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

Francesca H. Dakin; Ninna Meier; Emma Ladds; Sietse Wieringa; Joseph Wherton; Sarah Rybczynska-Bunt; Asli Kalin; Lucy Moore; Trisha Greenhalgh

doi:10.3399/BJGP.2025.0603

Published eLetters

eLetter submission guidelines

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors

First Name and Middle Initial *

First or given name, e.g. 'Peter'.

Last Name *

Your last, or family, name, e.g. 'MacMoody'.

Email Address *

Your email address, e.g. higgs-boson{at}gmail.com. PLEASE NOTE: your email address will be published.

Occupation *

Your role and/or occupation, e.g. 'Orthopedic Surgeon'.

Affiliation *

Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Jump to comment:

Relational infrastructure: what makes a practice feel like home in GP training
Sara Mirza

Published on: 05 February 2026

Published on: (5 February 2026)
Page navigation anchor for Relational infrastructure: what makes a practice feel like home in GP training
Relational infrastructure: what makes a practice feel like home in GP training
Sara Mirza, General Practice Registrar, Lewisham and Greenwich NHS Trust
Dakin and colleagues are to be congratulated for illuminating how “relational infrastructure” shapes the everyday reality of modern UK general practice.¹ Their qualitative study compellingly shows that what sustains teams under pressure is often less about technology or protocol, and more about how people relate to one another while doing difficult work.

As a newly appointed GP ST1 based in a practice within Lewisham and Greenwich NHS Trust, I read this paper through the lens of someone still learning what it means to be a GP. What has mattered most in my early training has not simply been clinical teaching, but the atmosphere of the practice: approachable leaders, reception colleagues who feel safe to raise concerns, and a culture in which questions are welcomed rather than tolerated. These relational features have quietly shaped my confidence, my willingness to speak up, and my sense that I belong in general practice.

The study also prompted me to reflect on how fragile such environments can be. Even in supportive practices, relentless demand and digital triage can pull teams apart, particularly for reception staff who manage much of the emotional labour of access. Maintaining connection across roles, therefore, requires deliberate effort, not just goodwill.

I was particularly struck by the authors’ finding that team-centred training was associated with trainee retention. This resonates strongly: early experiences of working...
Show More

Dakin and colleagues are to be congratulated for illuminating how “relational infrastructure” shapes the everyday reality of modern UK general practice.¹ Their qualitative study compellingly shows that what sustains teams under pressure is often less about technology or protocol, and more about how people relate to one another while doing difficult work.

As a newly appointed GP ST1 based in a practice within Lewisham and Greenwich NHS Trust, I read this paper through the lens of someone still learning what it means to be a GP. What has mattered most in my early training has not simply been clinical teaching, but the atmosphere of the practice: approachable leaders, reception colleagues who feel safe to raise concerns, and a culture in which questions are welcomed rather than tolerated. These relational features have quietly shaped my confidence, my willingness to speak up, and my sense that I belong in general practice.

The study also prompted me to reflect on how fragile such environments can be. Even in supportive practices, relentless demand and digital triage can pull teams apart, particularly for reception staff who manage much of the emotional labour of access. Maintaining connection across roles, therefore, requires deliberate effort, not just goodwill.

I was particularly struck by the authors’ finding that team-centred training was associated with trainee retention. This resonates strongly: early experiences of working relationships may determine whether new GPs stay in the profession long term. In this sense, relational infrastructure is not merely a workplace culture issue - it is a core component of how we train, retain, and support the future GP workforce.

As general practice continues to digitise, we must treat relational infrastructure as essential professional infrastructure, not a pleasant by-product of good teams.

References

1. Dakin FH, Meier N, Ladds E. et al. Teamwork and relational infrastructure: a qualitative study of modern UK general practice. Br J Gen Pract 2026; BJGP.2025.0603. https://doi.org/10.3399/BJGP.2025.0603.
Show Less

Competing Interests: None declared.