Request a Quote

Please complete the form below, we’d love to hear from you!

Perhaps NHS leaders like this should be moved into their own pending folder!

“What if I told you 10 years from now your life would be exactly the same? Doubt you'd be happy. So, why are you afraid of change?” Karen Salmansohn, bestselling author  

I am returning to a previous blog where I asked those who are shareholders in GP federations, what message their behaviours sent: only this time it’s about the message to health economy stakeholders from the local Foundation Trust.

“Thank you for your email – due to the volume of e-mails that I receive on a daily basis, as I’ve only been courtesy copied into this message it has automatically moved into a pending folder to be reviewed when time allows.

If you require me to take any action in relation to this message, I would ask that you send it to me directly and are clear about the action that you need from me.

Kind regards”

Without a word of a lie, this is what comes bouncing back to your inbox if you copy this Director of a Foundation Trust into an email.  I have to say, I was stunned when I saw it.

I don’t know about you, but when I copy people into any email it’s for a purpose and it’s something that I feel it’s important that they see.  That could be because I might welcome a response from them, or because there’s important information that I want to convey.  Either way, I only copy people in when it is a necessity from a business perspective. 

I know only too well that we all have email inboxes that are groaning under the strain of the huge volume of email traffic, and yes, I understand that the upshot can be that it’s easy to miss something important.  It’s the quickest, most instant, way to communicate these days and I do accept that it can often be misused: fling back that quick reply to show that you’ve pushed the ball into someone else’s court, hand off that problem that you’d rather someone else dealt with, or react too quickly to something that’s made you cross and it’s all to easy to hit reply without giving a response due thought and attention – the upshot being risking offence and upset.

I get all of that, but this is different.  I don’t know about you, but I understand “cc” to mean “carbon copy” not “courtesy copy”; if I’m including you in an email, it might be out of courtesy, but it’s more likely because I believe it’s important that you know about the subject and would be happy to have a response from you. Indeed, I may even welcome a response from you.

There are a number of ways this message could be interpreted – like the writer’s self importance and lack of respect for those who have felt it important enough to copy them into a communication – but for me, probably the most appalling thing about this response is the total and utter lack of accountability displayed by the person who felt it appropriate to have this message pop back as a response.  It firmly puts the ball back in the court of the person sending it, in terms of responsibility, and to convey to them that this person really doesn’t give a stuff about how busy the sender might be, but let’s create them a bit of extra work by possibly having to repeat an action that they’ve already completed.

For me, this is senior management at its worst, and exemplifies one of the reasons why the NHS is in the state that it’s in.  To me it comes across as arrogant, disrespectful, lacking in insight and at its heart that total and utter lack of accountability.  Is it any wonder that the current modus operandi of top down change is making no difference at all when people who approach communication in this way are leading the process? If they have no respect for you, why would you have any respect for them; it fast becomes a self-fulfilling prophecy and without engagement nothing changes.   Perhaps leaders like this should be moved into their own pending folder!

What is clear is that the NHS cannot go on as it is. Most people I come across in the NHS accept change is required, which then leaves the question, how best to execute the change.  The top down approach is not working. The reason for that failure is that people respond positively to change when they are engaged in the change right from the start. They resist change when it comes from on high and they don’t feel they have ownership of the problem or have a stake in the outcome. So how do we deliver long-term, sustainable change in an organisation the size of the NHS?  

Let me use an example. Back in the late 1980s Royal Mail faced a number of challenges: the need to modernise in order to keep out private competition, underfunding, on-going industrial action (postal workers held their first national strike for 17 years in 1988), poor quality and missed targets amongst the top of the pile, there was a whole lot more.

The response was to deliver a programme of change under the banner “Customer First”, which went on to engage every member of staff, from the cleaners upwards, including every postman and postwoman in the United Kingdom, right through the middle and senior managers. Considering the workforce at that time was many more than today’s 150,000 (I recall over 250,000), you get the picture that this was no easy task, and yet that’s exactly what they did.  Everyone owned a stake in the changes required; everyone had the opportunity to influence and shape the changes and were then involved in implementing the changes. While the changes didn’t solve all the problems, they went a long way to resolving the need to modernise in order to survive offering “Universal Postal Services”, which refer to the provision of basic postal services to the UK population, including delivery to any address throughout the UK six times per week, and a sufficient network of letter boxes and post offices or postal partner offices.

What this demonstrates if the will exists to do it, it is possible to engage everyone within an organisation in owning, shaping and implementing long term sustainable change.

For the level of change required in the NHS today I cannot see an alternative way other than to engage everyone, including the patients, right from the start of any proposed changes. The top down approach hasn’t worked and won’t work. The time now is for a new model of engaged and sustainable change, which delivers the NHS of the future.

What message do your behaviours send?

If you are thinking about delivering any form of change and are looking for a model to engage every stakeholder in that change, and would like more information on how BW Medical Accountants can support you, or to arrange to speak to one of our experts please contact or call 0191 653 1022.

Additionally, if you should have questions for us please email and we will do our best to answer these within the blog. 

Next Event / Workshop

There are no upcoming events.

  • BW Medical Accountants have a good working knowledge of General Practice and are keenly aware of the challenges Practices face within the changing environment of the NHS.  We have been very impressed by the way BW Medical continue to deliver the range of services they provide from Accounts to Tax and NHS Pension advice. 

    We have found Practice consultation and engagement from BW Medical specifically helpful to shape the future of the Practice.

    GP Partner
    GP Practice, Newcastle
  • We had no hesitation in moving to BW Medical Accountants.  For any business your accountant is integral, and for us one of the most important factors to this relationship is to have a personal and trusting approach, which BW have undoubtedly achieved. 

    The service we receive and the interest they show in our practice assures us that they have a genuine interest in us and commitment to us.  More importantly they are always helpful and polite to answer even the dumbest of questions!  They give us confidence and reassurance knowing that they are always very up-to-date with all the numerous changes within general practice and we would have no hesitation in recommending them to other practices seeking a professional and personal accountancy service.

    Jackie Rotherham, Practice Manager
    The James Street Family Practice, Lincolnshire
  • We changed to BW Medical Accountants and I would say we have just had the most transparent and understandable end of year meeting and the best planning advice I have ever had in 16 years of practice.

    GP Partner

Newsletter Signup