Effective joint working is the key to successful general practice.  It may be joint working between the partners in a practice, joint working between the practices in a PCN, or joint working between the PCNs in an area.  Joint working is difficult, and where it is not effective individuals, practices and general practice as a whole all suffer.

The most important metric for joint working is trust.  How much do I trust my partners/the other practices/the other PCNs?  Where my trust is low I assume the intentions of others are poor, I avoid interaction where I can, and I am unwilling to be helpful because I do not believe there would be any reciprocation.  Life in a low trust environment is generally tense, unpleasant and often draining.

I spend much of my time supporting joint working within general practice.  Here are 5 steps that I have found to be extremely helpful in shifting from a low to higher trust environment:

1. Stop communicating primarily by email. One clear indicator of poor relationships is where the majority of the communication takes place by email.  The problem with email is that it is one way and open to misinterpretation.  You are not there to correct any misunderstandings when the email is being read.

2. Communicate by talking at least once a week. It is far better to have a short conversation of 20-30 minutes once a week than to have a (poorly attended) monthly meeting interspersed by heavy amounts of email communication.  Simply shifting the mode of communication from email to conversation in this way can have a huge impact.  It shows respect (people feel more valued when they are told things in person rather than by email), and allows questions and concerns to be answered and dealt with straight away, as well as preventing misunderstandings from festering.

3. Communicate in person. Whilst there has been a huge time and convenience benefit to meeting and talking online, it is very difficult to develop and improve relationships in a virtual space.  It is too easy for individuals to simply disengage from the conversation (how often are we in meetings where the majority of people have their cameras off and are on mute?), rather than have their concerns noted and dealt with.  Online it is difficult to spend enough time understanding and valuing each other as people, as without shared coffee breaks or pre-meeting chat we focus only on the business.

I worked recently with a PCN that shift from monthly virtual meetings and email as the primary communication route, to weekly half hour virtual meetings and a monthly face to face meeting with far less reliance on emails.  The impact on relationships across the PCN was transformational.  Trust that had become low was restored.  There was a shared confidence in a new sense of transparency, and a new willingness to take actions together as a group of practices.

4. Show vulnerability. The counterintuitive thing about building trust is that you build more trust by sharing your weaknesses than your strengths, and asking for help builds more trust than offering to help.  If I ask you for help I show that I respect you, that I believe you have strengths that I do not have and that I trust you enough to show you my weakness.  Conversely if I offer to help you I reinforce your belief that I think I am better than you, that I have no sense of my own weaknesses, and even that I may have a secret agenda to take you over – however well-intentioned the offer may be.
5. Admit when you are wrong. We all make mistakes.  Sometimes we are convinced that a course of action is the right one to take, but with hindsight we can see the error of our ways.  But it makes a huge difference to other people if we are prepared to put our hands up and say we are sorry when we have made a mistake.

I worked with one federation who had a difficult relationship with some of the PCNs in its area.  But this all suddenly changed when in one meeting the federation acknowledged that it had made mistakes in the past, said sorry for the impact of those mistakes, and asked what it could do to put them right.  Almost immediately the relationships were changed and moved to a much more positive place.

While it is generally true that trust can be hard to gain and is easy to lose, my experience has been that by starting with a good intent and taking the right actions in line with these 5 steps trust can be rebuilt surprisingly quickly.