Sorting out GP Workload 1 – Culture

We have all been in practices where everyone is working together really well. They are great places we would love to be a part of. They have a really strong culture and they do more with the same people and time than those without it (1). And that is why improving your culture is the single biggest thing you can do to help your workload.

But what is culture?

Culture is the values that we share and how we behave among ourselves and with others. It is learned by observing what people do rather than from a handbook. We are all sensitive to the culture where we work and will naturally fit in and start to show the same behaviours we see around us. It can feel like strong culture is a kind of magic which some places have and some places don’t. But in fact culture is like a muscle – if you do the right things you can make it stronger.

Start with the leaders

Your culture is about your whole team and it only works when everyone is part of it. But ALL the leaders need to understand what needs to be done and be fully committed to it. If any of the partners aren’t “walking the walk” and don’t get corrected then your staff will see that your culture is phoney and nothing will change.


Culture starts with knowing that we are all on the same team and all pulling together. Making a safe place where you feel supported by everyone around you and know they want you to succeed gives you the freedom to do your best work. If you are spending half your time protecting yourself and making sure you look good to others then it is not only exhausting but sometimes you do the wrong thing because it is the safe  thing. Belonging doesn’t just happen, it is created by the way you welcome people to the team, explicitly agree how you behave together, and how you treat people who are moving on.

Everyone is important

Spend time getting to know each other. Not just the skills people bring to work but the whole person – who they are and what they want out of life. Leaders should set an example in this: making the effort to check in on each of their team. Everyone needs to feel their voice is heard and they can contribute. Ask them what you should continue, what you should do more of and what you can do to help them work better.

No Dickheads

This mantra of the New Zealand All Blacks means that no one is more important than the team and entitled, selfish or deceitful behaviour won’t be tolerated. It is essential that everyone, regardless of status or skills is held to this standard. If anyone is acting like a jerk (even the Senior Partner) then everyone, from the lowliest receptionist up, should feel able to tell them to stop. We are all custodians of our culture and it is built up (or broken down) by all the little choices we make every day.

Build trust

You imagine that you have to find out if you can trust someone before you can let your guard down with them. However building trust works the other way round. Allowing people to see your weaknesses and letting them choose to support you builds a mutual bond where you know you can rely on each other. This can’t be forced and you need to let people go at their own pace, but as a leader, you can set the tone by being open about when you have messed up or need help. When the team knows that you are weak in an area, they can still let you try, in order to get better, but they can cover you so there isn’t a problem if you don’t get it completely right. And this openness is such a relief because you don’t have to keep pretending.

Deep purpose

The culture of your team is based on your shared values and from these values springs your purpose, the reason your team exists. As a team you will only get so far until you uncover and focus on your core goal. Most GP surgeries would say their purpose is “Helping people in our community live longer and enjoy better health”. Your purpose will help you choose which path to take and what the “non-negotiables” are. As leaders you need to be authentic to your purpose. Your team will spot immediately if you abandon your principles when the going gets tough. Spending time with your team taking about your goals allows this to be a shared vision and gives them a voice in and ownership of your team purpose.

Results matter

Although relationships are critical, if you aren’t doing everything you can to get closer to your goal then your results will be mediocre. There is much talk in the NHS about excellence, as if excellence was the goal, but is is not. The goal is moving the needle in the right direction as much as you can with whatever tools you have. As a team you need to explore which results really matter and how to achieve them.

Rules and Risk

Your team needs to learn from what worked and use that to guide what they do in the future. Without these rules you would continue making the same mistakes. But there are times when doing something new and taking a risk produces a better outcome. If slavishly following protocols would still let the patient die then you may have to break some rules. Such risk taking needs to be open and honest. The team needs to know what you are doing and together you need to see how you can cover the possible downsides. Maverick anarchy (think House MD) is another form of Dickhead behaviour and has no place in a strong culture.

“Culture eats strategy for breakfast”

This doesn’t mean that strategy is unimportant. But if you don’t have a strong culture then you will struggle to implement your strategy. If you need to develop both your culture and your strategy, sort out your culture first.


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