Don’t put off the inevitable

Difficult conversations in small GP practices often happen too late, so early dialogue is essential

In small GP practices, difficult conversations with staff are rarely avoided out of neglect. More often, they are postponed out of goodwill, pressure, or a desire to keep things steady in an already demanding environment.

I often meet GPs at the point where an issue can no longer be absorbed into the background of a busy day. By then, it has usually been carried for some time. The GP is tired. The atmosphere has shifted. The conversation no longer feels optional.

The difficulty is rarely the conversation itself, but how long it has been carried.

Why difficult conversations are delayed

In small practices, relationships are close and roles overlap. Staff may have worked together for years. Addressing performance or behaviour can feel risky, particularly when recruitment is difficult and continuity matters.

There is also the reality of competing pressures. Clinical work takes priority. Administrative demands accumulate. Conversations that feel uncomfortable or emotionally charged are easily deferred in favour of what feels more urgent.

Often, there is a quiet hope that things will improve, or that the issue will resolve itself. Sometimes it does. Often, it does not.

When a conversation is delayed, the issue rarely stays the same. It gathers context and becomes layered with frustration, assumptions, and unspoken tension. By the time it is addressed, it is no longer just about what is happening now.

When issues come to a head

I frequently see practices at the moment when delay is no longer an option.

In one practice, a longstanding administrative staff member had been in place since the early days of the service. Experienced and committed, she held a strong position within the practice. Over time, however, there were recurring concerns about how newer staff were treated. Some left after relatively short periods, citing feeling undermined or criticised, though concerns were rarely raised formally.

As the practice expanded, a new GP partner and an additional medical secretary joined the team. The newer secretary settled in well and was regarded positively. Over time, patterns of behaviour began to surface that caused concern.

The situation came to a head following a sharp interaction witnessed between the two administrative staff members. Later that morning, the newer staff member approached one of the partners and said she was finding it increasingly difficult to work in the environment and was beginning to question whether the role was sustainable.

What had previously been managed through quiet accommodation could no longer be ignored. The risk of losing a valued staff member had become real.

Inheriting what was never addressed

Another familiar scenario arises when a GP takes over ownership of a practice and inherits longstanding staff relationships along with it.

In one such practice, a senior staff member had worked there for more than two decades. Over the years, there had been multiple patient complaints against this staff member. These were often addressed informally, usually through a quiet word, with the intention of maintaining harmony.

Over time, this approach created a precedent. Issues were acknowledged, but not properly managed.

When the original partner retired, a longstanding assistant GP took over the practice. Keen to address matters more formally, they soon found that behaviours were deeply entrenched and expectations firmly set. What might once have been manageable through early intervention had become difficult to unravel.

The process that followed was lengthy and draining. Although the staff member eventually left, it came at considerable cost to the practice in terms of time, morale, and financial impact.

A wider pattern

These scenarios are not unusual. Variations of them arise repeatedly across practices.

In many cases, staff challenges could have been addressed more effectively if they had been addressed earlier. When left too long, these discussions become harder. Trust may already be affected. Staff can feel blindsided. GPs often feel frustrated, not just by the issue itself, but by how long it has been carried.

By the time action is taken, the conversation is no longer about performance alone. It is about history, precedent, and the weight of what has gone unsaid.

Earlier conversations, different conditions

Earlier conversations are rarely dramatic. They tend to be quieter, steadier, and easier to recover from. They allow issues to be named without being personalised.

This is not about being confrontational or overly formal. It is about timing. Conversations held earlier take place under very different conditions than those forced by escalation.

Putting something off does not make it disappear. It simply changes the circumstances under which it eventually has to be addressed.

Finding a steadier way in

For many GPs, the hardest part of these conversations is knowing how to begin. The moment can feel loaded, and the fear of saying the wrong thing is often enough to delay it further.

Choosing language that opens the conversation, rather than framing it as an accusation, can help steady both sides. Simple, neutral phrasing often reduces the sense of confrontation.

Examples of such phrases include:

▶ “This has been brought to my attention, and I felt it was important to discuss it with you and hear your perspective.”

▶ “I want to check in about something that’s been concerning me and get your view on it.”

▶ “I’ve noticed an increase in patient complaints recently, and I’m concerned about how this may be affecting the practice.”

Language like this does not pre-judge intent or outcome. It signals that the issue matters, while leaving room for explanation and reflection.

These conversations rarely need to be perfect. They just need to be clear enough to open dialogue before positions harden.

Sometimes having a few words in mind is enough to make starting feel manageable.

Paying attention to the inevitable

Most issues do not resolve themselves. They either surface early, when there is still room to talk, or later, when the conversation feels unavoidable.

A strong practice is not one that avoids difficult conversations. It is one that recognises when something needs to be addressed and creates space to do so before it becomes unavoidable.

A strong practice is not one that avoids difficult conversations

Paying attention to the inevitable often makes conversations easier, not harder.