This site is intended for health professionals only

Culture change: a new era in The New Forest

7 March 2011

Share this article

Malcolm Benson

Practice Business Manager
New Forest Central Medical Group, Hampshire

I have spent 20 years managing companies in the small and medium enterprises (SME) market, so you may think it strange that I find myself as Practice Business Manager in a rural practice with two separate surgeries (at Sway and Brockenhurst).

However, given my background and aspirations, it is not so surprising. I spent 15 formative years with Mars Confectionery, followed by 20 years as a senior director/managing director of small-to-medium-size companies in sporting goods, fine jewellery, sports manufacturing and mobile technology. I spent time working in the USA, mainland Europe and the Far East, which culminated in me orchestrating a management buy-out for a business in 2008.

Since then I have worked as an interim manager and a turnaround specialist in a variety of companies all over the UK and Europe. When my last project finished, in the winter of 2008/2009, I decided it was time to re-evaluate my career, improve my work/life balance and at the same time put something back into society and the community.

Subsequently I joined the Sway and Brockenhurst Surgeries in May 2010 as Practice Business Manager. I have since repositioned and rebranded the practice as New Forest Central
Medical Group.

I work long hours (my choice) from about 8am to 8pm most days. I find my 9am to 5pm hours are spent in meetings, dealing with staff issues, patients’ queries, commercial aspects and liaising with doctors and nurses. My “evening work” includes administration, business development, strategic planning and formulating the procedures and processes for the future.

Early achiever
I am an early riser and get up at 4:30am. We keep horses at our home, as we are lucky enough to live in the New Forest. I exercise my horse before work so at weekends I can compete at show jumping and eventing in horse trials.

For the first time in my career I work and live in the same area, with a seven-minute commute across the forest. I am based at the Brockenhurst Surgery where I have an office and meeting room. However, I spend quality time at both practice sites. The two surgeries are only three miles apart and all staff, doctors and nurses work at both locations on a rota basis, so I touch base with the entire team every week.

I have aspirations to be a partner in the practice in due course, as I am totally committed to the role, what can be achieved and the dynamic future for general practice. Becoming familiar with the NHS and general practice has been a steep learning curve, but this has given me an unblinkered and fresh approach to every aspect of my role; I take nothing as given, but challenge and question internally and externally.

I often quote from Rudyard Kipling’s tale The Elephants Child: “I keep six honest serving men, they taught me all I knew, their names are What and Where and When and How and Where and Who” and this is my mantra. I also do not accept the “we have always done it this way” approach; as I keep reminding my team, the only thing that is constant is change! I see no way that this will alter in the coming months and years as we embrace the white paper and the challenges and opportunities that this will create.

I have been surprised at the inevitable level of bureaucracy within the NHS and related areas, and the long-winded approach to meetings, agendas, minutes, actions and requests, but gradually I am beginning to prioritise and be selective as I have a better appreciation of the bigger picture.

However, I am not a box ticker, form filler or admin executive. I have set up a structure within our practice where I focus on the business and commercial aspects of the practice to create an efficient, effective, professional, successful and profitable commercial environment to allow the partners and GPs to operate at maximum clinical levels for the benefit of patients and the practice.

While there are many day-to-day challenges that need to be addressed and action plans put into place, I am not afraid to get involved and have a “hands on” management style/approach. I am also in the process of a strategic review of the practice and its business goals, to ensure we have high standards and professionalism throughout the organisation. I am preparing a three-year business plan for 2012, 2013 and 2014. This will obviously encompass the white paper challenges and opportunities, as well as what is right for general practice and our particular operation.

I see my role as providing leadership and an interface between staff and the doctors to ensure the clinicians’ time is focused on patient care. We have already identified the priority for outcomes and the culture change that is sweeping through general practice, where Andrew Lansley talks about “no decisions about me without me”. This is at the core of our practice thinking and patient care; we aim to provide the best possible service to the community at all times and all the decisions we make – albeit there has to be a commercial aspect involved – are for the good and wellbeing of all our patients.

I am very fortunate to have open-minded partners, who are willing to allow me to drive through the commercial changes. It is a pleasure and a delight that they give me full responsibility to manage the practice. In fact I chair the weekly partners’ meeting at 7:30am every Tuesday. I also chair a monthly strategic board meeting (one of my initiatives) and as appropriate/required evening meetings to address and discuss certain key aspects of the practice.

We are currently recruiting two new part-time partners to replace Dr Sally Smith, who retired in June. I am fully involved in the interview process and will assist in the selection. We hope to have this completed by December so we can refocus in 2011 and share the workload across five partners.

We in general practice now face not only the need to increase income and revenue, but also to control the cost base. This is one of our biggest challenges, which I am tackling with gusto.

Staff and services
The New Forest Central Medical Group’s current operation was established in 2001, but the history of GP partnerships in the area can be traced back for more than half a century. The practice’s two surgeries provide services split approximately 50:50 between populations at each site.

The practice serves not only the population in their two respective villages but also those of the surrounding hamlets. The list size is increasing gradually and is presently around 7,800. The population of the area almost doubles in the summer months when the many hotels and campsites are full.

The practice lies within the boundary of NHS Hampshire, the largest primary care trust in England, and the National Park, known as The New Forest. A General Medical Services (GMS) practice, there are presently three partners (soon to be five): Dr Stephen Baynes, Dr Mark Orton and Dr Ian Fitzsimmons. In addition, Dr Karen Jenkinson is a salaried GP and Dr Paul Dollin is a one-year ST3 placement, who started in August.

I manage the practice as I have any commercial business: I split my time between managing the team and ensuring we have well equipped and best-trained personnel. The commercial aspects of the business involve working closely with our accountants and advisers, considering the strategic issues and the longer-term goals, ensuring that we do not miss any opportunity to generate revenue, and providing the best possible service for our patients.

During my first six/seven months I worked very hard to develop a team that I empower to work at the highest level. This allows me not to get too involved in some of the detailed work that would take me away from the bigger picture and the strategic activities.

Looking ahead
The future is very exciting for general practice. While I am not looking at it through rose-tinted glasses, I am a “glass half-full” individual. With my energy and enthusiasm I am driving changes through the practice, as well as ensuring that we embrace the white paper, maximise the good and minimise the bad.

In my short time with the practice I would like to think I have managed to deliver significant changes in the way we work. Changes to the practice that I have overseen include: a new website and intranet site; new job descriptions and performance reviews; redesigning reception and waiting areas; creating processes and policies that are clearly communicated and understood; and undertaking a full demand survey with consequential changes to the appointment system (given there is no silver bullet) that generally meets the needs of the patients.

A lot has been achieved but there is a lot more to do. As we move into a new year and a new era for general practice it is with excitement, energy and a balanced commercial view that I look ahead to 2011. I can’t wait for it to come!