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Ep 99: How to resolve disputes in Practice – with Dr Clare Sieber

This week Tommy and special guest Dr Clare Sieber discuss how to mediate a bitter dispute between GP partners in GP practices. Find out about Clare’s unique skillset and more in today’s episode! 

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Show Notes:

Clare is a practicing GP in West Sussex, currently working 6 sessions a week.


She is a fully insured CEDR-accredited mediator and gained a qualifying law degree whilst working as a GP. She only mediates conflicts that involve GPs, mainly:

  • commercial disputes in general practice (partnership, property and PCN disputes)
  • workplace disputes (i.e., disputes between employees)

Before becoming a mediator, Clare worked as a Medical Director for Surrey and Sussex / Wessex Local Medical Committees, supporting and advising GPs in the South of England. A lot of this work involved providing pragmatic support to individual GPs, Partnerships, and PCNs that found themselves in conflict.

Clare also delivers training to GPs, Practice Managers, LMCs, and CCGs about dispute resolution and managing conflict. 


Common conflicts in General Practice:

Most commonly, Clare deals with partnership disputes. These are frequently about the exit (i.e., the retirement) of a partner from a partnership, whether that be a partner that wants to leave the partnership but can’t, or can’t yet, or a partner whose retirement has been agreed, but the buy-out process is being disputed, or a partner whose other partners would like them to leave but they have no mechanism to expel the partner.

Partnership disputes also often involve money, premises issues (whether the premises is owner-occpied or leased), GMC/NHSE-level investigations against partners and long term sickness. There’s also a smattering of fraud, divorce, adultery and crime that can feature in a partnership dispute!

Practices can also get into conflicts with the other practices in their PCN, something which is becoming more common these days, or in conflicts with their employees over terms and conditions.


How to resolve conflicts in General Practice:

Make sure you speak to your LMC – they are the experts at resolving conflicts within their practices. Every LMC offers a slightly different service, some may offer a mediation service even, but the minimum that they will be able to provide is some pragmatic support to the parties in the conflict as a whole.

What is Mediation?

Mediation is a voluntary process where people can come together to find their own mutually agreeable solution to a conflict or disagreement under the guidance of an impartial mediator.

The process is flexible and tailored to the needs of those involved. Usually the parties and the mediator meet together in one space for a brief meeting before moving into breakout rooms where they work with the mediator to propose suggestions and make offers to each other to resolve the issues. A mediator who understands the context of a dispute will be able to help the parties to think creatively about ways that the problem can be solved. 

Mediation is a ‘safe space’ where parties can attempt to resolve their issues in good faith. The whole process is confidential, and although most mediations result in a legally-binding agreement that ends the matter on the same day, there is no obligation to reach an agreement.

The voluntary nature of mediation means that a participant can walk away at any time. If an agreement is not reached, the slate is wiped clean, and everything said in the mediation stays confidential and cannot be mentioned in ongoing or new legal proceedings (this is a legal principle known as ‘without prejudice’). 

Agreements can be tailored to a specific situation, including elements further-reaching than a court of law could order such as creative use of payments, notice periods, leave, profit shares, partner duties, sabbaticals, references, and messaging to staff and patients. In addition to having a more pragmatic outcome, the process of mediation is also much faster and cheaper than legal proceedings. It will cost a partnership in the region of £3000, and some CCGs are happy to reimburse the costs of a mediation.


How does mediation work in practice?

As mediation is voluntary, ALL of the parties in the dispute must be prepared to participate in the process – it cannot be forced upon anyone. In reality, once the principles of mediation that are mentioned above are understood, there is little reason not to participate. 

With a partnership dispute, all partners (including those on long term sickness absence, or those on a mutual assessment period) will need to be involved. If the dispute relates to – or if an agreement is likely to involve changes to – property ownership, then all of the property owners (who may be retired partners or family members) will need to participate. Occasionally, people chose to bring their legal representatives with them to a mediation. 

Once all have agreed to go ahead, the mediator will arrange 1:1 calls via Microsoft Teams with each party. These meetings are confidential. This is to make an introduction, explain the process, and understand that person’s background to the issues and how that person thinks they could be resolved. 

A mediation agreement is signed by all parties and the mediator using electronic document signing software, which ensures that everyone understands the confidential and without prejudice nature of the process. 

The parties will then need to set aside a full day (or two half days if that is not possible) where they all can attend the mediation. The mediation starts with a brief meeting of everyone together where each party has the opportunity to speak uninterrupted about the issues and how they see them being resolved. Everyone then moves into smaller breakout rooms. These rooms are a private space in which the participants can talk confidentially to the mediator, and the mediator will then take any agreed messages, acknowledgements, offers or suggestions backwards and forwards between all of the parties. The mediator will explore the parties’ situations, challenge ideas, and coach the parties towards a solution. 

Almost all mediations result in an agreement that ends the matter entirely. The mediator (or the legal representatives) will draft this into a settlement agreement which is then signed by everyone, at which point it becomes legally binding. 

How do I find a mediator?

Mediation is unregulated as a profession, although there is a voluntary regulator called the Civil Mediation Council. A good mediator can be recommended to you by your LMC or your lawyer, and will have their credentials and ‘mediation CV’ ready to give to you so you can scrutinise their work.

If you are a BMA member, then do remember that the BMA offers a free interpersonal mediation service (for a workplace type of mediation).


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