Do PCNs Need to Rethink Leadership Roles and Titles?

Having recently met with Directors of Strategy and Directors of Partnerships and Transformation, I found myself thinking: are titles important? As the neighbourhood agenda takes shape, I think the answer is yes.

We’ve built PCNs around the Clinical Director role. It’s in the DES. It’s funded. It’s expected. But we haven’t had the same intentional conversation about non-clinical leadership.

As we all know, the PCN Manager role is not formally recognised in ARRS. There’s no dedicated funding stream, no national job description; however, networks can use the digital and transformation lead funding to create management positions. But the development of neighbourhoods could change this.

The NHS Confederation’s neighbourhood model already references an ‘operational manager’ sitting alongside the clinical director, lead GP and lead nurse (NHS Confederation, ‘Delivering a Neighbourhood Health Service’, 2025). And with single neighbourhood provider contracts expected from April 2026, these management roles will only grow in scope, accountability and visibility.

For PCN managers doing this work already, that’s not just validation, it could be a pathway to formal recognition and career progression that has never existed before.

In this blog, we cover:

• Why the rooms PCN managers are sitting in have changed

• What your title signals before you’ve even spoken

• How the neighbourhood agenda could create a pathway to formal recognition for PCN managers

• The difference between managing relationships and leading strategically

• The real question your network should be asking as the neighbourhood agenda takes shape

The changing context

Walk into any neighbourhood planning meeting. You’ll see Directors of Primary Care, Heads of Transformation, Associate Directors from ICBs, and Chief Executives from community trusts.

And then you’ll see the person representing the PCN, often introduced as the ‘PCN Manager’ or ‘Business Manager’.

Many PCN managers are doing extraordinary, strategic work, guiding networks through transformation, navigating complex governance, positioning practices for what’s coming. They’re operating at the director level in everything but name.

But titles shape perception before you’ve demonstrated your capabilities. When a ‘Business Manager’ sits alongside a ‘Director of Strategy’, there’s an immediate, unspoken positioning, regardless of who holds the strategic insight.

What’s in a title?

These titles often describe different scopes of work:

PCN Manager / Business Manager – typically operational: coordination, administration, contract delivery. Accountable to the Clinical Director and member practices.

Managing Director / Director – strategic territory. Setting direction, representing the network externally, and working alongside the Clinical Director as a leadership partnership. Accountable for outcomes, not just delivery.

CEO – ultimate accountability for performance, strategy, and sustainability. For networks with complex governance and multi-million-pound budgets, this may be entirely appropriate.

The question isn’t which title sounds best. It’s what reflects the scope, skills, experience and accountability your network actually needs.

Are networks asking the wrong question?

When title conversations arise, many PCNs decide based on internal politics rather than external positioning. Some ask: “What will the practice managers or XYZ think?” Instead of: “How do we need to show up in neighbourhood conversations?”

Some networks focus so much on keeping the peace internally that they hold themselves back from being taken seriously at the tables where decisions about their future are being made.

There’s a difference between managing relationships and leading strategically. One keeps everyone comfortable. The other positions your network for where primary care is going.

Recognition, not ego

People who say "titles don't matter" usually already have the title they want.

I'm the founder of a 10-year-old business, a CEO, an employer, a podcast host, and a writer. When people ask me what I do, I call myself a PCN Manager. I'm not overly concerned about my title because I know the skills and experience I bring.

For those who feel their title doesn't reflect what they actually do, the title can shape how they're perceived, and it can also devalue the skills and experience they bring.

I know of PCN managers who have petitioned their board for a title change, not asking for a pay rise, just for their title to reflect the work they do, how the role has evolved, and the increasing level of responsibility they carry. That’s not ego. That’s recognition.

It’s about the acknowledgement of the strategic nature of the work. It’s about parity in system conversations. A title can signal whether you’re a strategic partner or support staff. And yes, for some, it’s also about appropriate remuneration, because titles and pay scales are connected.

Getting this right

Let me be clear: not every PCN needs a CEO. Executive titles shouldn’t be handed out simply because someone asks for one. That would devalue the very recognition we’re talking about.

What matters is that the conversation happens for the right reasons and in the right order.

Start with what the network needs. What decisions must be made? What authority does that person need externally? Then build the job description. Then name it appropriately.

From there, either the right person applies for the role, or the role evolves alongside the person already in it.

The real question

You’ve accepted you need a Clinical Director, someone with clinical credibility and seniority to represent the network strategically.

Alongside your Clinical Director, what management leadership role does your network need? And are you designing that role based on what will position you for the neighbourhood agenda, or based on what will keep everyone comfortable internally?

Those are two very different questions. And they lead to two very different futures.

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 blog posts sharing insights on primary care networks.

Check out our facilitation services here: https://www.thcprimarycare.co.uk/primary-care-network-facilitation