have outlined one of my go-to tactics if you are struggling with this in your practice in this blog. But how do you stop things from going that far?

Get everybody’s buy-in to stop conflict in its tracks 

Every relationship hits lumps and bumps in the road – that’s perfectly normal. So when faced with a straightforward difference of opinion on which direction to take, I work through the ongoing issues and challenges they’re having, what their motivations are, what the challenges are and what they can see coming down the road. I also ask what is driving the change that is causing the problem.

This approach goes back to a point I often make, which is unless you’re 100% happy with your current outcomes, you have to be prepared to change the input in pursuit of a different outcome. And then, I help and support them through the stages of change to make sure we give them the delivery.

That often means letting people self-select their own level of engagement in the process. This helps to avoid hand-picking a subcommittee of people who will tell everybody else where they’re going wrong. It’s much better to engage people openly in the process so they can be accountable for their actions.

This is particularly important if things are not going well and relations are breaking down. Dispensing a solution without getting them involved will only make things worse.

People assume responsibility for the solution when they come up with it themselves

When people self-select their involvement, they own the problem and own the creation of the solution. If they follow those stages, they are much more likely to implement the changes and are much more invested in seeing whether or not what they’ve developed works.  

It’s a pretty straightforward model and process, and I use it a lot with practices where there are partnership disputes or primary care networks where the constituent member practices are not getting on.

One thing I always check is that continuing to have a network is the right thing to do and that it’s not reached the stage where there’s just no point trying to continue. Providing that’s not the case, this is a very simple, tried and tested process to follow.

Arbitration for GP practices, GP Federations and PCNs can reap rewards 

But what if things have reached that point? What if there’s been a major falling out within a GP practice, GP Federation or PCN? People aren’t talking to each other, nothing is working, and there just doesn’t seem to be a way forward. 

In these cases, a more formal arbitration route is necessary – and has achieved good results for my clients. I would typically gather everybody with a view or opinion on the problem together in a room, so they get the chance to state their case – uninterrupted.

It’s not about looking for rights or wrongs; it’s about hearing everybody’s view of the problem from the perspective of how they’re affected by it. As a result of that, we go around the room with a question and answer session as I start to gather information about the challenges.

That allows me to lay out what I see as the problem or problems. I then work with them through the options that have been considered to solve them, creating an options appraisal to get them to the point where we can negotiate an agreement on a new way of working. 

Trust the arbitration system to get a resolution 

It doesn’t always work – but I’ve really only had one occasion when that process didn’t deliver. However, that was a unique set of circumstances where one of the parties didn’t want arbitration, so it never got off the launchpad. 

Other than that, I have usually been able to successfully arbitrate and negotiate people through their issues.

In a recent case, two practices were looking at sharing a building. It wasn’t going well, but the arbitration process between the two GP practices got them to the point where it is now going well, and they’re fully progressing with their plans. 

So – whether they are minor issues to be worked out or some major entrenchment to negotiate within your GP practice, GP Federation or PCN, there is a system and a process that will help get you nearer a mutually acceptable outcome. If you’re interested in finding out how I can support you through this process, I’d be delighted to help anyone who finds themselves in that situation.

Scott McKenzie helps GPs, PCNs and GP federations build sustainable and resilient practices and organisations that thrive. If you want to know how to double your revenue and reduce the overwhelm, Scott can share these processes with you too. Schedule a call today.