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South Birmingham Primary Care Trust Management Styles

Primary Care Trusts (PCT’s) are NHS organisations that focus on the health and wellbeing of a regional population. PCT’s control a large proportion of the NHS expenditure since they are responsible for providing services to the local population based on the required needs.

The purpose of a PCT as defined by the Government is:

To secure, both in the role of commissioner and provider, high quality services for locality.

To improve public health and reduce health inequalities.

To be the lead NHS organisation in local partnership, with NHS Trusts, the local authority, other PCT’s, the voluntary and private sectors, in order to secure seamless provision of care.

The main role of a Primary Care Trust is needless to say in its name. “Primary Care” is the first initial consultation between the patient and the professional that shall be establishing the required treatment of the patient. These of which are compromised of GP’s, dentist, pharmacists and opticians. Moreover, PCT’s also adopt services from district nurses, therapists, health visitors, nurse advisors, school nurses, specialist nurses and many other professionals to provide services within patient homes, inclusive of walk in centres and community hospitals.

1.2 South Birmingham Primary Care Trust

In relevance to this study, the PCT taken into account will be South Birmingham PCT. This study will look into the management techniques that are currently in practice within the PCT, which may be affecting the productivity of the workforce.

Moreover, to propose improved techniques within management to successfully manage change if this is deemed necessary.

NHS South Birmingham commissions services for a population of 383,000 people.

(Fig 1: NHS South Birmingham localities)

Services include 64 GP practices, 70 General Dental Practitioners, 85 community Pharmacists, and 51 Opticians

“We look at the health of the entire local population and address issues specific to our area. Public health is an important role and includes issues such as poverty, obesity, diet, exercise, smoking and other factors”


Today’s National Health Service (NHS)

Today’s NHS is ever changing, placing more emphasis on managerial responsibilities upon heads of department, and managing change is perceived as being skilled at constructing, acquiring and transferring knowledge to reflect new knowledge and insights.

Following on from managerial responsibilities, the most important fundamental of any organisation whether public or private, is the staff.

South Birmingham Primary Care Trust, Management Style insight

Today PCT’s are managed by a team of Executive Directors headed by a Chief Executive. These directors are members of the Trust's Board, together with non-executive directors which are externally appointed. The Chairman of the Trust is a non-executive director. Other board members may include representatives from the Trust's Professional Executive Committee (elected from local GPs, community nurses, pharmacists, dentists etc.)

As the NHS is ever changing the importance of optimum management by the board is paramount. This directly places more emphasis on managerial responsibility on heads of departments. Also highlighting that managing change is perceived as being skilled at constructing, acquiring and transferring knowledge.

The management at South Birmingham PCT operate a hierarchical democratic culture. Tasks are set out for staff members by senior management and are expected to be received by a deadline. For example, a commissioning finance assistant has a set list of tasks to do per month, which are usually as per below:

First Week of the month

Produce end of month reports and explain any variances that do not match the balance sheet.

Second week of the month

Produce and send off monthly mandates for payment.

Third week of the month

Chase outstanding invoices and look into remittance advice.

Throughout the month

Process any invoices that we have received from other trusts and send to Shared Services payment agency to be paid.

So what is the problem? (Project Proposal)

As we can see from the above, work is very repetitive and constant which leads to boredom and poor productivity. Due to the nature of work there may also be more underlying problems that may need to be addressed, for example emotional stress. There are deep set norms and beliefs about the way work should be organised and how people are rewarded and controlled. Professor Herzberg once said that “most peoples idea of a fair day’s work was less than half what they could give if they wanted to.” He believed that the key to success was to create circumstances in which people wanted to give all they could to do the job. (Business Studies 2nd Edition).

South Birmingham PCT entails a very bureaucratic culture, or what Charles Handy would describe as a “the role culture” due to the many layers of management.

Study Objectives

The bureaucratic culture is not an ideal culture for the employees due to the changes that are currently being undertaken within the NHS. To meet the demands of a modernising NHS the PCT needs to adjust and maybe become more task driven and giving colleagues that have to deal with the day to day running of the PCT more responsibility to make them feel more valued.

This report shall analyse the following objectives:

Will a change in culture within the organisation help improve employee productivity?

To indentify need for change within staffing roles to develop motivation of employees.

It is understandable that an organisation that has been so set within its practices for such a long time shall be resistant to change within culture. The management shall probably be the most resistant to change since they have moulded the workforce into the existing corporate culture that has been instilled within the PCT. Therefore a sound conclusion for this study will only be achieved when all practices are investigated.

Analysis of the effects of management on employees.

The subject in matter is whether the management styles and corporate culture within South Birmingham PCT is overall affecting the productivity of the employees. The latter of this study shall enable us to discover whether this is primarily the case or whether the ‘bureaucratic’ culture within the NHS is just an anecdote. In an organisation where the culture is embedded into the employees it is difficult to bring change to improve organisations.

The Society for Human Resource Management 2005 (SHRM), suggests that any implementation of change heavily relies on employees making a smooth transition through the process, as the employees are at the centre of this implementation. It further goes on to say that HR is involved in most initiatives long before the changes are implemented as per a nationwide survey conducted across the UK which embellished many top private and public sector organisations.

If this study finds that management techniques affect performance of employees within the PCT, it will needless to say require a massive reconfiguration, involving many factions of the PCT.

Following from this the SHRM (2005) survey further found that major change initiatives were implemented by 58% of the respondents, 54% of these went through organisational culture change as a result of executive leadership, turnover and organisational values changed. Moreover, from the 58% correspondence, 53% implemented new or revised HR systems and 40% dealt with major staffing changes such as downsizing. The latter would only be significant to this study if management were to delegate more responsibility to secondary colleagues.

However, it can be argued that although successful companies must be able to manage change effectively, many a time it is often just as important to maintain continuity, which in essence applies that the process in place initially must be one of a very high standard. Business ideologies appear to be most effective when they remain constant over a long period of time.

The SHRM (2005) article emphasises that organisations should make decisions and create strategies that look beyond short – term solutions and lead to greater performance over the long term. With respect to South Birmingham PCT the short-term culture change may not be of an issue to the management, however, long-term performance undoubtedly should be; which lead to the core fundamental of this study, management styles and corporate cultures that affect the NHS.

As pointed out by Steve Willcocks in his Journal of health organisations, there needs to be a shift away from traditionally dominant hierarchies to network forms, with a consequent need to re-assess the style and form of health care management.

3.0 Methodology

It is important to approach this problem in the correct manner; it will require data sources for analytical review. These data sources may be in the form of primary or secondary data. In which primary data is collected directly by the individual investigating whereas secondary data is the data obtained from another’s research.

To underpin my research I believe that it is important to take both a qualitative and quantitative approach to gathering research. Qualitative method investigates the why and how of decision making and quantitative research refers to the systematic empirical investigation of quantitative properties in form of close ended questions

3.1 Research

Since the question in matter is to analyse whether management structures are having a negative impact on employees, our primary data shall be gathered from employees that are lower down in the hierarchical configuration. Constructive research shall quantitatively be gathered via questionnaires to enable a thorough picture of the underlying problems, if any, within South Birmingham PCT.

As groups have been specified from our sample selection, the correct method to be utilised would be systematic sampling. This is defined as,

“Systematic sampling” relies on arranging the target population according to some ordering scheme and then selecting elements at regular intervals through that ordered list. Systematic sampling involves a random start and then proceeds with the selection of every kth element from then onwards. A simple example would be to select every 10th name from the telephone directory”


It is important to note here, that the chosen method of sampling on the prioress that the study would be able to maintain the maximum level of randomness, at the same time to maintain a component of stratums.

3.2 Questionnaires

The Questionnaire will consist of 12 elementary questions of which can be found in appendix 1, 7of which are confined responses, i.e. they consist of limited responses tick boxes, the reason being that analysing is made more coherent and concise. However, Q7 - 12 is narrative response question which would provide opinions to be analysed on an independent basis. Thus these questions will allow me to consolidate the PCT’s concerns regarding the motivation and moral of employees and a sufficient basis for this investigation.

4.0 Statement of results

Statement of Results

Question 1




A – Power Culture



B – Role Culture



C – Task Culture



D – Person Culture





Question 2




A – 0-5 yrs



B – 5-10 yrs



C – 10-15 yrs



D – 15+ yrs





Question 3




Self – Actualisation









Safety / Security








Question 4




A – Never



B – Very rarely



C – Often



D – Always





Question 5




A – Never



B – Very rarely



C – Often



D – Always





Question 6




A – Yes



B – No





Question 7




A – Yes



B – No





The questionnaire results can be found in appendix 1.

The Questionnaire was initially distributed to thirty people in total. However, I only received 28 responses. Due to the nature of the study careful consideration was put into who the questionnaire would be issued to. Twenty five finance or admin assistants received the questionnaires. Five ‘Head of department’ directorates were also given the questionnaire, however, only three out of these five were returned.

5.0 Analysis

Now that all required data as per the methodology has been collected, using the correct methods as indicated in the latter, for this information must be analysed correctly so that it allows one to make a judgemental decision regarding the views of the employees within the PCT. By looking into each question individually we shall be able to gain a thorough picture about the primary environment the employees condone on a daily basis.

5.1 Questionnaire analysis

As the chart illustrates, the majority of our sample suggest that the culture within the PCT is a role dominated culture. This is described by Charles Handy as “being co-ordinated at the top by a narrow band of senior management.” This juxtaposes the original indication that the culture within the PCT is bureaucratic. The job description itself is a lot more important itself than the actual person that fills the position. Max Weber describes bureaucracy as a “rational legal system” he explains that “authority is exercised via rule and procedural systems.” Weber’s definition of bureaucracy is questionable in reality. Although a role culture does represent hierarchical structures and lack of responsibility to individuals due to higher authoritarian figures, it does not necessarily indicate a “legal system.” A legal system places emphasis on formal rules and regulations, however in most environments it is merely the case of procedures that employees are required to follow in order to meet corporate objectives.

The graph below indicates that many employees have fulfilled some social needs which does indicate that although the culture within the PCT is bureaucratic employees still feel a sense of social belonging within the environment they work within.

Abraham Maslow’s hierarchy of needs states that all employees have the same needs and can be placed in a hierarchy from basic physical needs all the way to self – actualisation which is when one feels they are achieving their full potential. Although his hierarchy is a thorough outline of individuals needs, it is arguable as to whether everyone’s “needs” actually are the same. For example, for one employee fulfilling ego / esteem needs may simply be reaching a certain pay band, whereas for another employee this may mean having certain goals, aims and desired promotions to meet. His hierarchy does hold a certain amount of bias. Herzberg argued that motivating factors such as responsibility and meaningful work are some of the most important factors to ensure self – actualisation, rather than generalising Maslow’ hierarchy to everyone.

So why is it that only a small minority of employees are fulfilling self actualisation? After all, most of Maslow’s hierarchy of needs do seem to be met with most employees.

After analysing how often employees felt stressed within their job roles, most employees said often.

Initially this could be affecting their overall performance which is why they may be feeling that they are not performing to their full potential. Stressors must be placed on individuals which is placing excessive demand upon them thus affecting productivity. These could include, working environment, culture, nature of the work being delegated to them. Mind 1992 conducted a survey of British firms and found that that one fifth of firms surveyed stated that nearly half of employee absence was related to stress. Although the questionnaire did not specifically ask the employees if the levels of stress caused them to have to take time off, stress can lead to physical effects on an individual such as headaches and depression, which in turn would result is a high labour turnover. Stress may also be affecting the moral and motivation of the employees, which again can lead to low levels of productivity.

However, it may be other factors that contribute to work related stress rather than the nature of the work itself. As displayed from the results below, employees have witnessed quite significant numbers of negative behaviour within the workplace.

Negative behaviour is very difficult to define, and since we did not want the questionnaire to impinge on any personal factors to the individual this has meant that our results are quite broad. Negative behaviour can vary from emotional stress to actual physical harm imposed upon any individual.

A study by Bernard Burnes and Rachael Pope specifically looked into “negative behaviors within two NHS PCT’s.” Although they did have difficulty in specifically defining negative behavior within the workplace, a strong definition is one of Einarsen at al 2003. She uses the term “employee emotional abuse” which is broadly “targeted, repetitive workplace communication that is unwelcome and unsolicited, violates standards of appropriate conduct, results in emotional harm, and occurs in relationships of unequal power.”

Their study also highlighted that over 50% of employees had experienced some form of negative behavior. The most common forms of negative behaviours in both groups of their respondents were:

claiming credit for someone else's work;

setting out to make a member of staff appear incompetent and/or make their lives miserable through persistent criticism;

deliberately withholding information/providing incorrect information; and

Isolating / deliberately ignoring/excluding someone from activities.

It is clear from their findings that much negative behaviour is represented via the initial nature of the job roles and the cultures embedded within the two PCT’s in question.

This may be the same reason as to why employees within South Birmingham PCT feel they are not self actualizing to their full potential.

6.0 Conclusion

6.1 Study Overview

This study has found that there initially is a problem with the culture within South Birmingham PCT. We can see from our primary analysis that the norms within the PCT may be affecting employee productivity. The questionnaires expressed concern for improvement within the PCT. Within the narrative responses a few employees had felt the need for more team work to be implemented into the daily activities within the PCT. This would ensure that all employees would feel a sense of belonging since their opinions would be detected by fellow colleagues, thus leading to a sense of responsibility.

Studies in the past have shown the same concern that has arisen from this study itself. The general culture within the NHS seems to be bureaucratic with hierarchical delegation. This contradicts what the Chief executive Officer, Julie Moore, of University Hospitals Birmingham states. She describes management styles as “relaxed and collaborative.” However, this proves difficult to consider since our primary data contradicts her views. It has to be noted that her position of Chief Executive may play some bias in her opinion of the true beliefs of the staff lower down the hierarchical configuration.

However, it does need to be brought to attention that this study concentrates on the finance department of South Birmingham PCT. It proves difficult to generalise this study throughout the whole of the NHS, even though the culture could be a similar situation in other NHS trusts.

6.2 Possible improvements and recommendations

It is clear that improvements would greatly prove beneficial to the PCT in the long term. A change in culture is the prospective idea to help improve employee productivity. By introducing more autonomous work groups this will allow employees to work counter-productively and have a clear say in what is happening in their direct working environments. A complete change in culture would be an idealistic approach. However, in reality it is clear that is a request for the impossible. Nevertheless, head of departments can make small changes within their own teams to try and make employees feel more valued and appreciated.

However, head of commissioning department did say that many theorists have tried to put their theories into practice within he NHS, but due to the nature of the public sector they have always been unsuccessful. He pointed out that the characters of Directors were very strong and domineering and since they were never adaptable to change, it was unlikely that their employees would be.

The NHS has also gone through and is still going through an enormous number of changes (Lilley, 2003; Newdick, 2005). Whether these cause or contribute to the high incidence of negative behaviours is difficult to say. However, research does indicate that the high incidence adds to the pressure under which staff work and is detrimental to their and the NHS's effectiveness. Which proves that an adaptation or improvement in culture could certainly improve employees productivity.

7.0 Reflective account of the Project.

This study has not only highlighted my personal concern that I have felt during the period I have been at the PCT, but has also exposed that others that have been here for much longer periods of time than myself still endure the same experiences.

Although I have not personally experienced any physical negative behaviour, I have felt sonorous emotional stress from my job role. Having such a repetitive, mundane role leads to a lack of motivation. I have personally taken days off work due to emotional stress. This initially elevated my research to see if other within the PCT had this mutual feeling.

I realised that my concern would not apply to directorates and senior management since throughout my year I observed how thoroughly challenging their positions are.

This is why I aimed to look into those employees with a similar position as mine or just slightly above.

Whilst handing out my questionnaires a large number of my sample showed a keen interest in my study. They asked me what personally elevated me to carry out this study. Although I was not very thorough about my personal experience since I did not wish to offend anyone, I just explained that it was of very keen interest to me. Most employees asked to see my overall findings and possible improvements I would recommend.

Personally, I have only a few more months left with the PCT and although I am extremely grateful for my time with the PCT and the help and knowledge that my own manager has given me I still believe that an implementation of change is required.

I am going to present my dissertation to our Director of Finance since the validity of my research is strong. Coinciding studies have also supported my study. Hopefully, this should be of interest to them. Even if they do not implement any change they shall initially get a primary insight into the characters and feelings of their employees.

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