Neighbourhood Working for PCN Leaders | A Strategic Framework to Guide Positioning

At THC Primary Care, we have been providing a range of insights, summaries, a webinar, and a neighbourhood MOT to support the move towards neighbourhood working, which can be found here.

We have also received a range of feedback. Some leaders are genuinely excited about integrated care. Others are more sceptical, fearing nothing will change or that the change we are heading towards is in the wrong direction.

One key question everyone's grappling with is: "What will this actually look like day-to-day?" Because nobody really knows.

Times are changing. If you're looking to lead a multiple neighbourhood provider, you're about to experience a fundamentally different type of leadership challenge. The NHS ten-year plan calls for significant transformation, but there's no manual for how to actually deliver it.

If that feels daunting, you're not alone. After 10 years supporting over 300 primary care organisations, I've watched leaders navigate countless changes. But neighbourhood working? This is genuinely uncharted territory for many.

Neighbourhood Working | The Job You're Really Trying to Do

On the surface, you think your job is to secure multi-neighbourhood provider status and maintain control of the direction of travel.

But here's what you're actually trying to accomplish.

Figure out how to work with organisations you've never truly been able to collaborate with before, to deliver something that doesn't exist yet, while keeping everything else running smoothly.

That's a fundamentally different job. And it requires a completely different approach than implementing something proven.

The challenge isn't technical - it's strategic thinking under uncertainty, in a context that's more complex than anything you've navigated before.

In your PCN, you now know when to push and when to pull back. You know how to work around certain people and the politics of how decisions really get made in your network. ( Even if your PCN is dysfunctional).

Now we need to take this a step further and deliver integrated services not only with our neighbouring PCNs but also with secondary, community, social care, third-sector, and private providers.

We can learn from others in this journey, but there's no 'standard approach' because the system-wide and local context will vary significantly.

What works in an urban area with strong community services might be completely wrong for a rural patch with different demographics and infrastructure.

But here's what successful leaders understand: not knowing how to do something yet isn't a weakness - it's an opportunity to:

• Experiment with approaches that fit your specific context

• Build relationships based on shared learning rather than competitive positioning

• Create models that actually work for your populations rather than copying someone else's template

A Framework for Strategic Thinking, Not a Recipe for Implementation

Since there's no tried and tested playbook for neighbourhood working, what you need isn't a set of instructions.

You need a way of thinking that helps you navigate complexity and make better partnership decisions in real-time.

Right now, PCN leaders are asking questions like: 

"Could other providers bid for our neighbourhood contracts?" and "Do we need another legal entity for multi-provider partnerships, or would an MoU work?"

These aren't implementation questions - they're strategic positioning questions that require understanding the forces at play in your specific context.

The 10 NHS Forces Framework

The Traditional Business 5 Forces (competition, buyer power, supplier power, new entrants, and substitution) - developed by Michael Porter and a staple in any business school curriculum - help you understand the market dynamics that will shape your partnerships.

But neighbourhood working introduces 5 additional complexities that traditional partnership theory doesn't address:

• Regulatory Control: When you're integrating across organisations with different regulatory relationships, who holds accountability for what?

• System Integration: How do you create governance for something that spans multiple PCNs, each with their own practices and ways of working?

• Workforce Sustainability: Managing teams across different employment models, organisational cultures, and professional hierarchies

• Population Complexity: Serving diverse populations across a larger geography with varied needs and expectations

• Digital Capability: Achieving interoperability across even more systems, organisations, and digital maturity levels

What This Means for Your Next Neighbourhood Conversations

Understanding these forces doesn't tell you what to do - it helps you ask better questions and make better decisions:

Instead of asking: "What should our neighbourhood model look like?" 

Ask: "Given these forces, what partnership approaches are most likely to succeed in our specific context?"

Instead of thinking: "We need to get everyone aligned..."

Think: "Where do our forces naturally align, and where will we need to work harder to create alignment?"

Instead of planning: "We'll implement the same model across all PCNs..." 

Plan: "We'll test approaches where the forces favour success, then adapt based on what we learn."

Your Competitive Advantage in Uncertain Times

The PCN leaders who will thrive in neighbourhood working aren't those who have all the answers. There'll be those who have the strategic thinking skills to navigate uncertainty intelligently.

They understand that the most successful neighbourhood models won't be the ones that follow a template. They'll be the ones created by leaders who understood their environment and worked strategically within it.

Your Starting Point

If you're about to embark on neighbourhood working, remember: nobody expects you to have it figured out. They expect you to figure it out thoughtfully.

That means:

• Understanding the forces that will shape your partnerships

• Building relationships based on mutual learning rather than competition

• Designing approaches that work with your context rather than against it

• Making strategic decisions even when you don't have all the information

We hope this helps.

Work With Us

Professional Development

If you want to master the strategic thinking behind these challenges: Join our Business of Healthcare Leadership Programme starting September 12th.

Deep dive into frameworks, case studies, and peer learning with other pioneering leaders navigating the same uncharted territory.

The PCN Members Club

If you need ongoing practical support for your neighbourhood conversations, join our PCN Members Club for just £497/year.

We have an exclusive master class coming up where I will be sharing top tips to help you facilitate your neighbourhood discussions on 4th September from 1:15pm – 2:15pm

Facilitation

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

Contact admin@theprimarycare.co.uk to book facilitation support.

About Us

THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network Management and the creator of the Business of Healthcare Podcast. With over 20 years in the industry, we've supported more than 200 PCNs through interim management, training, and consultancy.

Our expertise spans project management and business development across both private and public sectors. Our work has been published in the London Journal of Primary Care, and we've authored over 250 blogs sharing insights about primary care networks.