How to Navigate Financial Challenges in Your Primary Care Network (PCN)

At THC, we provide resources to primary care leaders who are navigating complex challenges in today's healthcare landscape.

This blog is for you if you're experiencing challenges and conflict when it comes to your PCN finances. Please note that you're not alone.

PCN leaders across the country are facing the same struggles: tense meetings about funding, frustration over uneven contributions, and the gradual erosion of trust among practices.

In this blog, you will find a series of facilitative questions to support you.

1. The Financial Challenge You're Facing

Despite investing countless hours, navigating complex relationships, and building something valuable with your PCN, tensions around money threaten the foundations of your network, and you may be experiencing:

• Tense moments in network meetings when funding comes up

• Frustration as some practices contribute more than others

• Erosion of trust among partners who once worked smoothly together

• The same conversations over and over again

While financially sustainable general practice is absolutely key, the reality is that networks must find ways to work together effectively to operate at scale and collaborate with larger organisations at the neighborhood level.

Without resolving your internal financial tensions, your PCN will struggle to be a credible partner in the wider healthcare system and may risk being 'done to' versus influencing the direction of travel.

Why Traditional Solutions Haven't Worked

You've likely tried several approaches already:

• Creating new spreadsheets and allocation formulas

• Drafting agreements and MOUs

• Having informal corridor conversations

• Perhaps even avoiding the topic altogether

But the tension persists because these surface-level fixes don't address the deeper issues you're really dealing with.

The Path Forward: Your Role as Facilitator

In our experience, sometimes, personal feelings and principles can prevent compromise. As a PCN leader, your role is to facilitate consensus, not impose your way. Finding middle ground is essential: create a space for give-and-take, where practices can meet halfway despite differences.

Before revisiting the conflict, ask yourself:

1. What conversations are being avoided?

2. What behaviours undermine collaboration?

3. What patterns are you reinforcing?

4. What historical tensions still influence your dynamics?

5. How might different practices have different experiences?

6. What is your network afraid to address?

In a previous resource, I broke down further questions for you to consider ⬇️.

Moving Forward

Networks that successfully navigate these challenges typically:

• Create a space for honest dialogue. Consider an external facilitator for tough conversations.

• Make expectations explicit. Clarify what “fair contribution” means, how it’s measured, and what your non-negotiables are.

• Reconnect with your network’s origins and purpose. Reflect on whether your original vision is still shared.

• Address power dynamics. Recognise how decisions are made, whose voices are heard, and where accountability lies.

Acknowledging the Uncomfortable Truths

Facing reality is critical for progress:

• Some networks are not built on solid ground. They may have formed out of compliance, not genuine collaboration.

• Trust and equity issues run deep. Long-standing grievances and power imbalances can make collaboration feel impossible.

• Avoiding conflict only delays the inevitable. Difficult conversations about finances and expectations are often postponed, allowing tensions to fester.

• Sometimes, networks do fall apart. Despite best efforts, some PCNs cannot find common ground and must face the painful process of breaking up. While incredibly tough, it can sometimes be the best or only way forward.

• Leadership means making tough decisions. Your job is to guide your network through discomfort, even if it means facing criticism or making unpopular choices.

By confronting these truths head-on, you unlock your potential to grow as a leader and build a more resilient network.

Your Next Steps

The solution isn’t just a better allocation formula—it’s addressing the underlying relational and governance issues head-on:

1. Name the difficult issues without blame

2. Create psychological safety for honest dialogue

3. Establish clear expectations and accountability

4. Recognise all forms of contribution

5. Identify areas for compromise

6. Focus on strengths, not just problems

Your success as a PCN leader comes from enabling consensus and middle ground, not imposing your vision.

Powerful Questions for Your Next Meeting

Use these facilitative questions to open dialogue and uncover solutions:

1. What would success look like financially in 12 months?

2. If starting fresh, how would we design our arrangements?

3. What concerns might people hesitate to raise?

4. What shared outcomes matter most?

5. What small step could build financial trust?

6. How will we hold ourselves accountable, and what is the consequence if we don't?

These questions can shift conversations from confrontation to collaboration.

If you’d like support facilitating these conversations, email us at admin@thcprimarycare.co.uk

We hope this helps.

Welcome to the Primary Care Network Members Club

Would you like to receive:

• Exclusive practical resources twice per month?

• Step-by-step guidance?

• Support to help you calculate your PCN salaries?  

• Access to masterclasses and Q&A sessions?

• 1-2-1 Coaching with Tara Humphrey - The creator of Members Club?

If yes, we are delighted to share our 12-month Primary Care Network Members' Club with you, and it can be accessed by an additional three members of your PCN team. 

Welcome to our PCN members club; click below to join today ⬇️