Primary Care Network Funding: Whose Money Is It Anyway?

At THC Primary Care, we create resources to support the leadership and management of primary care networks, and the focus of this blog is money. Having supported over 300 PCNs, it's fair to say that one of the most common sources of conflict when it comes to primary care networks is money.

Not so much the technical financial management, but rather disagreement about what the primary care network funding actually represents. This creates ongoing tension that undermines partnership working, even when practices have strong relationships in other areas.

This blog reveals:

✅ The three distinct "money mindsets" that exist across PCNs - the Poolers, Keepers, and Sharers - and explains how each approaches funding differently.

✅ Predictable tensions around ARRS roles, hidden investments, and transparency.

✅ Proven strategies that successful networks use to navigate these differences, including vision-driven planning, structured communication approaches, and decision-making frameworks that actually work.

This guide will help you build financial processes that work for everyone.

Primary Care Network Funding | The Three Money Mindsets

When PCN practices discuss spending decisions, they're operating from different beliefs about what the money represents:

The Poolers

Some practices genuinely view the funding as collectively owned by the network. They want joint decision-making processes, shared priorities, and investments that benefit the entire network rather than individual practices.

In practice: Poolers support hub-based models for services like social prescribing teams, and are comfortable with top-slicing for management and contingency funds, and no funding is paid directly to practices.

The Keepers

Others think about PCN funding in terms of individual practice contribution and return. They see their practice's patient list as their investment in the PCN and expect funding allocations proportional to their contribution.

In practice: Keepers prefer devolved funding models where each practice receives "their share" to manage independently, and frequently ask "where's my practice's allocation?"

The Sharers

Many PCNs take a pragmatic middle ground—they're happy to see investment in PCN-wide services and infrastructure, as long as some returns are distributed back to practices as dividends or direct allocations.

In practice: Sharers support collective investments but expect transparency about what portion goes to shared services versus practice returns, and want regular review of this balance.

Real-World Financial Challenges

Outside of the different financial mindsets, other predictable challenges occur when managing PCN budgets:

➡️ The Hidden Value Problem: Many networks pay for substantial services on behalf of practices, such as software subscriptions, training programmes, digital infrastructure, website maintenance, and enhanced access coverage, but fail to communicate this value effectively. Practices feel they're receiving no monetary benefit from PCN membership, whilst the network is actually investing thousands of pounds per practice in background support.

➡️ The Additional Roles Tension: Practices want to use Additional Role Reimbursement Scheme (ARRS) staff to hit Quality and Outcomes Framework (QOF) targets because core funding is decreasing. PCN leadership and management teams insist these roles should be "additional." Both perspectives make sense within their respective frameworks.

➡️ The Transparency Problem: Networks struggle with how much financial detail to share. Some practices want comprehensive breakdowns, others are overwhelmed by information, and some prefer to delegate financial oversight entirely.

Proven Strategies for Financial Success

To help address some of the predictable problems above, successful networks are using the following approaches to navigate these different money identities:

✅ Vision-Driven Financial Planning

Create a practical vision statement that connects spending decisions to agreed outcomes. This vision can then justify investments in staff training, induction programmes, and patient education because they directly support the stated goals.

✅ Transparent Planning

Networks that develop clear annual financial plans see fewer conflicts and better engagement. These plans show how funding will be used and what each practice can expect, creating transparency around collective investments and individual benefits.

✅ Regular Communication

Implement structured financial communications that include budget updates, service utilisation data, patient outcome metrics, and forward planning. Networks with consistent communication processes report higher trust levels and smoother decision-making.

✅ Decision-Making Frameworks

Networks with consistent decision-making processes experience fewer conflicts and more efficient resource allocation. Successful approaches include clear accountability structures and systematic evaluation criteria for new investments.

Common Pitfalls to Avoid

⚠️ The Trust Deficit: Without transparent processes, practices may assume the worst about financial management. Poor communication destroys confidence and prevents spending decisions.

🎯 The simple solution is to transparently share the finances quarterly and ensure your financial governance is kept up to date.

⚠️ The Documentation Gap: Many financial disputes arise from poor record-keeping and unclear agreements.

🎯 The simple solution is to follow your network governance and ensure financial decisions are documented.

⚠️ The Competence Challenge: Managing multi-million pound budgets with complex workforce requirements sometimes requires additional support, and it's important to recognise when to get that.

🎯 The simple solution is to work with an accountant and bookkeeper (if required) and ensure your financial processes are transparent and you're using financial tools which you have been trained on.

⚠️ The Expectation Trap: If dividends are paid back to practices, it's important to manage expectations that these amounts may not be the same each year. This is important for general practice planning.

🎯 The simple solution is to be crystal clear and explain the rationale for the payout and the sources of funding from which they came.

In summary

The "identity war" over PCN funding has real practical implications for how networks function day-to-day.

Networks that acknowledge these different perspectives and build robust financial processes can at least make progress despite their differences. Success in this case will come from creating systems that work across all mindsets.

Further Support

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.