General practice teams face challenging interpersonal situations daily. Yet how we respond to these moments can transform them from destructive conflict into opportunities for understanding and resolution. Between mounting patient expectations, workforce pressures, and the complexity of human interactions, conflict in primary care is inevitable. So don’t think you are immune.
What is conflict?
Conflict is a collision between differing perspectives, beliefs, or reactions. But conflict is more than a simple disagreement. It exists on a spectrum, ranging from minor annoyance, like “I’ve got a problem to solve,” to extreme threat, such as “I’m going to destroy you.” Recognising where a situation falls on this spectrum is the first step towards effective resolution.
The Sources of Conflict in Primary Care
Conflict in general practice emerges from multiple overlapping sources that can be broadly categorised into four domains:
System-Level Pressures: These include unrealistic expectations about appointment availability, access to specific clinicians, or treatment options that exceed what primary care can reasonably provide. Organisational changes like deploying a new appointment system, staff restructuring, or altered protocols. These can create uncertainty, different perspectives and resistance. Over-promising by the practice or wider NHS, followed by inability to deliver, generates disappointment and anger. Resource constraints mean someone’s needs will inevitably go unmet on any given day.
Individual Factors: Patients can often bring their whole lives into the consultation room. Home life stresses, financial worries, relationship breakdowns, caring responsibilities, housing insecurity, etc., lower people’s thresholds for frustration and can manifest as conflict over seemingly minor issues. Fear about symptoms or diagnoses can drive demanding or aggressive behaviour as patients try to regain a sense of control. Previous negative healthcare experiences create defensive postures and distrust. Some patients may actually relish conflict, seeing confrontation as a means of being heard or taken seriously. Similarly, primary care staff have lives outside work that may colour how they handle day to day requirements of their jobs.
Communication and Understanding Gaps: Misunderstandings about comments, treatment plans, or practice policies create fertile ground for conflict. Different opinions about appropriate care between patients and clinicians, or between team members, can lead to confusion and frustration and can cause a lot of friction between teams. When people feel unheard or dismissed, minor disagreements escalate rapidly.
Professional and Interpersonal Dynamics: Within teams, conflicting approaches to patient care, workload distribution disputes, and professional boundary tensions generate internal conflicts that can disrupt working relationships. Power imbalances—whether perceived or real—between different professional roles, or between clinicians and patients, can create agitation and misunderstanding. When staff feel overwhelmed, undervalued, or unsafe, their capacity for patient-centred communication diminishes, increasing the likelihood of conflict.
When you can understand where a conflict originates, it helps determine the most effective response. A patient angry about appointment availability requires a different approach than one struggling with health anxiety, just as a team conflict about role boundaries needs different handling than a misunderstanding about clinical protocols.
How does conflict make you feel?
When conflict emerges, it triggers powerful emotional responses in everyone involved. People may experience anger, frustration, anxiety, confusion, feelings of being overwhelmed, defensiveness or shame. They might feel scared about the outcomes of an interaction or utterly baffled by system complexities or personality differences.
Interestingly, some individuals actually relish conflict, seeing it as an opportunity for engagement or change. Recognising this diversity in conflict responses helps us avoid one-size-fits-all approaches.
The Needs Beneath the Surface
Here’s a fundamental truth: every conflict is ultimately about unmet needs and the methods people use to try to meet them. As individuals, we share universal needs of safety, respect, belonging, support, acceptance, health, rest, and recognition, among others.
When these needs are met, people feel satisfied, connected, safe, seen, and valued. Their self-esteem remains positive, and they experience a sense of relief and support. But when needs go unmet, disappointment and resentment take root. People feel dismissed, unvalued, at risk, and vulnerable. These feelings manifest as fear, tears, bitterness, or that sense of being misunderstood or victimised, which then manifest in how people communicate and act.
How to Identify True Needs
There’s a classic story from negotiation training that perfectly illustrates the hidden nature of conflict. Two children are fighting over the last orange in the house. They’re pushing, shoving, both insisting, “I need it!” A parent intervenes, cuts the orange in half, and gives each child their share. Problem solved—or so it seems.
But as the parent watches, something strange happens. One child peels their half, throws away the rind, and eats the fruit. The other child peels their half, throws away the fruit, and begins grating the rind for a baking recipe. The parent realises the mistake: if they’d simply asked “Why do you each need the orange?” one child could have had all the fruit for eating, and the other could have had all the peel for baking. Both needs could have been met 100%.
The error wasn’t in the fairness of splitting the orange—it was in assuming both children wanted it for the same purpose. They were engaged in “positional bargaining” (I want the orange vs. I want the orange) when they should have been discussing their underlying interests (I want to eat something vs. I need an ingredient for baking).
This scenario plays out constantly in general practice. A patient demands an appointment with a GP but is offered a paramedic consultation instead. Surface-level, this appears to be about professional credentials or service value. But dig deeper by asking, “What would you want from seeing a doctor today?” and you’ll often discover the real need: assurance that their health concern will be properly assessed, that someone qualified will address their worry, that the consultation will end with clarity and a plan.
Even though the paramedic may not be able to meet the patient’s request, this opens space for dialogue: “I can’t arrange a GP appointment today, but I can offer you a thorough assessment, proper examination, and a clear plan forward.”
A Framework for Identifying Conflict Scenarios in Primary Care
Watch for these warning signs:
Patients expressing unrealistic expectations about appointment availability, treatment options, or service scope
Emotional escalation disproportionate to the immediate situation (often indicating unmet needs from elsewhere)
Language that catastrophises or frames situations in absolute terms of right and wrong
Behaviours driven by attempts to exert power or control
Interactions where promises made previously cannot be fulfilled
Recognise that people may not be in the same conflict space as you. A patient may be in high conflict while you’re simply explaining system constraints. This asymmetry requires conscious awareness to prevent escalation.
When and How to Deploy Conflict Resolution Behaviours
The Thomas-Kilmann Conflict Mode framework offers five approaches, each appropriate for different situations:
Collaboration (Win-Win): Use when the relationship matters, time permits, and creative solutions are possible. This is ideal for complex patient needs or team disagreements where ongoing relationships are essential.
Compromise (Middle Ground): Deploy when time is limited, both parties have equal power, and a temporary solution will suffice. Common in busy clinic situations where immediate decisions are needed.
Accommodation (Lose-Win): Choose when the issue matters more to the other party, when you’re wrong, or when preserving the relationship outweighs the specific outcome.
Avoidance (Lose-Lose): Sometimes appropriate when emotions are too high for productive discussion, when the issue is trivial, or when others can resolve it more effectively. Be cautious about always avoiding issues because chronic avoidance breeds resentment.
Competition (Win-Lose): Reserve for emergencies, when unpopular decisions are necessary, or when protecting against exploitation. Use sparingly in patient-facing situations.
Practical Strategies for Difficult Conversations
Your ability to navigate conflict effectively depends on several factors: your communication skills, your current physical and emotional state, the specific situation, your emotional intelligence, and your role within the practice.
Start with honest acknowledgement. Sometimes we genuinely cannot meet someone’s needs. Rather than pretending otherwise or becoming defensive, state this clearly while affirming the person’s value: “I understand this isn’t what you hoped for, and I can see this situation matters greatly to you. While I can’t provide XYZ, let me explain what I can offer and why it might still address your underlying concern.”
Remember that a good outcome isn’t always about getting what someone wanted. It’s about making them feel valued and acknowledged. People can accept disappointment when they feel heard and respected far more readily than when they feel dismissed, regardless of the objective outcome.
Frame your responses to communicate worth. Even when delivering unwelcome news, your tone and approach can convey that “you are worth more than I may be prepared to give at this time.” This isn’t about making false promises but about maintaining human dignity within system constraints.
For example, when a colleague raises a concern during a hectic surgery session:
Response A: “I don’t have time for this right now. Can we talk later?”
Response B: “I can see this matters to you, and I want to give it proper attention. I’m not in the right headspace to discuss this fairly right now, but can we schedule 20 minutes tomorrow afternoon? I don’t want to dismiss this—I just want to do it justice.”
Both defer the conversation, but Response B validates the colleague’s concern while being honest about current limitations.
This further illustrates an important principle: it’s helpful to verbalise your feelings during interactions rather than acting out your emotions. Saying “I’m feeling defensive about this feedback, so give me a moment to process it properly” is far more constructive than snapping back or withdrawing. When you name your emotional state, you provide context that helps the other person understand your response without experiencing it as a personal attack, while maintaining the professionalism essential in primary care teams.
Moving Forward
Conflict typically can follow a predictable escalation pattern, like a volcano building pressure before eruption. Loss or threat to needs triggers feelings, which drive behaviours. If you can interfere with the feeling stage, it could prevent behaviours that produce conflict.
In primary care, this means:
Creating systems where common needs (being heard, feeling safe, receiving timely care) are met proactively.
Training staff to recognise early emotional warning signs. I hope this article offers a resource for understanding the patterns.
Empowering team members to address concerns before they escalate.
Building organisational cultures where expressing unmet needs is safe and encouraged.
Conflict resolution in general practice isn’t about eliminating disagreement—that’s neither possible nor desirable in a complex healthcare environment employing and serving diverse populations. Instead, it’s about building skills and systems that allow conflicts to serve their proper function: highlighting unmet needs, surfacing different perspectives, and creating opportunities for better solutions.
The next time you face a difficult interaction, pause to ask: What need is going unmet here? What does this person actually require beneath their stated demand? How can I acknowledge their worth even if I cannot meet their specific request? These questions don’t solve every conflict, but they change the nature of the encounter, and that makes all the difference.
Read more about the Hidden power of workplace interactions for culture and success here.
References
Thomas, K. W., & Kilmann, R. H. (1974). Thomas-Kilmann Conflict Mode Instrument. Tuxedo, NY: Xicom. https://kilmanndiagnostics.com/overview-thomas-kilmann-conflict-mode-instrument-tki/
Saltman, D. C., O’Dea, N. A., & Kidd, M. R. (2006). Conflict management: A primer for doctors in training. Postgraduate Medical Journal, 82(963), 9-12. https://pmc.ncbi.nlm.nih.gov/articles/PMC2563732/
