We did something a bit different today as an executive team. We used the “goldfish bowl” technique to explore how to support the transition from PCT-led to Consortia-based commissioning. I apologise if you already know what this technique entails. For those of you who don’t; we put four chairs in the middle of a circle of chairs with three people seated on them, who kicked the discussion off. If you wanted to contribute you could take the spare chair, but someone had to then vacate a chair and join the outer circle. The idea of doing this came from one of my assistant directors who is on the Generation Q programme. It worked really well. We all had to listen. Getting up to join the central trio signalled and prepared everyone for a contribution.

So what did we discover? PCTs have been given a tricky task to deliver! At the NAPC conference last week a contingent of GPs and managers from our patch heard the Secretary of State announce “Pathfinders.”  We discussed the implications and what it might mean. Collectively we feel we are in a strong position to support what needs to be done, but it isn’t easy. What we need to do is work out how to support emergent consortia, whilst remaining accountable for delivery and financial balance.  We need to devolve management resource to consortia whilst continuing to do all that the Department of Health and Strategic Health Authorities expect, in terms of reporting and assurance. In parallel, we have to accelerate reductions in management costs. We have to plan for a future where the plans need to be owned by the consortia – which don’t exist yet. We need to make sure patients’ interests stay central and that the system continues to deliver what it should. We need to ignore the fact that we have been labelled as bureaucrats and “treacle” (!?), yet will have to remain on the burning deck for as long as it takes. We need to look after our staff who are worried about their futures.

At the end of the session, as the tasks were handed out and accepted with good grace and purpose, I felt proud to work with a team that puts aside their personal concerns and remains determined to create a legacy that will, we hope, give consortia a flying start and the public the services they deserve. We have no future, probably, as an organisation but that doesn’t mean we don’t care about the future.  In the goldfish bowl I saw some really great values illuminated.

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.