Teamwork and relational infrastructure: a qualitative study of modern UK general practice

Abstract Background Clinical and support staff in modern general practice must work across in-person and digital modalities to deliver high-quality, safe care in a context of high workload, constant change and intermittent crisis. Navigating this environment is cognitively and emotionally demanding and requires complex teamwork. Staff morale is often low, and staff turnover high. Aims 1. To understand how the context of modern UK general practice affects staff wellbeing and teamwork. 2. To develop our understanding of how to improve these aspects of work culture. Design and Setting Multi-site case study of 10 GP practices across England, Wales, and Scotland. Method Mixed qualitative methods, incorporating ethnographic observations, interviews, and focus groups, to develop case studies. First, we conducted an in-depth longitudinal study of two practices focused on developing theory, which we cross-compared with eight others. Our analysis was informed by theories from organisational research, including psychological safety, relational coordination and attentional infrastructure. Results Staff wellbeing and effective teamwork depended on positive team relations. Practices in which such relations were valued and nurtured (i.e. those with a strong relational infrastructure) appeared to have stronger team identities, better coordination of work tasks, and higher overall staff wellbeing than those in which team relations were not actively nurtured. Staff relations were built and sustained through various individual actions and organisational routines. Conclusion This study has identified elements of 'relational infrastructure' with the potential to improve team relations, communication, and coordination, which may also enhance practices' resilience to withstand change and crises.