One aspect of my job that I have enjoyed over the last few years has been engaging with the public. It has never been dull. When I first arrived in Lincolnshire we did a lot of work, talking with the public and professionals about the principles we should use for commissioning services. This became a consultation called Shaping Health for Lincolnshire. It helped, I believe, set a new tone for the way commissioning was regarded and a new way of working with people to make change happen.

This way of working became a process which we have used since to change services and implement new models of care in Lincolnshire, led by GPs with support from professionals and local people. It does require patience.  It does require commitment and it does require belief. One of the biggest beliefs is that clinicians are capable and willing to lead such a process. That belief has never been ill founded. They have needed management support. Not just project management but also coaching and mentoring and guidance to help them navigate regulation and legislation. We have also all learnt the value of sitting in parish halls, waiting for people to drop in to discuss the finer points of proposed changes. One such memorable moment was sitting in a meeting room in Skegness with posters describing not only the changes we wanted to make (and have made with overwhelming public support), but also the history of the hospital. I discovered that the hospital got an X-ray machine a year before the town got any electricity! Engaging with people is an enriching experience.

These thoughts were swirling around my head as I sat in a workshop, last week, being run by one of our Clinical Commissioning Groups. It was about the consultation document they are preparing for the culmination of another Shaping Health process. I felt simultaneously sad and elated. I was sad because on previous occasions I have been in the thick of it. I have had accountability and responsibility for the process and have been closely involved. As I sat at a table with a GP, local politicians, and members of the public who all care deeply about their local hospital, I realised that I was pretty much redundant. The GP leaders in the room, supported by senior managers who used to work for me but now work for the CCG, were confident, assured, and leading a complex and difficult process with passion and commitment. The local GPs understand the importance of local services. They also understand the necessity to centralise services where that will bring the people they serve better outcomes. They live in the area. They are committed to the area. They want the best that is possible with the available resources—which was why I felt elated, seeing colleagues shape health for the future with the people they serve.

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.