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Manager threatens shock resignation

Three GPs share their approach to a practice conundrum

Case history

Your three-partner practice appointed a manager two years ago. She settled in well, the staff like her and the partners feel she is effective. Profits are adequate, if not stunning.

During her appraisal she blurts out that she's very unhappy. She says the partners exclude her from important decisions and undermine her by forcing her to impose their ideas, which, she says, are usually poorly thought out. She accuses you all of clinging to the past and giving in to staff pressure, such as when she tried to introduce advanced access.

She says the practice will sink under the new contract, and that unless you all support her in making changes, she will find a practice where she can manage instead of administrate.

Dr Vik Mohan

'Has there been an incident to trigger her outpouring of unhappiness now?'

Thank goodness we do formal appraisals! However, for this to come up in what I had expected to be a straightforward appraisal would be a shock. Why has it taken two years to come out? What a breakdown in communication. Clearly this has been bothering her for some time. Why has she not felt able to discuss it before? Has there been an incident, either at work or at home, to trigger her outpouring of unhappiness now?

I would see this as a learning opportunity for the partnership. What has gone wrong, and how might we stop this happening again?

Starting with the incident concerning advanced access, I would want to explore specific examples of when she has felt undermined, and what she would have done differently. She clearly has strong opinions and it may have been valuable to have heard these at the time, particularly if she felt our ideas were poorly thought through. I would want to let her know how surprising and upsetting this revelation is, and quite at odds with our perception of her having settled in well.

I would like to explore her expectations of her job, in the wider context of her personal and professional development, and what she would want to change. How much of this unhappiness is due to anxiety about the new contract?

So where does the truth lie? Are we dealing with a practice manager with unrealistic expectations or are we being given a real insight into a blind spot in practice affairs?

I would seek her permission to share this with the other partners and give them a chance to air their views. Then I could arrange a meeting with all of us to discuss a way forward.

Vik Mohan is a non-principal in Exeter, having qualified as a GP in 1999 – he is chair of the Exeter non-principals' group and has an interest in writing and performing comedy

Dr Abayomi McEwan

'Will we be repeatedly held hostage by this threat?'

It's important to express regret that matters have built up to this point. I would also try to assess whether her threat of resignation is purely an expression of her degree of dissatisfaction, or whether we are going to be repeatedly held hostage by this threat.

It's important to explore and acknowledge her dissatisfaction without making her feel she is entirely correct or that the threat of resignation will make the partners behave how she thinks they should.

In trying to find out how and where these differences have occurred, we should refer to her job description to see whether her stance is reasonable. Having aired areas of conflict, sensitive negotiation will be needed.

She says the partners' ideas are poorly thought through. This sounds as though there is insufficient communication and that all of us need help with managing change. The number of changes and the pace at which they are being introduced seems to be increasing exponentially. It's so difficult for GPs to cope with the patient workload. Finding time to step back, take an overview and work out a team solution often means giving up family or leisure time.

Both parties need to reflect on what they want to achieve. A good outcome would be to construct a prioritised list of ideas from the practice manager. The partners then need to meet to try to agree what we want to do and how to proceed.

An awayday for the whole practice team may be useful. The practice could approach the PCT for cover for this pressing situation – it could be one of the days when the PCT supports closure of practices for education and development.

This appraisal could be the catalyst for the practice to improve things all round.

Abayomi McEwan has been a GP for more than 20 years and is a primary care tutor for Epping Forest PCT in Essex

Dr Rachel Pryke

'I'd need to consider whether we are an inflexible bunch'

This sounds like a jolly good rant. Is it an understandable moan at the end of a pressurised day or an out-of-character outburst suggesting high stress levels that may be unrelated to her work?

I would explore whether she feels the whole world is one big problem, perhaps signifying loss of self-esteem and confidence due to domestic problems or health worries, and then assess her insight into how she is reacting to daily conflict.

I would take her concerns seriously and ask how she would like to address them – a meeting with the partners or an individual discussion. It might be a good idea to go through her job description together as a neutral way of highlighting areas of dissatisfaction and recognising things she did well.

I would need to consider whether we are an inflexible bunch, notoriously resistant to change, and discuss this with the other partners. If we agreed she had a point then hopefully we could be more inclusive in planning change. Clarifying communication pathways – such as circulating draft ideas before practice meetings – could increase her confidence when introducing new ideas to pressurised doctors.

As the new contract is complex, she is correct in trying to set up good mechanisms for collecting data and scoring points. But because this has significant workload implications for clinical staff, it needs to be a team approach rather than heavy-handed pronouncements from a managerial bully.

If she was demonstrating a critical and unbalanced view of how our well-functioning team made decisions we would need to be careful how we handled this because it could lead to claims of constructive dismissal. I would glance at guidelines about staff complaints and grievances to avoid being taken to a tribunal.

Rachel Pryke completed her VTS in 1993 –

she is now a part-time GP principal in

Redditch, Worcestershire

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