When PCNs Break Down: Why PCN Disputes Are Difficult to Resolve

Why PCN disputes are difficult to resolve

Primary Care Networks were intended to help GP practices work collaboratively, share workforce, improve access and deliver services that would be difficult for individual practices to manage alone. However, seven years on, many PCNs have become far more complex than the light-touch collaborations practices originally joined. They now involve significant funding, shared staff, enhanced access commitments, ARRS roles, clinical director leadership, service delivery responsibilities and increasingly demanding governance expectations.

The difficulty is that many PCNs are still relying on Network Agreements and governance schedules put together quickly in 2019, when practices were under pressure to form networks and before anyone fully understood how PCNs would evolve. This mirrors a wider issue in primary care governance: agreements that were suitable at the outset may not provide enough clarity once relationships, responsibilities and financial pressures become more complex. Some practices joined networks with organisations they did not know well, did not fully trust, or had previously found difficult to work with. That starting point matters, because a signed agreement cannot create trust where it did not already exist.

Unlike an ordinary commercial arrangement, a practice cannot always simply leave a PCN when relationships break down. Geography, list size, commissioner approval and the lack of realistic alternative networks can leave practices feeling trapped in a collaboration that no longer functions well. Opting out of the PCN DES may be theoretically possible, but in practice it can mean losing access to funding, shared staff and services that patients and practices have come to rely on.

Financial transparency and mistrust

Financial transparency is often where underlying mistrust becomes open conflict. PCNs now manage substantial funding streams, including core PCN funding, enhanced access funding, IIF-related payments and ARRS reimbursement. Where reporting is unclear, irregular or hard to interrogate, concerns about money can quickly become concerns about fairness, control, competence and whether the PCN is being run for the benefit of all member practices.

Decision-making and governance pressures

Decision-making is another common source of dispute. Governance models that were adequate when PCNs were first formed may no longer be suitable now that networks are making decisions about employment risk, premises, subcontracting, staff deployment, service delivery, patient access and shared funds. Disagreements can arise over voting rights, vetoes, the role of the Clinical Director, the involvement of practice managers and whether larger or smaller practices have appropriate influence.

The problem of shared purpose

Beneath many PCN disputes is a deeper problem: the lack of a shared purpose. Some practices may see the PCN as a narrow DES delivery mechanism, while others want it to become a broader vehicle for transformation, workforce development and neighbourhood working. Some want PCN resources to support individual practice resilience, while others favour centralising more services at network level. None of these positions is necessarily wrong, but conflict becomes more likely where practices have never had an honest conversation about what they want the PCN to be.

Why ordinary correspondence often fails

This is why PCN disputes are often resistant to ordinary correspondence, formal meetings or legal letters. The stated issue may be a payment, vote, member of staff, service specification or Clinical Director decision. The real issue may be that the practices no longer trust each other, no longer share the same understanding of the PCN’s purpose, and have no agreed way of managing disagreement.

Clare has previously discussed how mediation can help in PCN disputes by creating space for practices to explore the issues beneath the stated disagreement, rather than focusing only on the immediate presenting problem.

Sustainable routes forward

There are usually three sustainable routes forward. Practices can rebuild the working relationship through clearer governance, better financial reporting and a renewed shared purpose. They can renegotiate how the PCN operates, with clearer boundaries and less reliance on goodwill. Or they can explore whether a change in membership, structure or participation is possible, while recognising the practical constraints.

Why unresolved PCN conflict should not drift

What is rarely sustainable is allowing the dispute to drift. Unresolved PCN conflict can destabilise shared staff, delay service delivery, undermine patient access, damage relationships with the ICB and increase pressure on already stretched practices. PCN governance should therefore be treated as a live and serious issue, not a document signed once and left in a folder.

How mediation can help PCN disputes

Where relationships have become strained, mediation can provide a structured way for practices to discuss trust, money, decision-making, purpose and the practical constraints of PCN membership. It can also help challenge some of the common assumptions about mediation, particularly the idea that it is only useful when all parties already want to repair the relationship. It can help practices decide whether the relationship can be repaired, whether governance needs to be reset, or whether a managed separation or restructuring should be explored.

PCN disputes are about more than administration

PCN disputes are rarely just administrative problems. They are disputes about trust, power, money, purpose and the reality of being bound together by geography as much as choice. Unless those underlying issues are addressed directly, the same conflict is likely to reappear, even if the immediate disagreement is temporarily resolved.

About General Practice Mediation

Dr Clare Sieber supports GP partners, practices and PCNs in resolving disputes constructively and confidentially.

For PCNs facing unresolved governance or relationship difficulties, Dr Clare Sieber provides confidential support to help practices explore whether the working relationship can be repaired, reset or restructured.

If your PCN or practice is facing governance or relationship challenges, you can book a free 30-minute consultation at a date and time convenient for you.