20th July 2006
Is it time for retirement?
I am 55 and work in middle management in a primary care trust that is being reconfigured. Having originally trained and worked as a health visitor I moved into management when primary care groups came along and my children were growing up so I no longer needed the flexible working hours that health visiting could accommodate.
I still enjoy helping improve services but this reconfiguration has made me think it may be time for a change. I know it seems rather late in the day to do this but I think only recently has it begun to dawn on me and many of my colleagues that life in the new organisation may be rather different. We may have to move offices which would mean more travelling and I am worried that there may be a lot of disgruntled people around, when the dust has settled and many former colleagues have not made the cut and are no longer around.
My last appraisal went well and I am fairly confident that I could get a post in the new organisation. But as I am fast approaching retirement age should I cut my losses and take redundancy? Find a little part time job to keep me occupied? Or should I consider doing some kind of refresher course and go back into health visitor work? My husband and I do have plans for our retirement but he is not due to retire for another two years and I do not think I am ready to take it easy just yet. What would you do?
Jenny Rogers writes:
The question is, what do
you really want? Can I guess? Your dismissive phrase, 'little part-time job', says it all. It sounds most unlikely that this would keep you happy.
It is also extremely rare in my experience for clients to return to a profession which they have cheerfully abandoned many years previously, though the former Archbishop of York, who has now returned to the simpler life of a parish priest, reminds us that there are occasional cases where this is exactly what fulfils some people. But I don't hear any longing in your voice for the day to day experience of working direct with patients. Health visiting sounds like a distraction to me.
So, in the new PCT you might have to travel a little farther to get to work but there are always some downsides to any job and you could use the additional time to listen to favourite CDs, the radio, read or just chill out, depending on how you travel. Furthermore, there will indeed be grumpy people to manage, but this is what management and leadership is about - persuading people to do things that they would not otherwise have done.
You had a good appraisal and feel that your chances of getting a new job are high. You've discovered a taste for management and it sounds as if you are good at it. You are only 55 so stop taking the view that you are somehow ancient and past it, you're not. You have years of useful paid work ahead of you and enriching your experience now will give you more choices later.
One word of warning: if and when you do compete for the new job, do so wholeheartedly. That apparently bland and benign question: 'Why do you want this job?' is one of the most important in the interview. Any visible doubts will scupper your chances of being offered the appointment.
Kate Gordon writes:
With all the information you have given I am intrigued as to what prompts you to ask of us ‘What would you do?’ The most important thing is what do you actually want to do? From my perspective and where I am now, in both my career and my life, that question is quite easy for me to answer, but I am not living in your reality and what really motivates you so cannot answer for you.
There are plainly quite a lot of influences that need to be taken into consideration, not least that your last appraisal went well and that you seem fairly confident in getting a post in the new organisation, which many people would give their eye teeth for. However I sense that there are other things that are important to you, and I think you need to work these through: potentially more travelling; a different, and possibly unhappy, team to work with; approaching retirement; redundancy; part-time; return to health visiting; and your husband’s retirement.
I think there are options for you to explore. Firstly you could spend some time one weekend on considering what you would really want to do if there were no obstacles at all and you could have what you want. To make the most of this I would suggest that you spend some time beforehand getting yourself into a really positive, dynamic and creative state of mind and then let your unconscious mind come up with options that you can play with. Once you have these more fully formed you might want to talk through the options that really appeal to you with your husband which might clarify what you really want to go for.
Secondly you could look at all the issues to consider and list the pros and cons of each of them and then prioritise or rank them so that you are clear in your own mind which are the most important to you. You could also list all the things you don’t want in a job which will bring further clarification. Once you have done that you will know what key aspects you will need to have checked off for any jobs you apply for and also what you are happy to compromise with. You still enjoy improving services and this will still be key in the new organisations, so there should be opportunities for you if you decide you want to pursue service redesign work. There is also likely to be project work of various sorts, much of which has service redesign as fundamental to taking things forward.
Other things you might like to also consider are: What is important to you for your work-life balance? Flexible working or decreasing your hours as a step towards actually retiring? Are you seriously thinking about returning to a clinical caseload? What can you do to maintain a positive attitude at work, including influencing the team’s attitude?
I suspect that you probably have quite a good idea of what avenues you seriously want to explore and how to go about getting there, but need some prompting to achieve it. Have you spoken to your manager or a mentor to help you come to your decisions? If not, that might be a productive approach too.
Keith Johnston writes:
I recommend you shape your next actions around the plans you and your husband have made upon his retirement in a couple of years. Your actions clearly depend upon the nature of these plans.
For example, you might both be planning to cease paid employment entirely and look forward to retiring to that Majorcan villa, but need to maximise your earnings over the next two years to build a nest egg.
Alternatively, you might be planning to develop new interests after retirement on a paid or unpaid basis and need to develop your skills in different areas. In the case of the former you will want to secure a post in the new organisation at the optimal salary level, to maximise your earnings [and your eventual pension] over the next two years and you might therefore be prepared to sacrifice travel to work and other concerns.
Alternatively, a part-time job would create the space for you to develop those new skills and interests you will need once you retire. You mention the prospect of redundancy and at age 55 and with the premature retirement benefits currently available this too is an attractive option. Your PCT should be offering career management help and you must take advantage of this support in considering your options. In summary, whatever you choose must fit with and support your plans in two years’ time.
6th July 2006
I'm exhausted and stressed
I feel hopelessly out of touch and too old for my workplace. After graduating and spending many years working for a small business in a job that was fun but not very well paid and not very career orientated I got my act together about five years ago and did a post graduate qualification.
I found it harder than I thought to find work, which really knocked my confidence, but am now working for an acute trust.
The department I work in is very busy, with a number of key national targets to meet, and there is something of a late hours working culture. I often feel obliged to work late because many of my colleagues are still at their desks at seven or eight o'clock.
Add to that the fact that although I am only in my mid-thirties most of the people I work with are quite a bit younger and do not seem to mind working late. I genuinely feel out of touch with them.
But most importantly, although I do not have children my personal relationships are suffering because I feel exhausted and stressed all the time and my partner's patience is wearing thin because I come home late and then want to talk shop all the time.
I want to stay in the NHS because of the security - years of poor pay and temp work have left me with some debts - but cannot carry on like this. Can you help?
Jenny Rogers writes:
Whoa! Let’s take stock of what’s happening here. You’ve got debts; your confidence took a pounding because you found it relatively hard to find a job and now you’re working with a group of swivel-eyed workaholics apparently too young to know any better.
You’ve lost perspective – our typical response to a situation where escape appears impossible. The solution is not ‘out there’ but in you. Look first at your assumptions. They are all potentially flawed. It would be difficult to get another job – it might not; the NHS offers secure employment (try saying that to a PCT Chief Executive at the moment); I have to work late because my colleagues do – no you don’t.
Nothing in your email suggests that anyone is managing you or that you have any clear idea of what is actually expected. Book a date with your boss now. Ask for clarification on the goals you are expected to meet in your job. Discuss what resources you need in order to fulfil them – this could be time, money or training. Be straightforward and politely challenge any unreasonable expectations. Beware of appearing to whine – concentrate on being composed and straightforward. Taking control in this way is the first step to feeling better. If the demands really are preposterous then you need discreetly to start the job-search process now, either inside the NHS or elsewhere.
Long hours directly correlate with inefficiency and burn-out so it is essential to revert to a normal-length day immediately and to tell your colleagues calmly that you are doing so. Ask yourself what’s the worst that could happen. Answer: your colleagues think, Lucky so and so – going home at 5 30!. Are they likely to punish you in any way? I don’t think so.
You are right in one of your assumptions: that your partner relationship is a lot more important than anything in the workplace. Talk all of this through with him or her, ask for support in keeping you on track and plan in some nice treats where you can relax and enjoy each other’s company with shop-talk banned.
Bryan Carpenter writes:
"It seems that you made a positive decision five years ago to kick-start your career and career aspirations, but it seems to have faltered.
It is sad that someone who is only 'thirty something' feels so out of touch and depressed. You are young, and there are so many opportunities for people like you. It seems that you have no ties which bind you to your current job and I would advise that you take the next positive step and decide where you would like to be in 5 years time, and how you will get there.
Be realistic, but go for something which will excite and motivate you. There is certainly no need to work long hours simply because everyone else does. This is leaving you tired and exhausted, and simply results in stressing you out - making you less effective. A realistic work/life balance is so important and you need to address this.
Make a positive plan to develop your career and go for it - you might surprise yourself!"
Jan Sobieraj writes:
Unfortunately ‘security’ in the NHS is no longer guaranteed so you need to think about why you really want to stay in your job and pursue a career in the NHS. What is it that you like and are good at? How do you want to develop your skills? It sounds like you can’t carry on working as you are, as it will lead to possible ill health and poor performance. If you’ve identified a problem your manager and colleagues will also have noticed it too. The time for a significant change is here and your first step is to focus on your actual performance. Do you know how you are doing? If not find out from your managers. It could be that despite your misgivings you are the one person able to cope within a normal day. Long hours usually means inefficiency and occasionally too much to do. It sounds like you are coping if you can leave on time. How others work is up to them but it looks like the organisation has a problem – not you. A late hours culture is effective in the long term.
Being in your mid 30’s is certainly not too old and your experience and wisdom are very useful. Build on this and agree with your manager a future work plan that enables you to have a personal life.
We all have different demarcations between home and work and you need to agree how this will work with your partner, but my guess would be that performing well, getting constructive feedback and managing your workload effectively with reasonable hours will make your life a lot more satisfying.
20th April 2006
Can I work and be a carer?
I'm a finance manager in a primary care trust. Recently my widowed mother has become ill and it's fallen on me to provide closer care for her. I want to feel confident about broaching the subject with my manager, but in truth I'm worried about the consequences. I had a child last year and have struggled with my work-life balance anyway since returning from maternity leave. Now I want to go down to three days a week to share the care burden of my mum. I'm worried that her demands may increase and that with PCT reconfiguration and financial deficits that raising the issue will harm my current and future career prospects. I could leave, but how easy would it be to get back in at a later date. I know it sounds callous - and that there's more to life than work - but we really need the money.
Jenny Rogers writes:
This is a horrible situation to be in, squeezed as you are between the demands of the youngest and the oldest generation. First, are you sure that you have tapped into all the available sources of other help for your mum? You are in a good position to check this out with colleagues. Pursue all avenues relentlessly – they will not be offered unless you ask.
I don’t think you have any option but to raise the issue with your manager because it will soon be obvious anyway and the burden of a secret becomes intolerable. Openness is better. Prepare for the meeting with your boss carefully by thinking through their likely worries. In effect you are re-pitching for your current role, so do it by reminding your manager of your many strengths and your continuing commitment to your work. Anticipate any practical problems your three-day week might create and offer solutions – suggesting how you could delegate some parts of the current workload to someone else. Be confident; expect success. Don’t whine or apologise – you have nothing to apologise for.
Your worry about leaving is, unfortunately, well-founded. So assuming you get the answer yes to your request, my advice is to give it a whirl on the three-day basis and see how it goes for at least a year.
However, during this time, you might also quietly explore what the alternative careers might be. As a finance manager you have skills with scarcity value and some kind of portfolio career could be attractive to you and others – for instance doing freelance work for companies who are too small to have their own finance staff and combining it with part time employment.
Many people in your situation find that this gives them the flexibility they need and has the added advantage that they can potentially also earn more.
Finally, like any carer – and I speak from personal experience here – it is essential to have some time just for you. Plan that in and protect it fiercely!
Keith Johnston writes:
One of the major achievements of NHS organisations over the past five years has been the positive implementation of approaches to improve the working lives of NHS staff.
Your PCT will have already secured Improving Working Lives accreditation and will be well on the way towards, if not already achieved, IWL Practice Plus. As part of its approach to IWL, your PCT will have introduced a wide range of facilities to support staff like you who are carers. These initiatives will include flexible working arrangements such as flexible hours, part time and job share facilities and carers leave.
You might be worried about the consequences of broaching the subject with your manager, but the fact of the matter is that alongside your responsibilities you also have the right to access IWL facilities. Talk in confidence with your personnel manager or trade union representative and find out about the details of your organisation flexible working policies before you speak to your manager.
Finance managers are an extremely important resource and you should not under estimate your value. Explaining your situation and needs should result in an extremely positive and flexible response from your employer, which avoids the need to consider the question of leaving.
Katy Gordon writes:
First off, you’re a finance manager, so in the current climate where financial balance is the absolute 'must do' target your knowledge and competences are in great demand. You should feel reassured about your future.
With regard to approaching your manager, have you spent some time setting down the key points you would like to discuss, what potential options there are and how you are going to raise them?
If you want to reduce your hours have you looked at what would work for you but might also suit your PCT? This could be looking at flexi-time: hours per month which could be spread so that if there is more work at the beginning of a month you do more hours then and less the rest of the month. Could you do some work from home? Would working just mornings be an option? Would annualised hours be an option, where you could be flexible with your hours to suit times of year and any extra pressures at particular periods, such as year-end?
Think about what works best for you and what you would be prepared to settle for after negotiating.
Another option if you are worried about speaking to your manager could be to speak to someone in human resources first and talk things through with them.
In the new world job shares and flexible working may well suit trusts more, and the government is keen to develop a flexible workforce, and enable mothers to work, so you are in a strong position to take your work-life balance and career forward while at the same time working with your PCT to help them deliver financial balance. What could be better than a win-win situation?
16th March 2006
Mother’s choice
I am currently working as a patient and public involvement manager for a national charity and am due to go on maternity leave in 10 days. I really want to do something new and different on my return. I'm considering training to be a child psychotherapist or maybe continuing in PPI in an organisation like the Healthcare Commission. What advice can you give me on these different sorts of options? And are there other roles I should be looking at?
Keith Johnston writes:
I am sure career changes will be the last thing on your mind in 10 days’ time! However, a period of maternity leave does provide the ideal opportunity to take stock and review your life priorities, including career choices. You want to do something ‘new and different’ and yet one of the options you have identified seems the same role but in a different organisation.
I suggest that you start by thinking carefully about your career to date and the combination of talents, skills, goals, motives and values that drive your career choices. Career Anchors – Discovering Your Real Values, written by Edgar Schein, is a really helpful diagnostic model that can help you clarify your career drivers. The next step is to keep an eye in professional journals and broadsheet newspaper advertisements for careers and jobs that appeal to you, no matter how diverse or different they may be. Get hold of relevant information packs and just see what is out there. This research phase will stimulate all sorts of ideas and connections and you don’t even have to apply for any of the jobs! Finally, your fall back option has to be to return to work after your maternity leave. Do therefore keep up with PPI developments and maintain and refresh your existing professional networks whilst you are away on leave.
Jan Sobieraj writes:
There are a couple of aspects to your question: first, timing and second, the sort of field you might consider.
In terms of timing there are both personal and organisational aspects – what do your current contract terms say regarding maternity leave and what’s the expectation of your organisation about your return?
You might also want to bear in mind the huge organisational changes going on in the NHS, with mergers and job reductions expected at unprecedented levels. These may carry on for another 12 months, with lots of job competition in the meantime.
However, your experience will be very useful in an NHS/social care context, and the government’s recent white paper sets out a vision where people are more in control of their own health and care, have more choice and a louder voice. As a result I expect there will be a greater focus on patient engagement and public involvement. Many foundation trusts are now actively engaging with thousands of patients and the public.
You will need to be clear about the many options you have and, clearly, completing a child psychotherapist course is a significant undertaking.
Try writing down what you enjoy doing and what you are good at – it will help focus your thinking. Also be practical about sources of funding and how much you need and want to earn. It could be that a part time role, even staying where you are now while training could be possible. If you’re still unsure, spending some time in different roles will help. Use your contacts to shadow someone in a likely organisation. If you have a geographical area you are targeting this will also help you see first-hand the possibilities for future employment.
Jenny Rogers writes:
Everything starts with identifying what really drives you. Think about a day or week in your current role when you felt inspired, happy and satisfied. Say aloud to yourself what it was about that time that triggered those feelings and write it all down without self-censoring. You might write something like, ‘felt I was learning’; ‘worked one to one‘; ‘really connected with my colleagues’. What needs does this suggest that absolutely must be met in any new role?
Now think about your skills, both ‘hard’ skills - any technical knowledge that you have - and the so-called ‘soft’ skills that are actually so hard to do, such as influencing, communicating, and leading. Which of these skills do you want to use in future and which might you let go? Which skills are you drawn to but may still be under-developed? What do you need to take into account as far as your personal circumstances go? For instance, could you afford both the time and money that the child psychotherapy training would involve?
While you are on maternity leave, in between dealing with sleepless nights, baby sick and how to get back into a size 12, use the time to look all around the health and social care world. Which roles seem like a good match to both your needs and your skills? If you are still drawn to child psychotherapy, find such a person and ask what training and previous experience he or she has. Ask about the grim days as well as what brings them joy.
Changing jobs is always easier if you are looking for a new role in the same profession and the same sector. To change both role and sector is high risk and often means having to start at the bottom again. But sometimes that is wise, especially if the thoughtful pondering I have advocated above leads you to the conclusion that you need to make a radical change to feel happy and satisfied.
23rd February 2006
I seek freedom to use my skills
I'm an A&E staff grade doctor in my late 40s. I've got an MBA and have started a PhD looking at policy drivers in emergency medicine. I have an interest in strategy and the future development of services in the emergency sector but have spent a year up against a concrete ceiling trying to find a way to put my skills to use. Physicians and the NHS have not yet grasped the potential of MBAs. I'd like to maintain a commitment to clinical medicine while contributing to the development of the NHS' future structure. What can I do?
Jenny Rogers writes:
I know it’s disappointing that people are not more impressed by your MBA, but the non-clinical world cares far more about managerial track record and emotional intelligence than it does about passing exams. Nonetheless, you have an interesting CV. But the kind of role you’re looking for is rarely advertised. It will be a DIY opportunity and will start with a short-term secondment. With luck, it will grow into the kind of permanent part-time role which will allow you to continue with your clinical practice.
To get to that desirable stage, you have to stop waiting for an employer to spot your potential – it will never happen. Instead, write yourself a two-sentence description of what you’re looking for, phrasing it so that you emphasise the problems you can solve for any potential future employer. ‘I’m looking for a job where I can bring my skills and experience in <then you describe them> to solve the problems of <then you describe them>.’ You will be able to put it more elegantly than this.
Now take a piece of flip chart paper and draw your social and professional network on it. Look for 50-100 names. Who do you know, even vaguely, who could introduce you to the central agencies in the NHS, including the Department of Health, and the academic or semi-academic think tanks (eg the King’s Fund) who in their turn might introduce you to the person who will recognise what you have to offer?
Then it’s a slog, I’m afraid. Start with your own medical director and chief executive – they will be well connected. Aim to set up one or two meetings a week. Never say, ‘Gi’us a job’. Instead, confidently describe what you offer and what you are looking for and then ask, ‘What advice would you give me about where to look and who to talk to?’
You may discover that the opportunities that emerge are a bit different from the ones you imagine are available, but stay open to feedback. It may take a while, but you’ll get there if you stick with it.
Keith Johnston writes:
You seem to be at a career crossroads, with your ideal preference being to combine clinical medicine with a role in redesigning emergency services. The issue seems to be the ‘concrete ceiling’ you are coming up against and the first step is to address this barrier.
Emergency medicine is a key issue for NHS organisations and innovative solutions to meet government targets, increase throughput and reduce costs will be in high demand. I am assuming that you have already offered your support to your own clinical director. Have you thought carefully about the needs of your directorate and Trust leaders and presented your offer of expertise from a perspective that helps them address their key agenda?
In reviewing your approach it might also be useful to consider seeking the support of a mentor within the wider trust organisation. A mentor can use their experience to help you develop strategies and to open doors both within and outside the organisation. Your medical director and director of service modernisation//development would be worth approaching in the first instance.
If you feel that the ceiling exists within your organisation, then you should consider whether the time is right for a change to an employer who will nurture your enthusiasm. Alternatively, consider becoming involved in emergency medicine policy development through your local strategic health authority clinical systems improvement lead or nationally through organisations such as the NHS Confederation and the King’s Fund. You could also contact the DoH’s emergency care strategy team, which has responsibility for developing policy on emergency care and welcome contributions from frontline practitioners.
Katy Gordon writes:
I think that there are many opportunities for someone with your experience, qualifications, skills and motivation – it is just a question of which direction you want to go in and how quickly. I am curious to know what other experience you have had over the course of your career as I get the impression that your interests have enabled you to do other things than follow a ‘traditional’ NHS pathway.
With regard to your interest in strategy and the future development of services in the emergency field a good avenue would be getting involved in the emergency care network locally. With all the proposed changes to service delivery especially with the White Paper that came out yesterday, there will be lots of project work becoming available which you could get involved with, and would also give you ideal opportunities to do your own networking. You could also look at what opportunities may be available for roles such as the clinical lead or other posts for the emergency network. Linking to your interest in development of future services there are opportunities for specific redesign work – again, this may be an option to work within the emergency network. How much involvement have you had to date specifically with NHS redesign and the tools and techniques for service redesign developed by the Modernisation Agency as was? This could provide an ideal platform to gain experience within NHS redesign and provide huge opportunities for sounding out potential further posts in the future. This could be both directly with, and on the periphery of, emergency care.
Other opportunities to look at roles could be with the strategic health authority or your local PCT as the emergency lead. With all the restructuring that is imminent there should be a range of possibilities for working with organisations to shape emerging roles, and therefore your own suitability for them. I am sure that with all your skills and experience, together with your ongoing interest in personal development, you should have no problem in finding a niche for yourself that combines all the elements which quite obviously motivate you.
5th January 2006
Life after modernisation
I am an experienced service improvement manager. After spending over three years at the NHS Modernisation Agency I deliberately took a fixed-term operational post at an elective centre to make sure that modernisation can happen in the real world. I am convinced that it can but the culture of the organisation has a huge impact and sometimes modernisation is a lot slower than you hope that it would be. I have approximately eight months of my contract at an elective centre left to run, and I have had no assurances about continuation. I am interested in the link between organisational planning and modernisation and a passionate believer that modernisation and continuous improvement should be very much part of that planning process. I am educated to master’s degree level with a healthcare professional background and have been in a number of service improvement roles over the last five years. Can you help with my next career move?
Jan Sobieraj writes:
There seem to be two parts to your current situation – making an impact in your elective centre and where to take your career in the future. Your starting point is to make a success in your current role. Whilst prospective employers will look across your career history, being able to highlight tangible successes in your current post and getting excellent references will be essential. Focussing on making a demonstrable impact should be a priority and this may even result in a contract extension or permanent contract being offered by your current employer.
Many organisations, particularly larger trusts, do still have service improvement teams separated from operational management but we are seeing a move to a more integrated approach where operational teams use many of the service improvement techniques with which you will be familiar. Finding a post in a larger organisation could be an aim and with operational and healthcare experience you should be an attractive prospect. You may also wish to consider project management in implementation of initiatives such as such as NHS Connecting for Health and workforce productivity, where service improvement techniques are being used to realise benefits. This could mean that working for a management consultancy is worth considering too. They advertise frequently, so you could informally sound one or two out now to get some feedback and give you more time to prepare for what they’re looking for. Clearly, managing yourself as a ‘consultant’ will be helpful and your Modernisation Agency work will be relevant.
Finally, you need to keep up to date with the latest thinking and techniques if your key strength and advantage is to be service improvement. There is a lot around on lean thinking for example and any forward thinking organisation will be looking for relevant expertise in this and similar areas.
In a challenging employment market, having a track record of delivery and a set of desirable skills is essential and many organisations should find yours useful.
Jenny Rogers writes:
What you say you are passionate about leaves me wondering whether your heart really lies in ideas and theories rather than implantation, and your three years at the Modernisation Agency suggest that you are attracted to ‘big picture’, strategic thinking.
I suspect your dilemma is knowing whether to continue in an operational job or look for a role where you could develop your interests in high-level innovation. My hunch would be the latter.
The clue is in your impatience with how slowly real change is implemented. It’s not just the NHS. You will find that this is true anywhere because organisational culture changes only with remarkable sluggishness, unless there is some major crisis or a dramatic change in leadership, neither of which really seems to be happening in the NHS. Mostly, it’s structural and systems change and we know that these do not deliver transformation.
If I am right about your true interests, then a job in a national or semi-academic think-tank might suit you, or one whose role is to audit standards and improvement. You could also consider the competitive world of consultancy.
You do not say what you believe your skills are and without this it is difficult to know what to suggest. Usually, our marketable skills are tightly linked to the interests that really fire us. So ask yourself what stands out as truly wonderful moments in the last four years? What do they tell you about what you really want to do? What skills do you have that differentiate you from colleagues?
When you have the answers to these questions you will probably find that the right role suggests itself. And it is never too early to start networking and making the kind of contacts that will lead to your next move.
Sally Gorham writes:
During the last five years you have worked as a health care professional, service improvement manager, operational manager, done a master’s degree and are now toying with a move into organisational planning. You sound like someone in a hurry, and inpatient with the pace of change in organisations.
Some people thrive on constant change and if you are one of them you could carry on jumping from job to job. There are lots of employment agencies specialising in interim management out there looking for people like you.
Alternatively this might be the time in your career to think about consolidating your experience. Most employers want to see a period where applicants have demonstrated that they can stick with a post through an extended period of organisational and cultural change, not just come in and produced quick fixes however important they are.
If you are going to take this approach, you will want to be sure that your next move is to a post that can sustain your interest. Go back over the jobs that you have done and make a note of what you liked and disliked about them. Use these lists to help you evaluate posts that come up over the next few months.
Then really do your homework on any job you consider applying for. If you get it you are ideally committing yourself for several years, not months – unless, of course, we have another NHS reorganisation. Good luck.
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