When PCN Decisions Create More Problems Than They Solve

Whilst there's a lot of attention on neighbourhood working at the moment, I think it's important to recognise the reality on the ground. For many PCNs, that agenda feels far away when they're still trying to work out the basic mechanics of how to function together as a network.

I had a conversation recently with a PCN that's completely fractured. Two camps with fundamentally different visions of what their network should be. Board meetings where five people stay silent and two oppose everything. A clinical director ready to step down after three years because the stress isn't worth it any more.

"We've lost the trust or the ability to work together. Some practices want additional services, others want the money devolved directly. Our meetings have become unproductive, and people complain afterwards instead of speaking up."

If you're reading this thinking "that sounds exactly like us," you're not alone. I'm seeing this pattern more frequently as PCNs mature and face harder decisions about their future.

Here's what I learnt from that conversation and what it means for your network if you're living through something similar.

How It Started: The Meeting That Changed Everything

Eighteen months ago, this five-practice network held what seemed like a routine board meeting. But it became the moment that divided them permanently.

The meeting was called to vote on devolving aspects of the PCN budget. Some practices pushed for the vote without proper consultation or impact assessment. Others felt blindsided and pressured into decisions they didn't understand.

"Some people afterwards said they were forced into making a decision without having the full background of what the impact would be. There was resentment that it had been allowed to take place."

The vote passed. Three practices got what they wanted: devolved budgets. Two practices felt completely sidelined.

The Aftermath: Two Different Visions

What emerged wasn't just a disagreement. It was a fundamental split about what PCNs should be:

Camp One: Wanted collaborative services, joint projects, shared resources. They believed in the original vision of integrated primary care.

Camp Two: Wanted devolved budgets, practice-level control, and financial autonomy. They saw the PCN as a funding mechanism rather than a collaboration vehicle.

Both approaches can work. But as one practice manager told me: "You can deliver successfully with either model, but you can't deliver both models in one PCN."

The Toxic Meeting Cycle

Fast forward to today, and their meetings have become unproductive exercises in frustration:

• Five board members stay silent

• Two members oppose everything

• Decisions get made, then people complain afterwards instead of speaking up during discussions

• Every conversation returns to past grievances and who disagreed with what

  
  

"We spend time in meetings talking about what's happened in the past, about where decisions have been made and who disagreed with them. We're stuck on that as a PCN."

The clinical director, who's been in post for three years, recently told colleagues: "If there's anybody else who would like to step up and become CD, please get in touch. I can't see myself wanting to carry on beyond April."

What Went Wrong

Looking at this situation, several critical failures occurred:

• No proper consultation process - Major decisions were rushed through without stakeholder input

  
  

• Lack of shared vision - They never established what kind of PCN they wanted to be

  
  

• Poor conflict resolution - Issues were swept under the carpet instead of being addressed

  
  

• Communication breakdown - People stopped being honest in meetings and started complaining in corridors

  
  

• Leadership fatigue - The clinical director became trapped representing both his practice and the network

The Hard Questions

When I spoke with this network, I asked the question many avoid: "Have you thought about splitting?"

"I'd be surprised if others said there haven't been those discussions within the practices." came the honest reply.

But they're still together. Why? Maybe they haven't fully explored it or found a more favourable option. This isn't failure, it's realism. Sometimes staying together requires acknowledging you might be better apart, then choosing to work on the relationship anyway.

What Could Have Been Different

This breakdown wasn't inevitable. Here's what might have prevented it:

• Structured decision-making processes with proper consultation periods

• Regular vision and strategy sessions to ensure alignment

• Professional facilitation during contentious discussions

• Clear conflict resolution procedures before tensions escalated

• External perspective to help navigate the complexity

The Path Forward

PCNs facing similar divisions have three realistic options:

• Recommit to collaboration - But this requires genuine buy-in from all practices, not just lip service

  
  

• Formalise the split - Sometimes an amicable separation serves everyone better than an acrimonious partnership

  
  

• Find a middle ground - Hybrid models where some services are shared and others devolved

  
  

The key is making an active choice rather than drifting into dysfunction.

A Word About Compromise

During my conversation, one leader mentioned finding "compromise" as a solution. But I think the language we use really matters here. Whilst it's natural to want compromise to find resolution, sometimes compromise can mean settling for something you don't really want to settle for.

When people think compromise means giving up something they genuinely want just to make others happy, you get resentment. Then you get frustration because they're going through the motions, saying yes in meetings but not really feeling it. They stop contributing meaningfully because they don't feel they have a real choice.

True resolution isn't about people grudgingly accepting what they don't want. It's about finding solutions that everyone can genuinely commit to, even if it's not their first preference.

Lessons for Other Networks

If any of this sounds familiar, pay attention to these warning signs:

• Meetings becoming less productive over time

• People complaining after meetings instead of during them

• The same arguments resurfacing repeatedly

• Board members staying silent during crucial discussions

• Leadership considering stepping down due to stress

  
  

Early intervention matters. What starts as a policy disagreement can quickly become an identity crisis that threatens the entire network.

The Reality Check

Not every PCN partnership is meant to last forever. The landscape is changing with neighbourhood teams and new delivery models. Sometimes the most mature decision is recognising when you've outgrown each other.

But breaking up isn't simple or easy. I know networks that have made that decision and come out the other side of it successfully. But if you're going to stay together, you need more than inertia. You need shared purpose, honest communication, and the frameworks to navigate disagreement constructively.

The network I spoke with is now investing in professional facilitation to either rebuild their partnership or plan a respectful separation. Either outcome is better than the current limbo.

Because the only thing worse than an amicable split is a slow-motion breakdown that exhausts everyone involved and serves no one, especially not your patients.

Struggling with Network Conversations? We offer Facilitation Services.

If your network is struggling with unproductive meetings, fractured visions, or ongoing tension, you don’t have to navigate it alone. Our facilitation services guide PCNs through tough conversations, help clarify shared purpose, and create decision-making frameworks that work for everyone.

Let’s talk about how we can help your network rebuild trust or plan a respectful, structured next step👇

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