Published: 06/10/2005 Volume 115 No. 5976 Page 27

It is all change yet again, and this one is the most fundamental in my 30 years of experience in the health service.

In effect, it is a double whammy.

There is the major strategic change of emphasis, with the government decreeing that a patient-led NHS is the way forward.

In addition, there is the looming functional and territorial change for primary care trusts into the bargain. So how do we cope with steering all this through, while keeping our eye on the ball and keeping staff on board and focused on the real job in hand: looking after the welfare of our clients - the general public.

It is natural for everyone to feel distracted by the forthcoming changes at a time when there seem to be more questions than answers. From a primary care trust point of view, as far as providers of services are concerned there will still be a need and a job. But who will run those services under the new structures?

Naturally, frontline staff will want clarity on this issue as soon as possible.

For directors and managers, the question of job safety is uppermost.

At the same time, such individuals will be expected to provide leadership and keep a steady ship running during choppy and changeable conditions.

It is not easy, and a good chief executive should be aware of these concerns and act accordingly. My message is: do not panic. We have been here before and many have come through it.

Steadying the troops and being there for your staff - available for advice and guidance - is the task of a chief executive during such times of upheaval or change of direction.

Personally, I believe in being as open and transparent as possible, as well as having an open door policy for staff. After all, helping your staff to be clear about their aspirations is part of Agenda for Change.

Chief executives are there to lead, guide, network and above all to give their attention to issues: attention is our currency.

It is helpful having been through the Griffiths changes of the 1980s, when the concept of general management and personal responsibility and accountability was introduced. In the late 1990s, NHS trusts were rolled out, with new roles for health authorities.

Then later in the last decade came primary care groups and, earlier this decade, PCTs. Now We are on for another change and another way of organising services and delivery.

What will be the role of the larger PCTs? How will the future provision of services be arranged and managed?

How will the cuts in management impact on the new organisation? How will the new teams gel?

It all adds up to more potential uncertainty, but we should not be frightened or overwhelmed. Instead, we need to take good care of ourselves, physically and mentally: we cannot help others unless we have personal clarity.

What will be, will be. We can try to influence decisions, but our political masters will ultimately decide what happens. And if you balance selfinterest with professional application and duty of care, something meaningful will come out of the mix.

The last thing you want is to end up bitter and twisted or disillusioned. It really is not helpful, necessary or desirable.

David Peat is chief executive of Burnley, Pendle and Rossendale primary care trust, winner of the Secretary of State for Health's Award at last year's HSJ Awards.