Handing over the reins: A PCN clinical director on stepping down

I became a PCN clinical director almost by accident. There was no burning desire to take on the role.  I was just the last to move my chair back at the fledging PCN board meeting in March 2019 when the ask went around the table.

As we set out as a nascent PCN, I realised there were gaps in my knowledge. Fortunately, I had some help from our federation with managing the finances and introducing me to the rudiments of project management.

It was almost fun in those early days. We had the agility to flex our workforce to local needs and could begin addressing some of the long-needed mental health support through the Additional Roles Reimbursement Scheme (ARRS).  We maxed out on mental health social prescribing link workers (SPLWs) and a mental health occupational therapist (rarely employed as additional roles in those early days), as well as employing some long overdue mental health workers for children and young people.

All of them were amazing assets, but they didn’t have enough time. No one did. The idea was commendable, for sure. But spreading the new workforce across a population of 50,000 would never bring meaningful change.

Changing remit

Then COVID came. Everyone worked together to deliver services, which was an incredible feat. But while we did the most fantastic work in the PCN, and the city, it was tough. It took so much time and energy, and we didn’t make the progress we could have made otherwise. Six months into the pandemic, we had the foresight to employ a dedicated project manager because the size of the challenge became ever more apparent.

As we came out of COVID, the ask changed with the coming of the integrated care systems (ICS). The remit of PCNs was now increasingly removed from what I had enjoyed, which was trying to address the unmet needs of our local population. Instead, conversations became about scaling up and protecting secondary care.

So I grew more disillusioned. For a year, I had been asking for a successor at our Board meetings, but there were no takers.

A turning point came when I signed up for a clinical director development course organised by our federation. One of the modules was on succession planning, and I realised my great interest in this was telling.

Handing over

It was a lightbulb moment. I wondered why I was signing up for this course when succession planning was now the most important factor to me. I also realised how much of the course content covered work I’d already done at the PCN over the past four years. So, maybe it was time to move on.

When I heard Jacinta Ardern announce her resignation as Prime Minister of New Zealand a few weeks ago, it resonated with me. She said that she no longer had enough in the tank. And I realised that this was precisely how I felt too.

The stars aligned when a GP came forward to take the role because he wanted a break from clinical work. There was no formal process. We just took our plan to the Board, who were delighted that none of them would have to step forward.

Looking back over these four years, I have no regrets. On the contrary, I have found some incredibly supportive new friends, both locally and nationally, through the NHS Confederation PCN Network. The evening Gin and Support meetings with all of these people in the dark months of COVID gave me the confidence to “Just **** Do It”. And that led to some wonderful projects happening in our PCN, which is very gratifying.

I have learned so much in my time as clinical director and I’m sure I will miss some aspects of it. But now it’s the turn of someone else.

Dr Brigid Joughin will stand down as clinical director at Outer West Newcastle PCN on April 1 and will also leave Pulse PCN editorial board after two years of dedicated service. She remains a GP at Throckley Primary Care Centre, Newcastle upon Tyne.