Change Management
Because asking "can't we just keep doing it the old way?" is not a management strategy.
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🌐 Web Resources
A hand-picked mix of official guidance and real-world resources. Because sometimes the best pearls are not hiding in the official documents.
Kotter's 8 steps, PDCA cycle, and NHS-specific change resources in one place.
How-to guides for practices implementing access, telephony, and care navigation changes.
Strategic thinking on how primary care is changing and how to lead through it.
Comprehensive toolkit covering SWOT, force field analysis, Kotter, OPTIMAL frameworks.
ADKAR, Lewin, Kotter, and Kübler-Ross change curve with NHS context throughout.
Clear, practical explanations of all major change frameworks and when to use them.
Detailed yet accessible guide — a favourite for GP trainees new to this topic.
Widely referenced article from Strategy+Business on what actually makes change stick.
Clear breakdown of what every change process needs to succeed.
Good starting point to understand the breadth of change management theory.
Practical guide to identifying and categorising stakeholders in a change project.
Peer-reviewed overview of Lewin, Kotter, Lippitt, and Rogers in a healthcare context.
💡 Why This Matters in General Practice
The NHS is in a permanent state of change. Whether you like it or not, you will be asked to lead, manage, or adapt to change throughout your career.
General practice is one of the most dynamic and pressurised healthcare environments in the world. New NHS contract requirements, integrated care systems, digital transformation, staff turnover, QOF changes, new NICE guidance — change is not occasional. It is constant.
Yet change is often handled poorly. Staff feel things are "done to them." Good ideas fail because the people side is ignored. Systems are introduced without proper training. Morale suffers. Outcomes disappoint.
Understanding change management gives you a vocabulary, a set of tools, and — crucially — an understanding of why people react the way they do. That understanding is what separates a GP who leads well from one who wonders why their team never seems on board.
- Moving from paper to electronic prescribing
- Introducing online triage (e.g. eConsult, AccuRx)
- Restructuring appointment booking away from the "8am scramble"
- Adding social prescribers, paramedics, or pharmacists to the clinical team
- Joining a Primary Care Network (PCN) and sharing staff
- Implementing new chronic disease management pathways
- Responding to CQC recommendations following inspection
- Merging with another practice
📖 What Is Change Management?
A clear definition — and why it matters to get this right from the start.
Change management is a structured approach to moving an organisation from its current state to a desired future state. The word structured is the key. Without structure, even good ideas fail — not because the idea was wrong, but because people weren't brought along.
Change management is not about forcing people to do something different. It is about understanding what needs to change, why it needs to change, and then leading people through the process in a way that preserves trust, maintains morale, and actually achieves the goal.
Most change programmes fail not because the technical solution was wrong, but because the human side of change was underestimated. People — not processes — are the hardest part of any change. Change management is primarily a people discipline.
Types of Change in Healthcare
| Type | Description | GP Example |
|---|---|---|
| Incremental | Small, gradual improvements to existing systems | Tweaking the telephone triage script |
| Transformational | Large-scale redesign of how the organisation works | Switching to a total triage model |
| Planned | Deliberate, managed change with clear goals | Implementing a new IT system with training and timeline |
| Emergent | Unplanned change driven by circumstances | Pandemic-driven shift to remote consultations |
| Structural | Changes to roles, teams, or organisational design | PCN formation, practice mergers |
| Cultural | Changes to values, behaviours, and norms | Moving from hierarchical to distributed leadership |
⚡ Quick Summary — The 60-Second Version
What it is: A structured approach to moving an organisation from where it is now to where it needs to be — without losing people along the way.
Key models: Lewin (Unfreeze–Change–Refreeze), Kotter's 8 Steps, ADKAR (individual change), Rogers' Diffusion Curve (adoption patterns).
Biggest obstacle: Resistance from people. This is normal, human, and manageable — but only if you plan for it.
Key tools: Force field analysis, SWOT, stakeholder mapping. Use them before you start.
In GP practice: Every system change — new clinical software, appointment model, care navigation — needs proper change management or it will underdeliver.
The golden rule: Communicate early, communicate often, involve people before they're asked to change — and celebrate early wins.
🧩 Models of Change Management
There are many models. Each looks at change from a different angle. You do not need to pick just one — experienced leaders blend them intelligently.
Lewin's 3-Step Model (1947)
One of the oldest and most widely used models. Simple, memorable, and still highly relevant to NHS change.
Prepare for change
Implement the new
Embed and sustain
Before anything changes, you need to "melt" the current state. This means creating awareness of why the old way is no longer sufficient. Without this, people dig in.
- Explain why change is necessary
- Show the evidence for the problem
- Create psychological safety — it's safe to let go of the old way
- Involve people in identifying the problem
The actual shift. This is the most uncertain and uncomfortable stage — people are no longer in the old way, but not yet settled in the new one.
- Communicate constantly — uncertainty breeds rumour
- Provide training and support
- Expect some confusion and tolerate it
- Celebrate small wins to maintain momentum
The new way becomes the new normal. Without this stage, people drift back. This is where many GP practices fail — they implement the change but forget to embed it. The new system needs to become part of how the practice just "works".
- Update policies and procedures to reflect the new way
- Recognise and reward the new behaviours
- Induct new staff into the new system from day one
- Review and consolidate after 3–6 months
Lewin's model works best for machine-like organisations with clear hierarchy and predictable workflows. It works less well in highly political organisations where power is fragmented — for those, Carnall's model or Kotter's is a better fit. Most GP practices sit somewhere in between.
Kotter's 8-Step Model (1996)
Developed by Harvard Professor John Kotter from studying dozens of organisations. Focuses on the people behind the change — making it ideal for healthcare.
Make people feel why change cannot wait. Show the data. Tell the stories. The burning platform has to be real.
Build a team of credible, respected people who champion the change. Don't try to do it alone.
People need to know where you're going. A foggy vision creates anxiety. A clear one creates hope.
Use every channel. Repeat it. Be consistent. Correct misinformation quickly.
Identify what's blocking people from changing and fix it — whether that's training, resources, or a manager who disagrees.
Plan visible, early successes. Wins build credibility and momentum. Silence breeds doubt.
Don't declare victory too early. Keep pushing until the change is deeply embedded.
Anchor the change in culture. Link it to what the organisation values. Celebrate it as "how we do things now".
Because healthcare is fundamentally a people business. Kotter's model is built around leadership, communication, and human motivation — exactly what's needed in a multi-professional GP team where hierarchy is flatter and people cannot simply be told to change.
ADKAR Model (Hiatt / Prosci, 2003)
While Lewin and Kotter focus on organisational change, ADKAR focuses on the individual — because organisations only change when the people within them change. Developed from studying over 700 organisations.
Imagine your practice is introducing a new online triage system (e.g. eConsult):
- Awareness: Tell reception staff why the 8am call rush is unsustainable and what data shows
- Desire: Show them how the new system will make their daily experience better — fewer call floods, less patient frustration
- Knowledge: Run hands-on training sessions with the actual system
- Ability: Allow practice sessions with test patients before going live
- Reinforcement: Weekly check-ins, celebrate reduced call volumes, address problems quickly
ADKAR is sequential. You cannot skip a step. If someone lacks Desire, providing Knowledge will not help. If someone has Knowledge but lacks Ability, they will fail publicly and become more resistant. Always diagnose where someone is stuck before trying to move them forward.
Rogers' Diffusion of Innovation (1962)
Rogers studied how new ideas spread through populations. His insight: not everyone adopts change at the same speed — and the reason matters. This model helps you understand who in your team will champion change and who will resist it.
Do not try to convince the Late Majority and Laggards first — this is an enormous waste of energy. Instead, focus on identifying your Early Adopters (about 13–14% of your team), win them over, and let them influence the majority. The critical mass for change is typically around 20–25% of adopters — once you hit that, the rest follows.
- Advantage: Is it clearly better than what we had? Show the evidence.
- Compatibility: Does it fit with our values and ways of working?
- Complexity: Is it simple enough to understand and use?
- Observability: Can people see it working for others?
- Divisibility / Trialability: Can we try it before committing fully?
Rogers described a tipping point he called "critical mass" — the moment when enough people have adopted a change that it becomes self-sustaining. Before that point, you have to push. After it, momentum carries you. Your job is to reach that point as efficiently as possible by focusing on the right people first.
Carnall's Change Management Model (1990)
Professor Colin Carnall's model is particularly relevant for complex, politically charged organisations — which makes it very applicable to the NHS. Unlike Lewin's model, which works best in more machine-like organisations, Carnall's model is designed for settings where power is distributed, professional autonomy is high, and not everyone answers to the same line manager.
Carnall's model centres on three interacting dimensions that must be managed simultaneously during change:
People go through predictable emotional stages when faced with change: denial → anger → bargaining → depression → acceptance. Leaders must understand and support people at each stage, rather than expecting everyone to arrive at acceptance at the same time.
Change requires leaders to demonstrate specific skills: managing transitions, managing organisational culture, managing organisational politics, managing strategy, and managing people in transition. These are distinct skills, not just "being a good manager".
Change should ultimately improve performance. But during the transition, performance often dips before it improves — this is expected and normal. Leaders must protect the organisation during this dip and set realistic expectations with staff and stakeholders.
Use Carnall's model when your organisation operates more like a political system — where influence matters more than authority, where different stakeholders have competing agendas, and where resistance comes from cultural and political sources rather than just inertia. This describes most NHS organisations perfectly.
Comparing the Main Models
| Model | Focus | Best For | NHS Context |
|---|---|---|---|
| Lewin | Process stages (Unfreeze → Change → Refreeze) | Structured, predictable change in "machine-like" orgs | Implementing a specific policy or protocol change |
| Kotter | Leadership and people motivation (8 steps) | Large-scale, complex change needing buy-in across many people | Transformational change across a practice or PCN |
| ADKAR | Individual change (Awareness → Reinforcement) | Understanding why a specific person is not changing | Diagnosing individual staff resistance and tailoring support |
| Rogers | Spread of ideas through a population | Understanding adoption patterns and targeting the right people | Rolling out new clinical or administrative innovations |
| Carnall | Complex, political organisations with distributed power | Politically sensitive or culture-change challenges | Managing change in NHS organisations with competing agendas |
Skilled change leaders do not pick one model and ignore the others. They use Kotter to design the overall approach, ADKAR to understand individual resistance, Rogers to target adoption strategically, and Lewin or Carnall to understand the organisational context. Think of the models as lenses, not recipes.
🚧 Resistance to Change
Resistance is not a problem to be overcome. It is information to be understood. The better you understand why people resist, the more effectively you can lead them through.
Resistance is a natural and normal human response to change — particularly in healthcare, where current practices are deeply ingrained, patient safety is paramount, and professional identity is closely tied to how one works. Expecting no resistance is naive. Planning for it is wise.
Why People Resist
😟 Fear of Failure
"What if I can't manage the new system? What if I look incompetent?" Particularly common when digital or technical change is involved.
🔒 Comfort With the Current Way
People have invested years learning to do things a certain way. Change makes their expertise feel devalued or threatened.
❓ Lack of Understanding
"Why are we changing? What's wrong with how we do things now?" Without a compelling reason, change feels unnecessary and disruptive.
🗣️ Not Being Consulted
Staff who feel change is "done to them" rather than "with them" will resist, even if they might otherwise agree with the change.
📉 Loss of Status or Role
Change can threaten people's perceived position, autonomy, or area of expertise. A GP who has always managed a specific disease area may feel threatened if that changes.
⚡ Past Experience of Failed Change
"We tried this before and it didn't work." NHS staff have often lived through many failed change programmes. Cynicism is earned, not irrational.
⏱️ Timing and Workload
"Right now is the worst possible time." Change during periods of high pressure will almost always face more resistance — even if the change itself is well-designed.
🏛️ Cultural Norms
Deeply embedded professional cultures (e.g. medical hierarchy, clinical autonomy) can make certain changes feel threatening to professional identity itself.
Strategies for Overcoming Resistance
💬 Involve People Early
Involve staff in designing the change, not just implementing it. People are far less resistant to changes they helped create.
📢 Communicate the "Why" Clearly
The reason for change must be compelling, honest, and concrete. Data helps — but stories help more. "Mrs Jones could not get through on the phone for 3 days" is more motivating than a spreadsheet.
🏆 Celebrate Early Wins
Early success builds momentum and credibility. Publicise wins generously. Make the benefits visible quickly.
👥 Recruit Champions
Identify respected colleagues — Rogers' Early Adopters — who can model the change and reassure their peers. A change championed by a respected colleague is far more persuasive than one imposed by leadership.
🎓 Provide Training and Support
Many people resist because they are afraid of looking foolish. Good training removes that fear. Make training low-stakes, practical, and available when needed.
⏰ Time It Thoughtfully
Avoid launching major changes during periods of extreme pressure — winter months, immediately after inspections, during staffing crises. The best idea launched at the wrong time will fail.
👂 Listen to Concerns Genuinely
Some resistance contains useful feedback. A GP who says "but what about patients without internet access?" is raising a legitimate concern that will improve your plan if you listen.
🔄 Use PDSA — Start Small
A trial or pilot feels less threatening than a big bang. People are more willing to try something than to have it imposed. Start with willing volunteers and let success speak for itself.
🔧 Practical Tools for Change Management
Use these before and during any change process. They are quick, practical, and much more useful than they might sound.
📊 Force Field Analysis — Understanding What's Helping and Hindering
Developed by Kurt Lewin, a force field analysis maps out all the forces that are helping your change happen (driving forces) against all the forces that are resisting it (restraining forces). The goal is to strengthen the drivers and reduce the restrainers.
Example: Introducing online triage to a GP practice
✅ Driving Forces
- High call volumes causing staff stress
- Patient complaints about 8am access
- Senior partner champion for digital
- ICB offering funding support
- Other local practices have done it successfully
- Strong evidence base for access improvement
⛔ Restraining Forces
- Two GPs prefer face-to-face initial contact
- Reception staff anxious about new system
- IT infrastructure not updated
- Concerns about digital exclusion of elderly patients
- No dedicated training time in the rota
How to use it: Score each force 1–5 for strength. If your driving forces outweigh restraining ones, the case for change is strong. Use the analysis to target your efforts: address the strongest restraining forces rather than trying to overcome them all at once.
🎯 Stakeholder Mapping — Who Matters and How to Engage Them
Stakeholder mapping places each person or group on a two-axis grid: how much influence they have over your change, and how much interest they have in it. Your engagement strategy should differ depending on where they sit.
Keep satisfied. These people can block your change. Don't overwhelm them with detail — give brief updates and make sure they feel respected and informed.
Example: Senior partner not directly involved in the change
Manage closely. These are your most important stakeholders. Engage early, involve in planning, share decisions where possible. Their support is essential.
Example: Practice manager, lead GP, nursing lead
Monitor. Keep a light touch. Inform them at key milestones but don't burden them with every detail.
Example: Attached community physiotherapist
Keep informed. These people care about the outcome and will be watching. Regular updates keep them engaged and prevent them becoming vocal resistors.
Example: Reception team members, patient participation group
🔍 SWOT Analysis — Sizing Up the Situation
A SWOT analysis (Strengths, Weaknesses, Opportunities, Threats) is a structured way to assess both internal and external factors before committing to a change. It is best done as a group, not in isolation — different roles in the practice will see different things.
| Helpful | Harmful | |
|---|---|---|
| Internal | Strengths — What does the practice do well? What resources do we have? | Weaknesses — What do we lack? What are our current gaps? |
| External | Opportunities — What external factors could help us? Funding? Policy support? | Threats — What external factors could undermine the change? Staffing, finances, patient population? |
A SWOT is a conversation-starter, not a decision-maker. Use it to surface assumptions, surface hidden concerns, and ensure everyone has the same picture of the landscape before the change begins.
🗃️ PDSA Cycle (Plan-Do-Study-Act) — Testing Before Committing
The PDSA cycle is the backbone of quality improvement in the NHS. It is also a powerful change management tool because it allows you to trial a change on a small scale, learn from it, and refine before rolling out to everyone. This dramatically reduces resistance because staff know it's a test, not a done deal.
Set aims, predict outcomes
Implement the test
Analyse what happened
Adapt and repeat or adopt
Instead of "we're changing the appointment system from Monday," try "we're going to test online triage for 10 patients per day for 2 weeks, gather data, and then decide together." This reduces threat, increases engagement, and improves your chance of success. It also shows respect for the staff living through the change.
📣 Communication Planning — The Most Underused Tool
Most change programmes communicate too little, too late. The vacuum created by poor communication fills quickly — with rumour, anxiety, and active resistance. A communication plan ensures the right people get the right message at the right time.
| Stage | Message | Audience | Channel |
|---|---|---|---|
| Before change | Why we need to change, what we're planning | All staff | Team meeting + written summary |
| During planning | How decisions are being made, how staff can input | Key stakeholders | 1:1 conversations + team updates |
| Before launch | Exactly what is changing, what it means for each role | All affected staff | Training sessions + written guide |
| During change | Progress updates, early wins, acknowledgement of difficulties | All staff | Regular team briefings |
| After change | What we achieved, how things will be sustained | All staff + patients | Team meeting + patient communication |
🗺️ A Practical Change Management Process for GP Settings
Whatever model you choose, this is the basic sequence that underlies all effective change in primary care.
Best Practice Checklist — 10 Principles for Managing Change Well
- Time it right. Avoid launching during periods of maximum stress. A well-designed change at the wrong moment will underperform.
- Make the change desirable. The benefits must be clear, concrete, and relevant to each person affected. "This will benefit the practice" is far less motivating than "this will reduce your morning call flood."
- Recruit help from within. Identify and engage Early Adopters who will champion the change among their peers. Their influence exceeds yours as a leader.
- Communicate early. Tell people about the change before it happens. Surprises breed suspicion.
- Communicate continuously. Regular updates — even "nothing new to report" — maintain trust and prevent the vacuum that rumour fills.
- Communicate on all levels. Different people need different messages. A receptionist needs to know what their day will look like. A GP partner needs the clinical rationale.
- Open the forum. Hold open discussions. Correct misinformation. Validate concerns. This is not weakness — it is leadership.
- Monitor as you go. Implementation is not a one-off event. Watch what's happening, identify problems early, and adapt without defensiveness.
- Ease the pressure at the right moments. Recognise when people are at capacity and give them space. Sustained pressure eventually creates backlash.
- Ensure full integration. 50% adoption is not a success. If only some staff have changed and others haven't, you have created a two-speed practice — which is often worse than staying where you started.
⚠️ Common Pitfalls
These are the mistakes that derail otherwise good change programmes. Recognise them before they happen to you.
- Starting with the solution, not the problem. "We're implementing X" before anyone has asked "what problem are we solving?" creates resistance from the outset.
- Ignoring the human side entirely. Focusing only on the technical or process aspects while neglecting how people feel about the change. Feelings drive behaviour.
- Announcing change, not managing it. Sending an all-staff email about a new system is not change management. It is the start of a much longer process.
- Declaring victory too early. Kotter specifically identified this as one of the most common errors. The change hasn't stuck until it's the new default for everyone — including new staff.
- Not addressing the vocal minority. One or two resistant voices — particularly if they are senior or respected — can undermine a whole change programme if not addressed thoughtfully.
- Underestimating the transition dip. Performance almost always dips during the change period. Leaders who interpret this as failure and reverse the change confirm everyone's fears and make future change even harder.
- Trying to change culture with a memo. Culture is changed through behaviour, recognition, and sustained experience — not by writing a new values statement.
- Ignoring the Laggards entirely. While you shouldn't start with them, you cannot ignore them forever. At some point, non-adoption becomes a performance or patient safety issue.
- No feedback loop. Implementing without reviewing. How do you know the change is working if you never measure it?
- Failing to update policies and onboarding. If the new system isn't in the induction programme for new staff, it will quietly erode over time as people revert to what they were taught.
💎 Insider Wisdom — What Trainees Actually Find Out the Hard Way
These insights come from the shared experience of GP trainees and GP educators across the UK. They are fully consistent with RCGP and GMC guidance — just more honest about the reality.
The Emotional Journey of a Trainee Leading Change
This is what the experience actually feels like — and knowing it in advance helps you stay on course when it gets difficult.
What Actually Works — Straight Talk From the Trenches
Pick a topic the practice actually cares about
The single most consistent piece of advice from GP trainees who have done this well: find a genuine pain point. Ask your trainer or practice manager, "What has been annoying us for months?" That's your project. A QI project or leadership activity that addresses a real itch gets far more cooperation than one chosen because it sounded impressive.
Start small and let it grow
Trainees who try to change too much too soon almost always run out of time and goodwill. Begin with a single, measurable process — one that can be tested within a few weeks. A small, completed PDSA cycle is worth ten grand plans that never get off the ground. The RCGP wants to see that you understand the process, not that you saved the NHS.
Ask, don't tell
One of the most common rookie mistakes: presenting a fully formed solution before asking for input. Even if your idea is excellent, people who weren't consulted will find a reason to resist it. The question "What do you think would help here?" does more to build buy-in than any PowerPoint presentation. Ask first. Adapt. Then present.
Work with the receptionist team, not around them
Reception staff are often the people most affected by practice changes — and the people least consulted about them. They also have insights that clinicians simply don't see. A receptionist who feels heard and respected will become your most effective champion. One who feels overlooked can quietly torpedo even the best-designed change.
Get your trainer on side before anyone else
Your trainer (Educational Supervisor) has political capital and relational trust in the practice that you, as a newcomer, simply do not yet have. Before approaching the whole team, brief your trainer privately. If they back you, the conversation with others goes much more smoothly. If they have reservations, you want to know now — not in a team meeting.
Don't start a leadership project in your final two months
This is very commonly flagged by trainers and trainees alike. In those final months you are managing SCA preparation, FourteenFish portfolio completion, and ARCP sign-off. Starting a fresh leadership activity then is stressful for you and unfair to the practice. Begin in the first half of your ST3 year and use the second half for embedding and reflection.
How to Have the "I Want to Change Something" Conversation
This sequence is consistently flagged by GP trainers as the right way to approach a change conversation — whether with a senior partner, a practice manager, or a resistant colleague.
💡 What GP Trainees Wish They'd Known Earlier
These insights are drawn from the experiences of GP trainees and educators across UK deaneries. Each one has been cross-checked against RCGP and GMC guidance.
"I spent weeks designing the perfect project on a topic I personally found interesting. Nobody else cared. My second project was about a problem the practice manager had been moaning about for a year — I had a full team on board within five minutes."
"The most resistant person in my practice turned out to be worried that the change would expose a gap in their own knowledge. When I made it clear the new system came with full training and no one would be expected to just figure it out, the resistance vanished almost overnight."
"Halfway through my leadership project things actually got worse before they got better. Call times increased, patients complained, and two colleagues came to my supervisor. I wanted to give up. My trainer pointed me to Carnall's model and said: this dip is normal and expected. If I persevered, the data would turn around. It did."
"My first draft just described what I did. My trainer said that's a log, not a reflection. A proper reflection says what you did, why it worked or didn't, which change management principle explains it, and what you'd do differently. That's the version that impresses the ARCP panel."
"I forgot to collect baseline data before my intervention. I had nothing to compare the results to. Everything I said afterwards was opinion, not evidence. Get your baseline numbers before you change a single thing. Even ten cases. Even a week's worth of data. Something."
"When it worked, I sent a quick email saying 'thank you to everyone who helped with this — look what we did together.' Three people came to say thank you back. That one email did more for the culture of change in that practice than anything else I did."
The GP Trainee Change Leadership Compass
Four directions you must orient yourself in, all at the same time.
ARCP panels and educational supervisors consistently describe the same pattern in reflections that stand out. A great reflection on a change management activity has five elements:
- What I did — a concise description of the activity and your personal role in it
- What happened — an honest account, including what went well and what didn't
- Why it happened — a named theoretical explanation (e.g., "this is consistent with Kotter's step 3 — the vision wasn't clear enough")
- What I learned about myself — specifically about your leadership style, your tendencies under pressure, or your relationship with conflict
- What I would do differently — a concrete, actionable improvement for next time
The weakest reflections describe only what happened. The strongest ones explain why it happened using theory — and connect it to personal growth. That is the difference between a competent reflection and an impressive one.
If you trained outside the UK, change management culture in NHS general practice may feel quite different from what you experienced before. Some specific things to be aware of:
- Hierarchy is flatter in UK primary care. Senior GPs are consulted and respected, but they do not simply issue orders. Change is expected to be built through consensus and conversation, not top-down directive.
- Your ideas are genuinely valued. The "fresh pair of eyes" concept means your outside perspective is an asset, not a liability. NHS education culture explicitly encourages trainees to identify improvement opportunities.
- Directness is valued, but so is tone. You can say difficult things — but how you say them matters enormously in UK workplace culture. A concern expressed as a question ("I wonder if we could improve X?") lands differently than a statement ("This system is wrong").
- Resistance may be subtler than you expect. In some cultures, disagreement is expressed openly. In UK NHS culture, resistance is sometimes expressed very quietly — through non-attendance at meetings, slow compliance, or polite "yes" with no follow-through. Learn to read these signals.
🩺 For GP Trainees — What You Need to Know
Change management might not feel like your concern as a trainee. It absolutely is — and the earlier you understand it, the better doctor and colleague you will be.
As a GP trainee, you will often be asked to lead or participate in quality improvement (QI) projects that involve change. Your ARCP and portfolio require evidence of leadership and change management. You will encounter resistance and need to know how to handle it. And as a future partner or senior GP, this knowledge will be among the most practically useful you acquire.
Practical Tips for Trainees Involved in Change
- Identify your key stakeholders first — don't wait until you have a plan
- Use a force field analysis to anticipate resistance before it appears
- Make sure you understand the problem before proposing the solution
- Find your champion — the respected colleague who will back you
- Plan your communication before your first team meeting
- Communicate more than you think you need to — you probably still won't communicate enough
- When you hit resistance, get curious before getting frustrated. Ask: "Where is this person in the ADKAR sequence?"
- Celebrate small wins publicly and generously
- If something isn't working, adapt — don't defend
- Document your process for your portfolio as you go — don't try to reconstruct it later
When reflecting on a change project for your portfolio or in a tutorial, assessors are not just looking for "we changed X." They want to see that you understand how change happens and why your approach worked (or didn't). A reflection that names specific models — "I used a force field analysis to anticipate resistance and targeted early adopters first using Rogers' principles" — demonstrates a level of sophistication that stands out.
- Quality Improvement (QI) projects documented on FourteenFish ePortfolio
- CbD cases that involve multidisciplinary or practice management dimensions
- Reflective entries describing your experience leading or participating in change
- Evidence of using change management tools (SWOT, force field analysis, stakeholder map)
- Leadership entries demonstrating ability to bring people along with change
👨🏫 Trainer and Teaching Pearls
Ideas for teaching this topic effectively in tutorials or educational supervision.
👨🏫 Common Trainee Blind Spots on This Topic
- Trainees often conflate change management with persuading patients to change — address this early
- Many underestimate resistance: "Surely if it's a good idea, people will just get on board?" — this is the single most dangerous assumption in change management
- Trainees rarely appreciate that the transition period (during the change) is the most difficult and where most failures occur
- Many select a model and apply it rigidly rather than using multiple models as complementary lenses
💬 Tutorial Discussion Prompts
- "Tell me about a change that happened in your practice during your time there. What worked? What didn't? Why?"
- "If you were introducing online triage to a resistant practice team, how would you approach the first conversation?"
- "Where on the Rogers adoption curve do you think you tend to sit personally? How does this affect how you lead change?"
- "Using ADKAR, diagnose why a hypothetical receptionist might still not be using the new system after 3 months."
- "What's the difference between a change that is implemented and a change that is embedded?"
🎯 Teaching Scenario for Tutorials
Your practice has just decided to introduce a new care navigation system. Reception staff will now ask patients three questions about their problem before booking them with a clinician. Two GPs are strongly supportive. One senior GP thinks it undermines clinical triage. The practice manager is worried about training time. Three receptionists are anxious about making clinical judgements.
Ask the trainee: Who is your most important stakeholder right now? Where would you start? What tool would you use to map the resistance? Which model best applies here?
🧠 Memory Aids & Quick Recall
Mnemonic — "ADKAR" for Individual Change
- "I need to understand the overall stages of change" → Lewin's 3-step
- "I need to lead a big people-centred change" → Kotter's 8 steps
- "A specific staff member is resisting — I need to diagnose why" → ADKAR
- "I want to understand how my team will adopt this new system" → Rogers' Diffusion
- "My organisation is politically complex" → Carnall
- "I want to test a change before committing fully" → PDSA cycle
❓ Frequently Asked Questions
Do I need to use a formal model for every change in my practice?
What should I do if a very senior colleague refuses to adopt the change?
My QI project didn't work — what should I write in my portfolio?
Is Lewin's model still relevant today?
What's the most important single thing to do when leading change?
How long does change typically take in a GP practice?
🎯 Final Take-Home Points
- Change management is a people discipline, not a process one. The technical side of any change is usually far easier than the human side.
- Resistance is normal, expected, and manageable — but only if you plan for it. Use force field analysis and stakeholder mapping before you begin.
- No single model is best for every situation. Blend Kotter, ADKAR, Rogers, and Lewin intelligently — they are lenses, not recipes.
- Communicate far more than you think is necessary. The vacuum created by silence fills quickly with rumour and anxiety.
- Involve people before asking them to change. Staff who help design a change are dramatically less resistant to implementing it.
- Use Rogers' adoption curve to target your energy. Win the Early Adopters first — they are the bridge to the majority.
- Use ADKAR when someone specific is stuck. Diagnose where they are stuck (A, D, K, A, or R?) before designing your response.
- Celebrate early wins loudly and genuinely. Nothing builds credibility faster than visible early success.
- Don't declare victory too early. A change is only embedded when it survives the departure of its champion and the onboarding of new staff who learn it as "how things are here."
- As a GP trainee, every QI project is also a change management project. Understanding this will make your projects better and your reflections more impressive.