What Does Good PCN Leadership Actually Look Like?

Every blog I write answers a question from my client work, and recently, a clinical director asked me: "What does good look like?" So here's my take, after 10 years supporting 300+ primary care networks.

Whether you're leading a PCN that's functioning but feels harder than it should, or you're struggling and need a reset, understanding what "good" actually looks like helps you know where you stand and what needs to change.

Good PCN leadership doesn't look like smooth sailing. It looks like navigating complexity, managing misaligned expectations, and showing up repeatedly, even when it's uncomfortable.

This isn't a "10 steps" guide. This is what good looks like in practice - including what it feels like.

1. Your Job Is Alignment, Not Uniformity

You're not trying to get all practices moving at the same speed. You're trying to get them moving in the same direction.

Good looks like accepting that Practice A will always be more engaged than Practice B. Practice C moves quickly; Practice D needs more time to process. That's not failure - that's reality.

Your job is to create alignment on where you're heading, manage the different paces without leaving slower practices behind, and acknowledge that one practice will likely always be less engaged.

This takes enormous time and patience. It's the corridor conversations, the relationship building, the "I know exactly who to call about this" knowledge that can't be captured on a timesheet.

The practices that thrive don't have uniform engagement. They have a CD and a manager who can hold that tension and keep everyone moving forward anyway.

2. Leadership Takes More Time Than the Allocated Session

In my experience working with PCNs across the country, the ones that function well have clinical directors, whether they're GPs, nurses, pharmacists, or physician associates, who dedicate significant time to the role, typically more than the one session a week that's formally allocated.

I'm not advocating that anyone should work unpaid. But the reality is that any leadership position occupies more brain space than the hours officially assigned to it. You're thinking about PCN challenges between patients, processing decisions on your commute, and having quick conversations that don't fit neatly into session time.

Good looks like being realistic about this from the start. Some CDs negotiate additional sessions with their partnership. Some find ways to protect the time they need. Some accept that leadership means their thinking time extends beyond their clinical time.

The question isn't whether the allocated time is enough (it rarely is) - it's whether you have the capacity and willingness to give this role what it needs, given everything else on your plate.

If the answer is no, that's legitimate. GP workload is already unsustainable for many. But if you're going to take on PCN leadership, it's worth being honest about what it actually demands.

3. Communication Is Inconveniently Personal

What's most convenient for you - one email to everyone, expecting everyone to engage the same way - doesn't work.

Good looks like: WhatsApp groups for quick updates, Teams meetings for structured discussions, quarterly in-person meetings for relationship building, practice visits to stay visible, newsletters (knowing some won't be read), emails for formal communications, phone calls when something needs a conversation, quick text messages for time-sensitive issues. ( Different practices need different approaches.)

Practice 1 loves an unscheduled call - spontaneous works for them. Practice 2 needs everything written down, needs notice, and needs reminding of governance processes. Practice 3 has regular management meetings - that's your entry point.

Good looks like getting to know people well enough to know how they prefer to be communicated with. This is relationship work, not administrative work. And it's inconvenient for you - but it's necessary.

4. Understanding Your Role: Director or Facilitator?

Different networks need different things from their leaders, and your job is to work this out.

Some PCNs want directive leadership. They want you to make the call, act in their collective best interests, and tell them what needs to happen. They're comfortable with top-down decision-making when it comes from someone they trust.

Other PCNs want facilitative leadership. Your role is to help them reach a consensus. Your judgment matters, but it's not definitive - you're there to facilitate their collective decision, which may not be the one you would have made.

This applies across leadership roles. Some PCNs have a CEO with significant autonomy and a mandate to represent the network. Others have managers who act as the mouthpiece of the clinical directors. Some have amazing administrators rather than dedicated managers. Neither model is wrong or right.

The tension comes when there's misalignment: the PCN wants a facilitator, but you're acting as a director (or vice versa). Or when different practices want different things from you.

Good looks like understanding what's expected of you and working within that role, even when it's uncomfortable.

5. You Won't Win Them All

Not every decision will go your way. Not every battle that comes up in the PCN will be one you win.

In a collaborative structure with 5, 6, 7, 8 practices, unanimous agreement is nearly impossible. There will almost always be one practice or one person who's unhappy with a decision - and sometimes that person is you.

Good looks like having the courage to say: "I know you're not happy, but this is the consensus" - and then still showing up. Or accepting: "This isn't what I would have chosen, but this is what the network has decided."

This isn't a one-time brave decision. It's the repeated bravery of turning up at meetings when you know someone's disappointed. It's making calls when you know they won't be unanimous. It's implementing decisions you disagree with because that's what consensus leadership requires.

If you want everybody to like you all the time, or you need every decision to align with your judgment, you're in the wrong job.

Good looks like tolerating the discomfort and leading anyway.

6. Radical Transparency, Especially on Money

Any hint of secrecy breeds distrust - even when there's nothing to hide.

Good looks like showing the finances. Not selectively. Not just to some practices. Show them all of it.

I've said this before in other contexts: we manage multimillion-pound PCN budgets on desktop spreadsheets. Financial transparency isn't just good practice - it's essential for trust.

When practices can see where money is going, where it's coming from, what's allocated and what's available, they can make informed decisions. When they can't, they fill the gaps with assumptions and suspicion.

This doesn't mean everyone needs to know everything about everything. But on the money? Show them.

The practices that work have CDs who aren't afraid of transparency, even when it's uncomfortable.

7. The PCN Is All of You, Not Just "Them"

Here's the pattern I see repeatedly: when things aren't going well, practices talk about "the PCN" as if it's something separate from them. They mean the leadership and management team.

Good looks like when practices see themselves AS the PCN.

Not: "The PCN isn't working" (externalised). But: "We need to work differently" (internalised).

This shift in ownership changes everything. Practices stop being recipients of PCN management and start being co-creators of PCN success.

Your job is to foster this collective ownership. But you can't do it alone - the practices have to step into it.

What Good Actually Feels Like

If you're reading this and thinking "this sounds exhausting" - yes. It is.

Good PCN leadership feels like: never quite finishing, always feeling like you're letting someone down, juggling multiple communication styles, making imperfect decisions with incomplete information, and showing up even when it's uncomfortable.

And if you're doing all of this and the PCN is still functioning, practices are still engaged, moving forward ( but imperfectly), and work is getting done - that's what good looks like.

Work With Us

If you're navigating difficult discussions in your network and would find it helpful to have someone facilitate the discussion, I'd love to hear from you. Sometimes having an outside perspective in the room makes all the difference.

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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 300 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.