In the frontline of change: Managing in the NHS

22 December 2015 -


The NHS experiences change on a daily basis, something James Bowman knows all too well. Here, he tells his story from the frontline of the most politically sensitive organisation in Britain

Blayne Pereira

James Bowman CMgr is a primary care business manager at Integral Healthcare Partnership, looking after three GPs’ surgeries in Lancashire, covering three doctors, two nurses, 19 administration staff and serving some 5,000 patients.

Bowman served in the army for 24 years, latterly as a combat medical technician, before taking his CMI qualifications and eventually becoming a Chartered Manager in 2014.

“Change is daily in the NHS,” says Bowman, “it’s constantly evolving.”

Here, he talks about the challenges of change in the most politically sensitive organisation in Britain – the NHS.

“My job is all about getting each practice to change its mindset, and think of itself as a business. I manage the NHS contracts and ensure what we are doing is financially viable.

“It’s my task to implement the orders of the clinical commissioning group; and this involves working closely with my doctors and nurses, sharing information, ideas and feedback. This constant dialogue ensures patients receive the appropriate care and treatment. Our main challenge is maintaining an excellent relationship with doctors and explaining to them the philosophy behind the decisions we make. This means that their typical query of ‘Why are we doing this?’ never even needs to be asked.

“An example of a key change we’ve implemented is specifically instructing doctors not to over-prescribe medication. But this has only come about after extensive consultation with the doctors. In our field, at our level, change management requires all parties to be filled in before any decision is taken.

“About two years ago, I conducted an audit and the outcome was staggering. It transpired that the practices had missed out on a large amount of income by failing to correctly claim the right expenses.

“The oversight occurred due to the constant change that takes place within the NHS – from the endless stream of government directives as it attempts to cut £30bn from the budget.

“When we discovered the blunder, my immediate concern was how many other mistakes had occurred. The audit took a long time to complete and, in an ever-more demanding landscape, it’s extremely difficult having to continually look so far back while also planning for the future.

“My approach is to make sure all staff feel empowered. They need to fully understand and embrace their roles in order for any changes to be a success. The NHS simply can’t afford big failures, so there is extra pressure on change managers to succeed in a high-pressure, high-profile taxpayer-funded organisation.”

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