GPs' anxiety about the nature of their role in primary care groups may lead to difficulties for managers who deal with them. John Watson suggests how to handle negative responses to change

The development of primary care groups is bringing a large number of managers into contact with GPs in new ways. For many GPs this is a time of considerable anxiety, and this can lead to conflict, especially if the manager misreads the extent to which many GPs have strong emotional ties to their particular practice and the value they place on the freedom to operate in their own way as an independent contractor.

Many GPs have limited experience of working with groups of different professionals, with their varying approaches to management issues. This can lead to difficulties as managing change requires the ability to develop a tolerance for uncertainty.

Work produces emotion and is influenced by it. Yet even the literature on various person-centred approaches to management tends to skim over this area. When emotion is encountered, it is often put down to personality differences or dismissed simply as a piece of aberrant behaviour on a particular occasion. But there are ways of handling such situations which are more effective than others.

It is possible to manage emotional situations effectively. There are two broad strategies: changing external circumstances, or changing ways of thinking about those circumstances. The first is often not possible, and the establishment of PCGs provides a good example of why this should be. Managers need to find ways of helping people change how they think of what are, to them, potentially distressing circumstances. This will include GPs who regret the ending of fundholding, the loss of staff or potential changes in their working practices. In looking for general principles that apply to such situations, the work of Ostell et al in managing emotion at work seems particularly relevant.1 They have developed six principles which can apply to relationships between colleagues, or manager-subordinate relationships.

Deal with the emotional response before you attempt to resolve the problem. People are unlikely to join in a problem-solving process if they are emotionally upset. Reflective statements which show you are listening and trying to really understand the other person can help. But they may simply uncover emotions without giving insight into how to handle them.

Avoid behaviour that heightens adverse emotional reaction. Trading anger for anger can be very unhelpful. Statements such as 'reacting like this won't help you' or 'you will just have to cope with it' are likely to alienate the other person, or reinforce the view that you don't understand. Using empathy to convey understanding, without agreeing with, or reinforcing, the emotional state, can help.

Recognise the differences between emotions.

Not all emotional reactions should be treated in the same way. Responses are most effective if they are appropriately matched to the circumstances

and the emotion. If the individual feels helpless, indicating how the anticipated event might be controllable, convincing them of their ability to

take more control and offering support can be helpful.

Attempt to find a solution to the underlying problem. Once emotion is dissipated, ways of resolving the problem can be sought. For some individuals, just expressing their feelings may be enough. Non-directive approaches can be helpful - for example, a manager helping a subordinate find a suitable solution that they can 'own'.

Learn to accept reality

It is important to accept that some personal and work problems cannot be solved. This may be because of legal constraints, for example, or because other people - with the power to do so - decide the situation will not change. The emotional person needs to be helped to accept reality. This entails learning to let go of unattainable goals.

Dealing with emotion at work can be difficult for managers who are more used to task-related issues, and dealing with some professional groups makes the task even more difficult because they are less familiar with managing change.

Managers should not assume adaptability is shared by others, particularly by professional staff such as GPs.

It is just as likely that the response will be 'if it ain't broke, don't fix it'. If managers are to manage change effectively, particularly when working with GPs, they will need to understand something of the particular mind-set of this group, the basis of the kinds of responses that can be forthcoming and appropriate ways of responding.


1 Ostell A, Baverstock S, Wright P. Interpersonal skills of managing emotion at Work. The Psychologist 1999; 12 (1): 30-35.