PARTNERSHIPS: DISPUTE CASE STUDIES

In the article below, published by the BMJ, one of the world’s oldest medical journals, Dr Ruth Taylor looks at some authentic partnership case studies from the medical profession.

(A) TYPICAL PARTNERSHIP PROBLEMS Disputes can arise owing to personality clashes, power struggles, bullying, financial advantage or impropriety, affairs, workload disparity, and frequent or long-term sickness. In partnerships there may be clinical performance concerns - for example, underperformance and risky practice; non-adherence to practice policies; and inappropriate staff handling. This is often a highly stressful, depressing, and expensive experience, and it is vital to address issues early and not allow them to set in.

(B) THE CASE STUDIES:

Repeated absences Dr A took frequent short and long-term sick leave, not always for understandable reasons. This caused repeated difficulties (1) ….. absence at short notice, maintaining sufficient appointments, and even (2) ….. targets for the Quality and Outcomes Framework. No partnership agreement was in place, and partners disagreed about a strategy. Eventually a new partnership deed was agreed, which allowed six weeks’ annual sick leave before the sick partner paid for a locum, and locum insurance was (3) ….. . Dr A’s sickness absence (4) ….., but the problem had (5) ….. eight years.

Marriage breakdown Dr B, whose marriage had (6) ….., started an affair with a member of staff. Dr C supported Dr B and tried to help him through the crisis. However, the affair continued to make relationships in the practice difficult. Dr C called a partners’ meeting, (7) ….. her concerns, and requested a way forward, but nothing happened. Communication broke down in the practice and Dr C resigned. The issue had (8) ….. unresolved for two years.

Long-term illness Dr D developed a long-term illness. Dr E asserted that Dr D was no longer fit to practise and demanded specialised medical reports, which did not support this assertion. Dr E again said that Dr D should resign owing to illness. The other partners did not agree. Relationships with Dr E soured. Many individual and joint meetings were held without resolving the conflict. Eventually a breakdown in relationships with Dr E led to legal action that resulted in him being expelled by the partnership under the terms of the deed. The dispute took five years to resolve. Legal action took six months.

Performance problems Dr F was recruited at a time when the practice was desperate for a new partner and there were few applicants. It emerged that Dr F had an aggrieved personality. She soon developed a list of grievances. She repeatedly upset or shouted at people, and, although not engaging in discussion at meetings, she sent insulting or hurtful emails between meetings. The situation deteriorated when Dr F summarily dismissed a member of staff. Subsequently, as a result of patient complaints Dr G started scrutinising Dr F’s work and discovered a series of problems. Dr G visited the local medical committee, which advised asking Dr F to leave and offering pay in lieu of notice. Dr F refused and took sick leave. One month later, she was expelled under the partnership deed, more than five years after recruitment.

Poor commitment Dr H noticed that Dr I had gradually reduced her work commitment by dropping sessions, shortening surgeries, and leaving early. She was increasingly occupied with private practice, used the practice premises for private patients, and worked sessions elsewhere. Her income was not credited to the practice, although this was a stipulation of the partnership deed. The partnership was unable to agree a way forward despite morale being badly affected. There was no clause in the deed about resolving conflict. Unsupported, Dr H refused to sign off the accounts as they were inconsistent with the deed. The issue had been worsening over 10 years and remained unresolved.