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Being able to communicate clearly with patients is a vital part of the GP's armoury, but dialogue within the practice is just as important as Dr John Couch explains
Meeting and communicating regularly with your colleagues is one of the most vital elements of a successful partnership. As a new member one of your first aims should be to understand and participate so that your integration is as brief and smooth as possible.
Meetings are useful to set goals, monitor progress, share ideas and build relationships. They are also an essential forum for solving problems and grievances whether clinical, administrative, financial or even personal.
Informal communication matters too
All practices communicate on various levels. Everyday informal items are discussed by
e-mail, telephone or face to face this is just as important as any formal meeting. You should not be a doctor who comes to work each morning, shuts the consulting room door and reappears at 6pm to go home.
Get to know all the staff and partners by talking and listening to them, rather than rushing past to do a call. Share coffee with the others. Building these links will serve you well.
Structure of partnership meetings
There are no set rules on how frequently partnership meetings should be held. Many practices have weekly meetings which can cover any or all the areas mentioned above. During the year there may also be one or two awaydays to look at more strategic issues and even the occasional 'extraordinary meeting' to discuss a single item that needs more detailed time.
In my first few years in practice our weekly meetings were not at all structured. Partners could bring their own items and if there were few or none then anecdotes would take over. Decisions were made ad hoc and we all enjoyed ourselves, but time was used very inefficiently. When one of my partners suggested we adopt a formal written agenda, with circulated minutes, our efficiency was transformed.
An agenda should cover the following:
· Date of this meeting and date of last meeting with list of those present
· Minutes of previous meeting
Are they accurate? Are there any amendments? The minutes must be agreed and preferably signed by all present.
· Matters arising (from the minutes)
Any new developments or information since previous meeting?
· Discussion items
The topics should be agreed and circulated in advance to all concerned, along with any relevant documents, to ensure everyone can consider them in advance of the meeting.
· Any other business
Any member of the meeting can introduce an item here but it is expected that these items should not involve lengthy discussion unless a speedy decision is essential.
· Date of next meeting
All minutes should be filed so that any previous decisions can be proved should there be any query or future dissent.
Check your partnership agreement
You must check your partnership agreement to clarify the rules of your partnership meetings and decision-making. There should be clear guidance on the following:
· What constitutes a forum?
How many partners need to be present in order to make routine or important decisions? The number can be different for each. One would normally expect at least half the partners for the former and all the partners for the latter (unless a partner is unwell or abroad in which case they should be contacted for their views). Important decisions should be defined.
· Do you have an equal vote?
This should be the case for all partners.
· What happens if a vote is tied?
In most cases decisions never need a vote. We all have to give way occasionally if it is clear that a majority of the others have a differing view. However, a tied major vote must be resolvable. It is now unusual to give the senior partner a casting vote, modern agreements will state that the status quo (ie no change) should apply in a tied vote. If there is still an unresolved issue the agreement should also contain a binding independent arbitration clause.
Listen, learn and ask
While you should not be mute at your first few practice meetings, it is sensible to listen and observe carefully. This has many advantages. You will get a much better feel for the practice and the way it functions. You will learn more about the individual items under discussion. You will learn the dynamics of the partnership which partners monopolise the meetings, talk the most sense, command more respect, irritate, have their own agendas or are on your wavelength.
This 'warts and all' approach is essential if you are to learn how you are going to fit in to the discussions and decision-making. Note also that decisions need to be made on two levels: 'How will this affect me and how will it affect the partnership?' The two will not always be the same. Learning when to give way is an important lesson, as is when and how to stand your ground.
Always read the minutes of the previous meeting and agenda items carefully and be prepared to ask questions at any stage. If the issues are not clear you cannot reach an appropriate clinical or business decision.
Make your voice heard
As a partner you must expect and consider yourself equal. Clearly you will be inexperienced at first but you should also bring fresh ideas to the partnership. To gain personal satisfaction from being a partner you must make your voice heard. If you do not it is your fault.
Once you have learned more about the dynamics of the partnership and the personalities of the partners it should become easier to contribute. If you feel you have something useful to say then do so.
Prepare your strategy if you want a particular item approved. Ensure your items are included on the agenda and prepare any documents carefully. If your practice has a projector, learn how to use Powerpoint software for a more professional presentation. There may be counter arguments, try to prepare for these too.
Do not expect all of your points and issues to be agreed. Business partnership is very much like marriage in this respect! If a point is rejected do not get frustrated or angry.
Consider the reasons why this happened. Could you have been wrong? Was your idea the best for the partnership as a whole?
If you feel you were right, consider other strategies. Can you persuade more partners informally? Should you accept defeat gracefully or sit on your idea and reintroduce it later? Can you get more evidence to support your case?
Conflict is thankfully rare in successful partnerships. Professional and respectful give-and-take is common. Once you reach this point your integration is complete.
John Couch is a GP in Ashford, Middlesex