Can You Run a Primary Care Network Like a Business?

May 11
5 min read

At THC, we provide resources for primary care leaders. In this blog, I want to explore whether there is a place for business principles when it comes to running a primary care network.

Where this question came from

Some of you will know that I host The Business of Healthcare Podcast, which has now released over 370 episodes.

The catalyst for starting it came from my MBA dissertation. As part of my research, I interviewed a number of GPs, all of whom held portfolio roles. New to the sector at the time, I naively asked whether they considered themselves a business person or an entrepreneur. All but one said no.

That answer sparked something in me. Because whilst the NHS is a national service, businesses do exist within it. And the question of how we think about that has stayed with me ever since.

I also want to be clear about where I am coming from personally. I am not a hard-nosed advocate for profit. As a parent and as a patient, my family has been a high user of the NHS. I will be forever grateful for the support, care, and service we have received. For all its faults, I, my friends, family, and colleagues benefit tremendously from the NHS. ( I am human and do have a heart 🙂)

So what do I actually mean by running a primary care network like a business?

Whilst I know a primary care network is not a business in the traditional sense, you did not set out to build a business. You did not identify a gap in the market, have to acquire new customers on a daily basis, or design a product.

I simply mean:

Leading underpinned by a vision, with an entrepreneurial lens and a long-term view.
Being clear on why you are doing what you are doing.
Knowing what you are saying yes to, and why.
Knowing what you are saying no to, and why.

Organising your resources to achieve your goals with some degree of system and structure behind you.

But it is not that simple, because:

You need to lead and manage this within the system's financial constraints, the patient's needs, different practices' organisational views, and the needs of the network. Lean too far towards any one of those pillars, and the whole thing becomes unsustainable.

It can be a stressful and constant balancing act.

What is the alternative?

The alternative is a PCN that functions as a mechanism, at best. Money comes in, money goes out to practices, and roles get filled because they need to be filled.

At its worst, it's run like an inconvenience or a project that no one or only a few people want to be part of, but it's just about tolerated because there is money attached to it.

That works, until it does not.

The networks that have not built any intentional thinking, no vision, no long-term view around how they operate, will find it harder to secure future opportunities, adapt to funding changes, and make the case for what they deliver.

Being entrepreneurial about how you run your network is not about profit. It is about being positioned to lead when the landscape shifts.

The approach that worked when PCNs were finding their feet is not necessarily the approach that will secure their future. That is why vision and a long-term view matter now more than ever, and the skill is creating a really vivid vision.

Every entrepreneur has to. Otherwise, when the going gets tough, you make decisions based on fear, avoid difficult conversations, argue about the same things, and fail to pivot when the market changes.

The environment you are working in makes this harder than it sounds

I know PCN leaders are operating in genuinely difficult planning conditions.

⬇️ There is a spend it or lose it culture that has been embedded in the NHS for years.

⬇️ There are pooled budgets that require collective decision-making across practices with different priorities and different pressures.

⬇️ There is a neighbourhood agenda that is building momentum, but without a concrete contractual mechanism in place as yet.

And underneath all of it, individual GP practices are looking to PCN resources and the income streams attached to them to help support their own sustainability.

The average PCN is now managing over £1 million worth of Additional Roles Reimbursement Scheme funding, and with it comes a level of accountability is significant.

What business thinking actually gives you

The good news.

You do not need to imagine you are a high-performing CEO managing a multi-million-pound budget. You already hold this role.

And the return on investment you are looking for is not always cash. In general practice care, time is the most precious resource we have.

✅ Does a decision give time back?

✅ Does it create capacity?

✅ Does it open up future opportunities?

Those are the questions worth asking before you commit.

As high-performing CEO's;

✅ Can you create a collective vision, one that everyone is signed up to?

✅ Can accept the constraints the NHS presents and see these opportunities or mere inconveniences which do not derail your vision, or choose to go alone. You cannot change the environment, but you can choose how you operate within it.

✅ Can you scenario plan and create Option A, Option B, and Option C. The lessons from capacity and access (CAP) funding are worth reflecting on here.

When CAP funding was removed, PCNs that had built services around it are now left with having to make difficult decisions quickly. Some of you will know exactly what that feels like. Had anyone considered what would happen at the beginning if funding were removed?

I am not saying core funding will be removed. But what if it was? What would that mean for the services you are currently running? Having thought through that question in advance does not create panic. It does the opposite.

It means that if hard decisions do need to be made, you can make them faster and with greater clarity because you have already done some of the thinking. That is what scenario planning gives you.

Not fear. Preparedness.

✅ Can you collectively agree to invest in the infrastructure to operationalise the vision, people, systems and governance? If you have no vision, you need no infrastructure. But if you have no vision, you also have no direction. And that is a choice you need to own.

✅ Can you write the plan down and focus on operationalising it — not on fighting the plan you created.

That is what I mean by running a PCN like a business. Not profit. Not customers. Just intention.

On the Podcast

Two people smiling, teal background. Text: The Business of Healthcare Podcast. Topic: Careers in Primary Care. Episode 373. Spotify, YouTube, Apple logos.

Further Support

The PCN Members Club

If you need ongoing practical support for your neighbourhood conversations, join our PCN Members Club.

Facilitation

If your network would benefit from a neutral voice for those tricky discussions, we also provide in-person facilitation.

Interim Management

We are perfect for you if you are struggling to recruit and need someone who can hit the ground running until the time is right for you to hire your permanent PCN Manager. With the experience and expertise of leading 11 Training Hubs and supporting over 300 Primary Care Networks and 3 GP Federations, we understand and appreciate the complexity of healthcare and what it takes to deliver projects at scale.

Contact admin@theprimarycare.co.uk to discuss the support you may need.