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New contract – don't forget the job satisfaction

Most of the contract debate has been about pay, but other factors will also be crucial in improving GPs' working lives, writes Dr Melanie Wynne-Jones

There has been so much emphasis

on money that many GPs have not yet had time to think through how the new contract will affect other aspects of the job.

But switching from personalised care to protocol-driven, cost-limited service delivery and competition with other providers, will have major implications for practices' day-to-day work and interpersonal relationships.

Some partners may still be mourning 'the loss of general practice as we know it' and lack enthusiasm for change.

They may be contemplating retirement, going part-time or changing career. This could destabilise the practice at a critical time.

Others may be impatient to maximise profits or move to new premises, and become frustrated or consider leaving if they feel unsupported in their ambitions.

Partners who have learned to accommodate each others' quirks and preferences may find they no longer wish to do so.

It may ultimately be better for all concerned

if this results in a relatively clean break, and this should be borne in mind when drawing up the partnership agreement.

However, many partnerships where GPs have previously worked harmoniously will hope to continue reconciling their different values and beliefs.

These will include beliefs/values about:

lContinuity of care and skill-mix

lConsulting rates and styles

lTensions between cash-generating and resource-consuming care

lRelative workloads and remuneration – are all patients equal, and how does seeing patients equate to time spent managing the business?

lWhich services the practice should provide – or abandon – and the effect on partners and patients

lInvesting in the practice versus maximising profits

lIndividuals' perception of work-life balance, their stage in life and how much time and effort they want to put into the practice's future success

lWhether and how partners should fund new premises

lCost-control – staff and other resources

lTeam working

lNew alliances between individual partners with similar goals

l'The GP's role' – what makes the job worthwhile? – potential for depression or burnout

lAttitudes to partners who are under stress, sick or not pulling their weight

There are so many strands to the new contract that practices may feel there is no spare time for meetings but it is vital to address these issues early, explicitly, and regularly.

Preventive strategies

Consultation, communication and anticipating/confronting problems are essential in any organisation, and most practices will be using some of these tools already.

They include:


lregular scheduled meetings with all partners present, plus time for informal discussion – for example coffee breaks taken together

lProtected time or awaydays (partners or whole practice)

lEfficient communication pathways

lA practice development plan

lAgreed targets and priorities

lMonthly or quarterly finance and performance review meetings, including up-to-date and contextualised statistics (involving the accountant where necessary)

lAssessment of individuals' strengths and weaknesses, aspirations and fears – Belbin team-role analysis1 or 360-degree appraisal2 may be useful

lAssessment of internal/external threats and opportunities

lPersonal development plans

lReview of partners' management roles – 'executive partner' or democratic 'board of directors' with specified roles?

lReview of practice manager's role/job description and practice's line management structure

lRegular review of workloads and profit shares

lCo-mentoring/opportunities to debrief, for example heartsink patients, significant event analysis

lPractice agreement which provides for all the above as well as provision for mediation


The range of solutions will depend on

the nature of the problem, but useful strategies, skills or resources – which may be found in-house or will need to be brought in – include:

lnegotiating/conflict resolution

lpeer support/mentoring

loccupational health

llocal medical committee

lsick doctors' resources3,4,5

lfinancial advice

llegal advice – for example, medical defence, employment law

lchanges in practice services/structure, including use of locums, to accommodate flexible working or changes in role.

Melanie Wynne-Jones is a GP in Marple, Cheshire



2 Jennifer King, 360° appraisal. BMJ Career Focus, Jun 2002; 324: S195

3 National Counselling Service for Sick Doctors 0870 241 0535

4 Sick Doctors' Trust (support for alcohol and drug addiction) 01252 345 163

5 Doctors' Support Network (support for mental illness)

07071 223372

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