Conflict Management for Sessional GPs: Choosing the Right Approach

Why conflict management for sessional GPs matters

Conflict (when thought of purely as disagreement between individuals) is an everyday part of our lives, and certainly a routine part of being a GP. It arises in our interactions with patients, between colleagues, and in our conversations with others working in the NHS.

For sessional GPs, handling these disagreements is often more nuanced as we are working across different practices without some continuity, have potentially low levels of influence, and the perceived authority with others that partners may have.

Effective conflict management for sessional GPs is not simply about resolving every disagreement, but about choosing when to engage, how to respond, and how much energy to invest.

Whenever we are faced with a disagreement or conflict, instead of thinking ‘How do I make this go away?’, the questions we should instead be asking ourselves are ‘Should I even engage with this?’ and if so, ‘How should I approach this?’.

There are two well-established frameworks that can help inform the approach that I often refer to in my mediation practice either when teaching or when mediating and helping colleagues experiencing a conflict to work through their issues.

These are the Thomas-Kilmann Conflict Mode Instrument and the Kraybill Conflict Style Inventory. Both provide a complementary way of understanding how we respond to conflict and, importantly, how to actively choose a response style rather than reactively relying on our own natural and potentially unhelpful styles.

The Five Thomas-Kilmann Conflict Modes

The Thomas-Kilmann model describes five core ways of responding to conflict, based on a balance between assertiveness and cooperativeness. Styles weighted towards assertiveness are to be used when the individual is more focused on their own concerns and the outcome, and styles in the more co-operative end of the spectrum are more focused on preserving the relationship with the person at the other side of the conflict, by addressing what their concerns are.

We find that when we use this mode before deciding how to engage with a conflict, it can be empowering to know there are always options, and it can be very powerful to actively choose to avoid a conflict by using this framework.

Equally, individuals will find that by using this approach they have more time for the conflicts that are most important to them, and spend less time on those that aren't, making work more meaningful and purpose-driven.

The first style is ‘competing’, which is highly assertive and focused on achieving a clear outcome. In general practice, this might involve refusing unsafe additional workload, declining inappropriate patient requests, or challenging a colleague’s clinical decision in an urgent situation. It is efficient (as it is quick) and often necessary when safety is at stake and time is of the essence. However, if used too frequently, it can strain relationships and create tension within teams.

At the opposite end sits the ‘accommodating’ style, where the emphasis is on maintaining relationships by yielding to others. This might involve agreeing to small requests, supporting colleagues under pressure, or allowing flexibility in low-stakes situations. While this can build goodwill, it carries the risk of boundary erosion or being perceived as a ‘walk over’. Over time, consistently accommodating behaviour and the avoidance of using our assertiveness can lead to increased burn out, quiet frustration, and other members of the team to become confidently dominant. This can be a natural style for those of us who are conflict avoidant; it is a quick ‘giving in’ to the other person.

The ‘avoiding’ style represents a step back from the conflict altogether - a more active and visible avoidance than above. There are situations where this is entirely appropriate, particularly when the issue is minor, out of our control, when emotions are running high, or when there is insufficient information to act. For sessional GPs, avoidance can sometimes be a pragmatic choice, especially in short-term roles where engagement may not lead to meaningful change. However, when overused, it can allow unsafe practices or unresolved tensions to persist and morale to gradually erode.

The compromising style sits in the middle, aiming for a solution where each party gives something up and essentially ‘meets in the middle’. This is often practical and time-efficient, particularly for resolving issues around tangible issues measured in integers such as pay and hours worked, but the limitation of this style is that it may not address the underlying problem and leave colleagues feeling unheard. It can also be a bit of a lose-lose situation for all involved.

Finally, the ‘collaborating’ style involves using a high level of both assertiveness and cooperativeness in working through the issues by fully addressing the concerns of all those involved, and is often the most effective approach for complex or ongoing issues. In practice, this might involve redesigning workflows, resolving team cultural issues, or working through challenging patient expectations. It is by far the most time-intensive approach and requires willingness from everyone involved to engage constructively. Some of us - particularly those of us that are natural ‘fixers’ - will default to this style. When it is reserved not just for the most nuanced and important issues, it can result in overwhelm and burnout purely by how much time and effort this style takes; it can be quite consuming.

Ultimately, we should approach each conflict or disagreement thoughtfully with a consideration of our individual priorities and whether these lie with the outcome, or the person at the other end, or both, and tailor our approach accordingly. We may be surprised to see that actually there are some conflicts in the workplace that we should be outright avoiding that we may have otherwise been tempted to get involved in, or perhaps more importantly, ones that we have been avoiding that we really ought not to.

The Kraybill Perspective

The Kraybill Conflict Style Inventory model builds on similar ideas but focuses on how conflict styles shift under pressure. It highlights that people do not operate in a fixed mode all of the time and instead, they tend to have default patterns that can change when they are stressed, tired, or working under time constraints i.e. in General Practice.

A GP who is usually collaborative may become avoidant when overwhelmed, someone who values harmony may over-accommodate during a busy clinic, and a normally measured clinician may become more directive when time is limited. For sessional GPs, this is particularly relevant. Moving between practices, adapting to different systems, and managing unfamiliar teams increases the likelihood of operating in a reactive state rather than a deliberate one.

Understanding this dynamic is important because it explains why conflict can feel harder to manage on certain days or in certain environments. It is not simply the situation; it is also the context in which we are responding to it, and therefore something we need to cut each other and ourselves some slack for!

Understanding Our Default Style

Before applying these models in practice, it is worth reflecting on our own tendencies. Most of us have a default approach to conflict, shaped by our personality, values, training, and experience. Some prioritise maintaining relationships, others focus on outcomes, and many shift between styles depending on context. I personally prioritise principles which can lead me to stray into a directive approach more than I probably should.

There is the option to take a paid-for assessment to understand our own conflict style if it isn’t obvious, and it is an interesting exercise to undertake openly as a team of colleagues as it often leads to epiphanies about why we interact with each other the way that we do: https://kilmanndiagnostics.com/overview-thomas-kilmann-conflict-mode-instrument-tki/ 

Recognising our default style, and how it shifts, allows us to step back and make more deliberate choices. This awareness is often more important than the specific model that we default to itself.

Applying the Models in Practice

The value of these frameworks lies in their application to real situations.

In patient interactions, conflict often emerges in subtle ways. A common example is the patient who raises ‘by the way’ concerns at the end of a consultation. In this situation, competing may be appropriate if time or safety is at risk, allowing us to set a clear boundary. Accommodating may be reasonable if the issue is minor and there is sufficient time. Avoiding the issue altogether tends to reinforce the behaviour and increase pressure over time. The decision is less about being right and more about maintaining a sustainable consulting style.

In colleague interactions, the choice of approach depends on both the nature of the issue and our role within the practice. For ongoing problems that affect team function, collaboration is often the most effective approach. For more limited or time-bound issues, compromise may be sufficient. In some cases, particularly in short-term roles, avoidance may be a pragmatic choice if engagement is unlikely to lead to meaningful change.

System-level conflicts within the NHS are often the most complex. Encountering unsafe or inefficient processes can create tension between our professional responsibility and practical limitations. In these situations, a more assertive approach may be required to protect patient safety. Where there is openness to change, collaboration can lead to meaningful improvements. Where there is limited influence, the decision may shift from how to resolve the conflict to whether to continue working within that system.

Deciding How Much to Invest

One of the most important aspects of conflict management is deciding how much time and energy to invest. Not every conflict requires a collaborative, in-depth resolution. Some issues are better addressed quickly, while others are not worth pursuing at all.

This decision depends on the impact of the issue, our ability to influence the outcome, and the duration of our involvement. High-impact situations that affect safety or team function are more likely to justify deeper engagement. Situations where influence is limited or the issue is short-lived may be better approached with simpler strategies, such as setting boundaries or reaching a compromise.

For sessional GPs, this judgement is particularly important. Time and energy are finite, and investing heavily in low-impact or low-influence conflicts can reduce our capacity to manage more significant challenges and ultimately look after our own wellbeing.

Summary

Conflict in general practice is not an anomaly. It is an expected part of the daily working in a complex, high-pressure environment. The challenge is not to eliminate conflict, but to navigate it effectively. It’s a shame that it is something that we don’t receive any formal training in.

The Thomas–Kilmann Conflict Mode Instrument and the Kraybill Conflict Style Inventory provide a structured way to think about how we respond. More importantly, they support a shift from reactive behaviour to deliberate choice.

For sessional GPs, this is particularly valuable. With limited control over systems and varying levels of influence, the ability to choose how to engage with conflict becomes a key part of working safely and sustainably.

Ultimately, effective conflict management is not about always choosing the same approach. It is about selecting the right approach for the situation, and recognising when engagement is necessary - and when it is not.