“It is only by saying ‘no’ that you can concentrate on the things that are really important.” Steve Jobs

I was talking to a PCN Clinical Director recently, who told me the story of how in one day she had received three emails and numerous phone calls, including to her practice receptionists, for her to say whether or not she was employing a link worker.  She and her practices remain undecided on how to progress with link workers (because they are clear they want the model of social prescribing to drive the employment of the team, not vice versa), but she is coming under increasing pressure to 1) spend more and more time responding to these types of process request and 2) put the needs of the system (and its targets to employ link workers) over the needs of the network.

I was talking to a different PCN Clinical Director who told me that he had received an email with a long list of meetings the system was expecting him to attend.  These included PCN assurance meetings, integrated care development meetings, and a whole raft of clinical “transformation” meetings taking place at the wider system level.  He felt pressure to go to as many of these as he could, and wasn’t sure whether saying no was an option or whether it was a requirement of taking on the new role.

In fact, I am sure it would be relatively straightforward for any PCN Clinical Director to spend all of their time responding to the constant system requests for information, attending system meetings and responding positively to as many of the meeting requests they receive as possible (although I doubt they would be able to meet all of them!).

The irony of this position is that despite this willingness to comply and respond positively, it will be these PCNs who in the medium term will be judged to be failing.

Ultimately, successful PCNs will be the ones who understand their local priorities, focus on building local relationships (between practices and with their local communities), and, most importantly, learn how to make change happen.  All of these things take time, and PCNs who spend their time meeting the requirements of the system will not have the time needed to do the things that are important.

And so the job of the leader, the PCN Clinical Director, is to say no to the things that are less important, in order to be able to say yes to the things that are.

In a recent conversation I had with Professor Becky Malby (a national expert in these matters, do check out her blog if you haven’t already), she recommended that to ensure PCNs focus on the right things they allocate at least 80% of the agenda time in any PCN meeting to innovation, change or improvement, and that the time for everything else should be limited to 20% of the time available.

For the new PCN CDs I was talking to that kind of prioritisation can feel very difficult.  But learning to keep focussed on what is important, and to say no to the things that are not, is critical for PCN success.