Loss and Change in Primary Care: Working with Organisational Anxiety

Facing loss and change has become increasingly a fact of life for those of us working in today's National Health Service. Dealing with the anxieties associated with loss and change is often a key task in therapy, yet it is something which therapists can find difficult for themselves in an organisational context. The pace of change in the public sector is increasing and those working in it have to deal with this reality. Often the initial response to new demands is one of dismay, a reluctance to hear more and an impulse to take flight. Initially the willingness to keep functioning may be compromised and for the individual it can take time to move on. When this time is prolonged, it may be at considerable cost to the individual and the organisation.

In this paper we describe the subjective experience of two clinicians with different trainings working in an organisation facing major change, in this case a large GP Fundholding Practice about to lose its fundholding status. We describe how we kept functioning by setting up ring-fenced time to think, coming together to bring our unconscious anxieties to consciousness, and finally, using the ideas from Menzies Lyth and from group analysis to provide a theoretical understanding of our experience. While this was useful to us, we recognised that it was an imperfect solution, and the account that follows is inevitably distorted by our own perspective.