Ben Allen, re-imagining General Practice

Ben Allen is a GP at Birley Health Centre, and Sheffield Clinical Director for Primary Care, with a special interest in elderly medicine and service improvement. Birley has bucked the national trend in patient satisfaction. Over the past two years while patient satisfaction nationally has declined from 68% to 38%, at Birley it has increased. He compares his initial impressions of Birley to the experience of riding a bike where all the components are high quality but they haven’t been assembled particularly well. He realised that his first efforts to intervene were merely addressing the symptoms and not the underlying culture, so he started a process of self-education reading books by Patrick Lencioni, Jim Collins, Brene Brown, Simon Sinek and Nancy Kline for example. This led him to develop three main principles: finding and nurturing potential, team dynamics, and being purpose and values driven. He observes that “everybody has so much more to them than their professional role and their professional training.” The organisation needs a clear plan for how it is going to bring out the best in staff, including providing a mentor for each person, who has an ongoing day-to-day relationship with the individual. Most of his thinking on team dynamics draws on the work of Patrick Lencioni. It’s firstly about creating an environment of psychological safety which allows people to voice their best ideas, and confess their mistakes without fear of censure. Secondly its about the quality of debate. Finally, if the first two have been done well, then people should be more prepared to commit to a decision, even if it isn’t the one that they would have made personally. Ben has done less work on crystallising the purpose of the organisation than he has done on the other two principles, but he thinks that is a question worth asking all stakeholder groups, including patients. He observes that “we can often go to work with our own purpose” and that purpose may conflict with the goals of others. And in the absence of a larger purpose, the aims of individuals can boil down to “getting through the day.” It’s only when you have that overarching purpose that you can ask “How are we doing?” Ben thinks that the type of leadership that the NHS needs is evolving. At present the principles he has outlined are not as understood and valued as they need to be. The ‘top down’ model is not fit for the complexities of modern healthcare. Meetings have changed fundamentally at Birley since the start of the improvement programme. They no longer have meetings that are about conveying information, for which an email or whatsapp would do. Instead, team meetings are about engaging people, obtaining ideas, debating issues, and building consensus. Ben says there’s lots left to do at Birley, but that he really does feel that it’s a self-improving place now. Things Ben would like to see happen going forward include a “blurring of the boundaries between the practice team and the public”, more work on purpose and values, and rotating the leadership of meetings so that younger staff are involved. Ben feels that with increasing workload and declining staff numbers there is a real risk of changing things “out of desperation to make something different.” In his view, the right question is how do you sustain the people who are currently in primary care, while you train up the next generation of GPs? He also thinks that the nation needs a wider debate about the purpose of the NHS. In his role as Clinical Director for Sheffield he sees himself helping general practice to thrive. He is still working on the best way to achieve that. One of his approaches has been to get people from general practice with energy and ideas together in order to build solutions. Recently Ben has read ‘Reinventing Organisations’ by Frederic Laloux. This charts the cultural journey from top down to purpose driven with self-managing...