Chemistry alone doesn’t hold a team together
For a long time I assumed that leading a general practice team, or being in any working relationship, hinged on interpersonal chemistry and goodwill. Get on with people, be decent, and difficulties resolve themselves. I’ve come to think that’s an incomplete model, and sometimes a misleading one. Where I’ve seen genuine breakdown in professional relationships, whether within a partnership or across a wider general practice team, the cause traces back to an unmet or neglected need far more often than it traces back to personality dynamics.
Emotion is the signal, not the problem
Frustration, withdrawal, resentment: these get treated as the problem itself. They’re not. They’re symptoms. Something underneath them is going unmet, and the emotion is just the first place it becomes visible. Treat the emotion and you’re managing symptoms. Trace it back to the need and you’re actually fixing something.
Take a common scenario. Someone in a working relationship handles the finances. The accounting isn’t clear. The terms of an exchange start to feel murky. There’s no established route for the other person to ask a question about it or contribute a view on what should happen next. A slow drift happens, until somebody names it as a trust issue, or frames the other person as difficult.
It was never really about trust. It was autonomy, the need to have a voice in a decision that affects you, going unmet for long enough that the relationship reshaped itself around the silence.
Three things this has changed about how I lead
First, I try to name the emotion but not stop there. Frustration or withdrawal in someone I work with is a prompt to ask what need sits underneath it, not a problem to smooth over.
Second, I try to build in dialogue before the silence sets in. A conversation early gives people room to share an idea or clarify an uncertainty while it’s still cheap to fix. Left unaddressed, the same uncertainty hardens into resentment, and resentment is expensive to undo.
Third, I check the structure of a team against these needs before I commit people to it, not after something has already gone wrong.
A framework for leading a general practice team
What are these needs? These draw on ideas like, but these five are the ones I see matter most in a general practice team. These five draw on established ideas in psychology, autonomy and belonging echo Self-Determination Theory and Nonviolent Communication’s needs framework, but they’re shaped by what I’ve actually seen hold general practice teams together, or pull them apart.
Autonomy: respect for someone’s judgement and professional instincts.
Belonging: care that runs in both directions rather than only downward through hierarchy.
Compassion: space for kindness and empathy when someone is struggling.
Identity: respect for the whole person rather than only their functional role.
Psychological safety: confidence that something shared in vulnerability won’t be used against them later.
If a structure doesn’t account for these five needs, it doesn’t matter how good the people in it are.
Structures, not goodwill, hold a general practice team together
Build structures rather than rely on goodwill. Goodwill doesn’t survive a structure that consistently fails to meet the needs of the people inside it, however decent everyone involved happens to be. If you want a team to hold together, build a structure around these five needs, and make sure people understand why it exists.
Read more about conflict and how to manage it here .
