Well, I’m now 3 weeks away from leaving the NHS. I’m actually only going to be doing 6 more days in work, so its running out very quickly, especially as I have said I will do a demand-capacity paper and clear my room out in that time.

I’ve sent an email round to colleagues to say that I’m going to take a career break, and giving a brief outline why (my ‘openess’ surprised my managers, it seems). I sent it both to the camhs mailing list and to other colleagues in various agencies; paediatricians and managers in my prior trust, EPs, commissioners, social workers and anyone I feel I have a working relationship with. Its been really nice to be sent well-wishes, and a lot of people have said they have similar feelings and wish they could do likewise. Of course there are people trying to read into it things I didn’t intend (for example I said “I will miss lots of you” which referred to the fact that I don’t really know some people on the camhs mailing list, but someone thought implied I was making a point there were some people I actively dislike). It has also made me realise the ’empty chairs’ in my professional network – two deaths and many people who have left the service over time that I have enjoyed working with.

So where am I starting my grand adventure in the real world?

At the moment my non-NHS work has been offering expert assessments of parenting, children’s needs and attachment relationships for the family court, in the context of Care Proceedings and complex custody disputes. I spend around 15 hours per week of my time on it, plus the same of an AP and some ad hoc admin. I currently turn away a lot of work by only accepting two small or one large case per month, so this has some scope to expand. I am a preferred expert for quite a good geographical patch, and get regular work from the same sources as well as many new enquiries. I have a good reputation and positive feedback about my work. However, I feel quite disorganised at the financial side – my invoicing is behind and I am poor at chasing unpaid invoices, so a lot of income is outstanding. Nonetheless I make enough for our family to live on with this work alone, so its my foundation from which to expand.

The areas I want to look at more are training, consultation, assessment, interventions, audit and research.

In terms of training, I have received very positive feedback for past training events, and have scope to offer training on various topics. The most easy/marketable being training others to deliver a group intervention I devised to support non-birth parent carers with ‘managing behaviour with attachment in mind’. I can also train social workers to do better assessments of children and adults when planning placements, whether foster or adoptive. I can also lecture/teach on issues such as the impact of trauma and poor early care, neurodevelopmental disorders, differential diagnosis between neurodevelopmental disorders and the impact of trauma and poor early care, transgenerational transmission of attachment issues, assessment/formulation, childhood mental health issues, etc. I’ve been invited to lecture for a chamber of barristers who have an interest in family law, and have some interest from Local Authority and private agencies locally, which I need to explore.

In terms of consultation, I need to pitch to Local Authorities about the value of this in choosing when to use experts and what to ask them, but also in terms of allowing social workers to evidence their thinking for care plans and court documents. This is something I am often asked to do, so I just need to work out the details and then ensure that I get people enthused enough to contract with me.

In terms of assessment, I think there is scope to offer detailed psychological assessments outside of care proceedings. These might be to private providers of residential and foster placements, or to Local Authorities. I just need to lay out a menu of what I can offer, and at what cost, and ensure that it is seen by the right people. My initial feedback has suggested there is a viable but niche market for this.

In terms of interventions, I am keen to offer my psychoeducational group for adoptive parents and foster carers to the market, as I believe there are funders who would consider this good value in supporting placements (and I enjoy delivering it). I’d like to also scope whethere there is a market for highly specialised attachment-focused interventions, as I believe that there is a gap between the time-limited and somewhat generic interventions offered in camhs and social care, and the intensive but hugely expensive packages offered by places like Family Futures.

In terms of audit, I am interested in how private providers of placements monitor their efficacy and whether they can show ‘added value’ through specialised outcome measurement. I also have a norm group for the knowledge and style of Local Authority residential care staff against which to compare more specialist providers. Again, it needs scoping, but the potential market is there, and when I have mentioned it I’ve had positive feedback.

In terms of research I am keen to build links with one or more local university, to write up papers, bid for research grants and continue to keep an academic strand in my professional life. I have about ten research papers which I have part-written and would like to submit to peer reviewed journals but have never had time. I may also pick up some teaching sessions, or supervision of post-graduate research. I’m in discussions about ‘visiting fellowship’ or ‘honorary fellowship’ or ‘research consultant’ type roles with a few academic centres. I just need to tidy up and update my academic CV and submit this for scrutiny to complete the process.

So, what about the pragmatics?

At the moment the plan is to have more of my own time (maybe 25 hours per week), plus an AP post which builds up to full-time, plus a half-time admin/business support role (again with the potential to build up over time), and one or more newly qualified CPs to allow me to expand the court work and build up all the other strands. I’ve got people in mind for some of the posts, and people to meet for others. I don’t want to end up with the burdens of being an employer too early, so my current thinking is to initially form a cluster of self-employed people with a cooperative aim, and then get it legally drawn up as a partnership in which I am the senior partner and hold the majority share. So, the staff I take on will be ‘junior partners’, contracted to the business but not employees (with the incentive of a small profit share, a christmas meal, and Costco membership, to compete with the NHS pension LOL). However, in the longer term I may form a ‘social enterprise’, though I may keep the court expert work separate from that because of the need to be independent and being uncertain it would fit the social enterprise model as well as the other aspects.

In order to have a base, I am going to rent an office. I haven’t quite worked out whether this will be a serviced office in a big office complex which provides reception and waiting areas and facilites, or whether to rent a small set of rooms with some other health colleagues (eg above a shop). At the moment I am swayed toward the former option as it appears more flexible.

I’ve got 3 weeks to sort everything out! (Actually, I’m not increasing my court work or taking on staff until September, so I’ve got a month of exploration after I leave the NHS as well, but I’m trying to prepare as early as I can).

Addendum 1: Today was my leaving lunch. We did it as a ‘bring and share’ in one of the group rooms at work. A colleague in my team, my supervisor/head of service and I all made short speeches. I was actually suprisingly touched when my colleague said that she considered my leaving a sadder event for her and the team than being moved to the other trust after we lost the tender for the CAMHS contract. I got a card, some paint your own Russian dolls (which I use as a metaphor in my work all the time) and a spa treatment day as my leaving gifts. More importantly I got several sincere hugs and good wishes, and very personal messages. I felt like it was an ending with no bad feelings, which was great. I do feel sad to be leaving my team though, we’ve been very close under the adversity of increased demand and I’ve really valued them, and the sense of humour we share as a means of managing the stress.

On the other side of the coin, I have arranged confidential waste paper disposal, and signed a contract for a new office in a serviced block. I’ve designed a business card and I’m going to print name badges, to match my private practise letterhead. I’ve picked out what furniture I want in my new office, and I’ve begun to think about equipment. I’ve written job descriptions and contracts for the 3 posts I am contracting (the band 5 equivalent AP, the band 4 equivalent 20 hour per week admin/business post, and a band 7 equivalent qualified CP post) and the first of those people has been interviewed and appointed, with people to meet and interview who I hope might fit the other posts. I’ve formed links to two local universities that will let me use facilities such as journal access and SPSS, and arranged with my trust to be able to keep my research data to write up in a way that meets ethics and data protection. I’ve also been thinking about the things my business can offer, and the potential market. I’ve had really encouraging noises about people wanting me to offer training or lecturing to them or their organisation, but its hard to know what of that will develop into genuine paid work. A surprising number of colleagues are also going off into the private sector and there are a few amongst them who will be useful network connections to hold onto.

The amazing post-script on this process though is that my trust are considering offering me redundancy! It feels like such a gift, when the likelihood was that I was going to leave anyway. I’ve got to get it in writing and then get legal advice, but it would really take the pressure off to leave with some extra cash in my pocket!

Addendum 2: I’ve had some legal advice and things are pressing forward. I’ve agreed to leave my trust permanently, and the paperwork is going through. I’ve also discovered that I can’t make a partnership as my business structure, as that pretty much relies on people only earning a predetermined profit share, when I am not in a position to predict turnover yet. So given what I want is to pay people an hourly rate plus profit-related-bonus, it looks like I am going to have to register as a limited company and then take on employees. This feels much further out of my comfort zone than I expected, as it means I’ll have to pay my employees’ tax and NI, and get employer’s liability insurance. That’s not to mention having to have contracts and policies and stuff. So it will be interesting to see what happens in the next few weeks. A lot will rest on the kind of work I can bring in, and whether the CPs I could employ seem like the kind of people who would be enough of an asset to my company to go through all that rigmarole!