The Conversation No One Wants to Have

You know that nagging feeling when someone isn’t quite right for the role? When you’re constantly having to step in and do work that should have been delegated? When colleagues start coming directly to you instead of going through proper channels?

There are whispers across the network that you still need to provide a great deal of direction, even though they’re well into the role. Staff, practice managers, and clinical directors are starting to lose confidence in the person, yet that person is still in post.

At our PCN Plus conference in April 2025, HR issues were by far the most common challenges experienced by primary care network leaders. The flip charts from our breakout sessions were filled with concerns about team performance, difficult conversations, and managing underperforming staff.

Whilst the specific details will vary, this is really common. And as a business owner myself, I have been in this situation.

If you’re reading this and feeling a sense of uncomfortable recognition, you’re not alone. You might be able to relate.

The warning signs are often there for months, sometimes years:

• Colleagues avoiding direct communication with them

• Requests for urgent information sent same-day with no understanding of workload pressures

• Basic responsibilities delegated back to already overstretched leaders

• No proactive leadership on key initiatives

• Meeting agendas that never evolve

“They don’t mean to wind people up” is a phrase I hear often. “But when something is challenging, they just leave it until someone asks again.”

PCN recruitment is notoriously difficult across all roles. Whether it’s management, clinical, or administrative positions, many jobs sit at the intersection of clinical understanding, business management, and complex stakeholder relationships.

Many PCNs hire the best available candidate rather than the right candidate. Sometimes that means:

• Career changers without primary care experience

• Staff from other sectors who don’t understand practice pressures

• Internal appointments that seem safe but lack the necessary skills

• People who see the role as a stepping stone rather than a commitment

The problem deepens when networks expect training to bridge fundamental gaps in capability or motivation.

What strikes me about these situations is how long leaders tolerate underperformance. Months, sometimes years of:

• Doing work that should have been delegated

• Managing relationships the person has damaged

• Watching network credibility erode with external partners

• Fielding complaints from colleagues and staff

“We’ve lost credibility because we’re allowing this to continue,” is a sentiment I hear repeatedly. “But they’re a nice person, and we keep hoping they will improve.”

The kindness is actually cruel to the individual, who is struggling in a role they are not suited for, and to the network, which is not receiving the performance it needs.

If you’re facing this situation, the first step isn’t jumping to performance management; it’s looking at yourself as a leadership team.

Start with an honest audit:

• Have you provided adequate support, supervision, and training?

• Are there regular one-to-ones with proper feedback?

• Have you clearly communicated expectations and what good looks like?

• Is the purpose of the role and core functions properly defined?

• Are systems and processes in place to help them succeed?

This isn’t just good practice; it’s essential groundwork that protects both the individual and the network. You can’t skip to “managing someone out” without demonstrating you’ve provided proper support first.

If the audit reveals gaps, address them:

• Implement proper supervision structures

• Clarify role expectations and success metrics

• Provide necessary training or development

• Establish regular review meetings

• Document everything along the way

If support is in place but performance remains poor:

• Seek advice from your HR provider before taking any formal action

• Document specific performance issues with concrete examples

• Follow proper performance management procedures

• Be prepared that this process is time-consuming but necessary

• Consider whether the role itself needs redesigning

• A formal 360-degree feedback process could be helpful 

The reality is this work is time-consuming. But doing it properly protects everyone involved and ensures you’re making fair, legally sound decisions. Many leaders are understandably concerned about employment tribunals, which is exactly why professional HR guidance is essential from the start.

Whether it’s management, clinical, or support positions, you need someone who can:

• Represent your network confidently with external partners

• Understand practice pressures and plan accordingly

• Take ownership of their responsibilities

• Build and maintain professional relationships

• Think strategically about service development

With neighbourhood working accelerating, all PCN roles require enhanced capabilities. Staff must help practices collaborate with partners they may not trust, navigate complex decisions, and demonstrate readiness for integrated working.

Someone who struggles with basic relationship management isn’t going to master integrated care partnerships.

If someone in your team isn’t working out:

• Stop hoping it will improve on its own – Long tenure doesn’t automatically lead to improvement

• Document specific performance issues – Vague concerns won’t support proper action

• Consider the network’s needs – Your responsibility is to the patients you serve

• Get professional support – HR processes exist to protect everyone involved

• Learn from the experience – What will you do differently in the next recruitment?

These challenges aren’t going away as neighbourhood working demands higher performance from all PCN roles. The networks that address underperformance early and professionally will be better positioned for the integrated care partnerships ahead.

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👇