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Pulling together – the BMA mediation service

20200079 thedoctor March issue 19

Conflict between GP partners can cause enormous stress and disruption and threaten the survival of a practice. The BMA offers free and impartial support through its mediation service. Tim Tonkin reports

GP partnerships have often been compared with marriage.

They each require qualities such as trust, honesty and good communication if they are to be successful and can go through difficult periods, with partners disagreeing or even falling out with each other.

While some clashes are a natural part of any business relationship, there are some disputes which, if left unresolved, can become intractable and ultimately undermine the effectiveness and stability of a practice.

In a worst-case scenario, workplace conflict can lead to the breakdown of a partnership and even jeopardise the continuation of the practice itself.

Mediation offers an alternative and constructive method of resolving conflict, focusing on the needs and priorities of the parties.


Falling apart

‘Conflict, in its full throes, can be so detrimental it really can threaten a practice’s survival, often for no good reason,’ says BMA mediator Niall Hermiston.

‘Practices that really don’t need to fall apart have been on the verge of it because unresolved conflict has such an impact on partners’ and staff wellbeing and work.’

20200079 thedoctor March issue 19 

As an ACAS-qualified mediator Mr Hermiston has been part of the BMA’s GP partner interpersonal mediation service since it was relaunched two years ago.

The service, which is free to access, seeks to provide impartial and confidential support to partners experiencing interpersonal conflict in the workplace by bringing them together to discuss challenges and agree a way forward.

The potential for conflict in general practice is high. Practices are under huge service and resource pressures which are well documented. Conflict can arise in any number of forms and for many, sometimes complex, reasons.

‘GP practices can be difficult workplaces. A lot of the pressures result when people leave practices and the fact that, as well as being a doctor, partners also have to run a business,’ says Mr Hermiston.

‘Conflict can arise because of disagreements about the business model and what the practice should be aspiring to be or what work it takes on. It is often challenging when senior partners, who have been there a long time, take on newer GPs, bringing with them new ideas and ways of approaching things.’



This is certainly a scenario GP partner Simon Bywater* can relate to.

After joining a practice as its newest partner, he says he went on to endure several years of bullying and undermining behaviour from a senior partner, which gradually took a toll on his mental and physical wellbeing.

‘What I had been naïve to was how threatened existing partners can be when new partners come in,’ he says.

‘He used to watch what I did clinically and would mention the GMC from time to time. He would even go out and visit patients after I had seen them without telling me, particularly when he thought something had gone wrong or that a patient might want to complain.’


No feedback

Dr Bywater says that, when he first joined the practice, he had felt unsure of himself in his new position, which was not helped by the fact his fellow partners never sought to encourage or offer feedback on his abilities.

The situation eventually escalated to the point where he ended up having to take time off work.

‘Nobody ever told me why I’d been appointed, so I wasn’t given any positive feedback,’ he says.

‘It didn’t fill me with confidence by not telling me why they had appointed me and then allowing a senior partner to undermine my confidence clinically and block just about every new idea that I tried to bring in.

‘The main thing was the fear,’ he adds.

‘There was always a threat that [the senior partner] was going to do something to make me lose my partnership, either by referring me to the GMC or undermining me in the eyes of my partners.’


Goal of reconciliation

Doctors looking to access mediation can approach the team directly, although many are referred from

Mediators act with the utmost impartiality and aim to treat all those involved in the process equally whether they were the ones to initiate mediation or not.

An initial assessment is carried out to judge if mediation is appropriate and a mediator takes charge at that stage. A team of mediators work across the four nations and travel to support GP partners going through the process.

After speaking one-to-one with each partner, mediators will then bring everyone together for a joint session of dialogue, truth and, hopefully, reconciliation.

20200079 thedoctor March issue 19

Ultimately, the aim is to encourage partners to devise the solutions and agree the next steps to resolving their workplace impasse, with mediators serving as honest brokers to this process.

‘Mediation is really about bringing together the people who are in conflict and trying to get them to understand each other’s perspective,’ says Mr Hermiston.

‘It differs from conciliation and arbitration [processes] in that it doesn’t judge, give or impose solutions, it’s about getting them [the partners] to come up with the solutions themselves. By doing that they’re much more likely to own the outcomes and that’s the bit that makes it so successful.’



Confronting and attempting to deal with conflict, particularly if it is a long-standing issue, might be a daunting prospect. However, the potential benefits of using the BMA’s mediation team cannot be overstated.

First and foremost are the financial benefits of avoiding the potentially onerous costs associated with private mediation firms or from the even more expensive and lengthy route of using the courts.

It has been successful in improving working relationships, creating a renewed opportunity for the successful practice to grow, improving partners’ welfare and job satisfaction.

One doctor recently commented: ‘I just wanted to thank you for everything you did to support us. You were fantastic. It was a really difficult process for me, but you made it bearable and productive. I feel a change in the surgery. It is not going to be easy, but I think we are able now to move in the right direction for us all.’

Another partner, at a different practice also said: ‘[The mediator] was professional, sensitive and fair, which is fundamental in such conversations. She helped us establish communication bridges between partners by looking at the shared aims rather than at the personal emotions, that were left outside the room.’

While there are no guarantees mediation will lead to a resolution, the process has undoubtedly helped many partners to overcome their differences and help to keep a practice together and get it back on the right track.


Workplace disputes

Dr Bywater only became aware of the option of mediation through the BMA while taking part in a leadership programme, and after speaking to a BMA adviser began the process of taking action to bring an end to how he was being treated.

Although the process was not an easy one, it ultimately led to a change in the behaviour of his colleagues and his role at the practice is now ‘in a very good place’.

‘When I first approached the BMA and revealed what was going on, they seemed to have a complete understanding of what I was experiencing,’ he says.

‘[The BMA] was brilliant as was the person I was referred to.’

Dr Bywater says while he thinks BMA members are aware the association provides support in workplace disputes, many might assume this only applies to situations where doctors are in conflict with their employers.

He strongly recommends efforts to raise awareness of the mediation support available to GP partners.

‘What BMA members want from their trade union is support in their time of need,’ he says.

‘I wanted a good resolution and the BMA seemed to be the best way to do that because it’s a professional body and trade union that represents all doctors and is therefore less adversarial [a mediator] than an independent firm or lawyer.’


Best outcome

BMA GPs committee chair Richard Vautrey (pictured below) says the partnership model is the foundation of his branch of practice, and ensuring GPs have the support they need during periods of disagreement or conflict is vital.

‘GP partnerships are at the heart of general practice,’ he says.

‘A good partnership, in which all members feel valued, listened to and engaged in decision making and the running of the practice, can lead to not just a good place to work but also a positive outcome for patients.

Richard Vautrey, GPC chair 2017

‘Like all parts of our health service, however, general practice can be a demanding and challenging environment in which to work, something that can place strain on even the closest partnerships.

‘Where these difficulties arise, it is essential to practices and their patients that doctors be given the support they need to address and attempt to work through whatever difficulties they might be experiencing.

‘Being able to speak to a source of expert and impartial advice, be it from the local medical committee or the BMA’s interpersonal mediation service, can make all the difference to a practice’s future and help to resolve issues that may otherwise lead to a costly and painful partnership split.’

* Names have been changed

Find out more


A pathway to peace – how mediation works

  • BMA mediators carried out around 12 cases since the service was relaunched
  • The service is run by six ACAS-trained and NOCN-accredited* mediators working across all four nations
  • There is no charge for interpersonal mediation as it is a benefit of BMA membership for GP partners, although partners accessing the service may incur costs such as arranging locum cover during the mediation process
  • The process begins with the mediator having a one-to-one conversation with each partner, before moving to a full day of mediation
  • The process is designed to be confidential, independent, neutral and voluntary; no one can be forced to partake in mediation
  • Mediators aim to provide an honest-broker role in bringing partners together, discussing the issues and then suggesting a framework for going forward
  • There is also the facility for separate commercial mediation in some cases, where BMA members are eligible for access to this service at a preferential rate.

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