How to address tensions and improve communication in your PCN

There are often commonly shared issues and tensions experienced by practices I encounter when working with PCNs.

Practices that feel that;

• They do not understand the purpose of the network
• There is no awareness of who does what at the network level or of what the network priorities are
• The network demands too much of their time
• The money that comes to the network should go directly to their practice
• They disagree with how the network is run
• Some practices do more than others, which causes friction
• Well-intentioned improvement projects may not be necessary or of benefit to every practice
• More forceful and driven practices may feel under-supported by the quieter practices
• The quieter practices can feel intimidated by the more forceful or well-established practices.

This list goes on and these differing perspectives over time can lead to resentment and cause conflict.

Practice colleagues feel the PCN leadership and management team should give more to practices. This may be in the form of communication, resources, money or autonomy.

The PCN leadership and management team repeatedly argue that the practices ARE the PCN and that they should do more to steer, shape, and implement the services, projects, and ideas.

If your network is experiencing some of these tensions, I would encourage you to:

1. Go back to basics

Organise a half-day away to discuss the network’s strengths, weaknesses, opportunities, and threats (SWOT analysis). Really use this time to understand your colleagues’ points of view. You may also want to discuss current issues faced by practices and issues on the horizon.

Often, we can unintentionally make lots of assumptions without taking the time to really listen to what is being said.

2. Acknowledge the different challenges, gaps, wants and needs between practices

It’s important to acknowledge that not every practice will be struggling with a particular issue. Well-intentioned improvement projects may not benefit everyone in the network, but the intention behind the activity is usually to either.

• Save money for practices
• Improve the quality of care
• Bring income into the network
• Take advantage of a perceived opportunity
• Work more collaboratively to save time and create efficiencies

You may have different considerations which are more important. Collectively, you need to agree on this as this will form part of your shared purpose.

3. Ensure everyone is clear on responsibilities and remit

It’s really important to understand who is doing what for each practice and in the leadership and management team and to hold each other responsible and accountable for the work they say they will do.

It will always be difficult when network members aren’t fully committed. However, skirting around issues or discussing this behind the backs of others creates a negative culture and makes the problem worse.
One key responsibility for everyone in the network is to commit to what they think is fair and to speak up professionally and constructively if they have a differing point of view.

Network members also have to acknowledge that compromise is necessary as they can’t always get what they want.

4. Read the information which has been presented

A very practical step everyone relates to is reading the information that has been circulated. Most networks will regularly have a board meeting accompanied by meeting papers. We all know how busy things can get, but reading the papers before the meetings is really important. Here, you will find the information you are looking for.

This may be an unpopular opinion, but it’s not a valid complaint to accuse the PCN leadership and management team of not providing the information because practice representatives:

• have not taken the time to read it
• turned up to the meeting late and then left early
• were multi-tasking during the meeting, had their camera off and weren’t even listening

This, understandably, makes decision-making extremely difficult.

Final thoughts…..

In order to have a successful or even semi-well-functioning network, practices and the PCN leadership and management team must provide equal input and output.

Acceptance of some unavoidable truths will also help reach a place of understanding and shared purpose.

Also, appreciating the following could be helpful:

• Everyone works slightly differently, and local priorities may differ, and that’s okay.
• Not everyone will get exactly what they want from the network, and that’s okay.
• In terms of effort, the more you put in, the more you will get out.
• There may be lots of additional work in the short term, but we are all in it together, and a shared pain might be a shared gain in the future.
• Priorities may change, but the patient should always be at the heart of everything we do.

These are just a few practical pieces of advice for you to build on.

Tara Humphrey is CEO of THC Primary Care, which provides interim management training to PCN leaders and has supported more than 120 PCNs.