Leading a Practice through Hard Times

It is easy to lead during good times. All you need to do is listen to your team and not do anything stupid. Leading in hard times is completely different.

First you need to realise that times are hard

This can be tricky because to begin with things can look to be fine, while underneath they are going wrong. This is where you need your most grumpy and awkward staff member – the one who won’t sugar coat things and doesn’t care about your feelings. They are your early warning system that you are in trouble. Abandon wishful thinking and our natural tendency to downplay problems and face the facts.

What is going kill you if you don’t get it right?

From the outset you have to identify those things that really matter – and become utterly ruthless about protecting them and concentrating solely on them.

  • Patient care and safety
  • Paying bills and wages
  • Retention and recruitment
  • Claims and earning

It is entirely fine to ignore emails, not return calls and not go to meetings if they do not help you avert the crisis. Any time spent doing anything else is wasted.


You are only a leader if people follow you. This is not something that you can demand and it is not based on your job title. Your team follow you because they believe that you are doing something worthwhile and that you care about them. General Practice is a Team Sport and you cannot achieve your purpose without them.


You need to be clear about the reason your practice exists. For most practices it will be along the lines of “Improving the mental and physical health of people in your community.“ Your purpose is what inspires you and those you work with will give blood, sweat and tears to achieve it. It is about something bigger than yourselves. It has to be important and it has to be real.


Your team needs to feel safe to do their work. They need to know you genuinely care about them and will look after them. You need to stop people from outside your team from wasting their time. You need to back them up in their dealings with others so they can act with confidence. You need to teach them how to look after each other so they feel safe even when you aren’t around. You need to train your most junior receptionist to stare down a CQC inspector and stand their ground.


You need to be the servant of the team. You should be prepared to do any job if it is needed to achieve your purpose. When was the last time you answered the phone in reception when they were all busy? When was the last time you made a round of tea and coffee? More importantly you need to have your door open so they can bring you things they can’t do and you need to regularly check in on them to solve problems. It is by serving that you teach them to serve each other.


You need to be the person who goes looking for trouble before it can affect your team. The one who runs towards problems not away from them. You need to be the person they can turn to in a crisis who will always take charge and be responsible for the outcome. You do not need to have all the answers – in fact you need to know and say when you need help. You need to tell them that things will work out, not because there won’t be problems or setbacks, but because you will work through things together and will come up with a solution.

Whatever it takes

You need to be fully committed to the team and your purpose. You need to show that nothing is beneath you and you will do everything that is needed. This doesn’t mean you do everything personally, you need to effectively train your team and delegate to them. You need to lead by example in looking after yourself and keeping strong for the long term. To mute your WhatsApp at night and not look at your emails over the weekend. And you need to expect and enable them to do the same.

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