Abstract
The objective of this thesis is to explore developments in general practice in the UK, to draw conclusions and make recommendations from these explorations. The review is, firstly, historical: the evolution of the medicine man of ancient times to today's fundholding GP. Secondly, it is qualitative, exploring in depth with individual GPs and in small groups how they experience their work, the pressures and the rewards. Thirdly, there is a theoretical review of conflict which illuminates the fact that well-managed conflict can be a positive pressure. The act of reconciling warring opposites can produce new life-enhancing solutions. Individual, intragroup and intergroup (or organisational) conflict are all explored. Fourthly, it is more quantitative, with an analysis of a questionnaire returned by over 350 GPs (60.5%) in Humberside and Surrey. The survey showed that the most frequently and deeply experienced conflicts were over: time for family life: night and weekend working; patients' expectations and unnecessary paperwork. The lowest level of job satisfaction was recorded by those between forty and sixty years. GPs were also equally divided over whether or not they should have practice leaders. Taken together, the findings suggest that the issues which need to be addressed are about organisation, education, practice and teamwork development, career structures and individual management. The main recommendations are: firstly, that practices should review their organisation and leadership structure, so that they can make proactive rather than reactive choices; secondly, that to reconcile some of the tension between business management and medicine some GPs could retrain more for business management. The third recommendation is that selection and teambuilding skills be given much greater priority in order to alleviate individual and practice stress. At a more national level the research establishes that separate reporting structures for the different elements of the primary care team encourage divisiveness. However, unifying the primary care team would require employing acceptable, local, trained managers.