The NHS 10-year plan drops in July 2025 and PCNs are asking the wrong question. Instead of ‘How do we become the integrator?’ they should be asking, ‘How do we become indispensable?’
The Reality: Not Everyone Gets to Lead
The London Target Operating Model reveals what's coming and is potentially setting the tone for the rest of the country. In London, each place will nominate an ‘integrator’ organisation to provide the backbone that enables all partners—primary care, community services, mental health, acute care, local authorities—to work together at the neighbourhood level.
While integrators provide essential coordination and infrastructure, they're not there to dictate how services should be delivered—that expertise lies with frontline providers. But the requirements are demanding—organisational maturity, complex budget management, digital integration capabilities, and influence across diverse partnerships. Many PCNs simply won't be the natural choice.
That's not failure—that's reality.
Beyond the ‘Seize or be sidelined’ narrative
The prevailing narrative suggests that if you don't seize the integrator opportunity, you risk being ‘done to’ rather than leading change. While there's some truth to this concern, there is an alternative view. You don't have to be the named integrator to wield significant influence.
The most influential organisations are often those that others depend on, not necessarily those with formal authority. There are visible players and then there are those with significant behind-the-scenes influence. Both matter enormously.
Consider the strategic advantages of being the trusted partner:
Less bureaucratic burden. While integrators wrestle with partnership complexity, you focus on patient care and clinical excellence.
Greater agility. You adapt more quickly than the lead organisation, responding promptly to emerging opportunities.
Relationship building. You become the ‘go-to’ partner everyone wants to work with, building influence that outlasts organisational arrangements.
Future positioning. The system is evolving rapidly, and there will be more than enough work streams for different parts of the system to lead based on their skills, experience, and patient access.
The strategic work: Unite primary care first
If you're not the integrator, your job becomes more important: uniting primary care itself.
A fragmented primary care voice gets ignored. Multiple PCNs saying different things creates confusion. But a united voice? That becomes impossible to ignore.
The integrator needs ONE clear primary care perspective. When primary care speaks with one voice about service design and delivery, that carries enormous weight.
This unity work is harder than being the integrator. It requires building trust across boundaries, finding common ground, and putting collective patient benefit above organisational self-interest.
We're seeing new GP Collaboratives emerge—broader arrangements bringing together practices, PCNs, and federations to work at scale. Unlike tightly defined PCNs, these are flexible entities including clinical directors, federation representatives, and at-scale providers.
But flexibility without unity is just organised chaos.
Five critical questions for strategic partnership
1. Voice: Who speaks for primary care when the integrator calls? One person or competing voices?
2. Value Proposition: What is your unique value proposition, and what evidence do you have to back that up? What data is shaping this positioning?
3. Relationships: What is your approach to building relationships with key people of influence across the system?
4. Readiness: What capabilities do you need to develop now to be taken seriously as a strategic partner?
5. Unity: How will you demonstrate that you can bring primary care together rather than add to the fragmentation?
Prove you can work together
This isn't theoretical. Unity requires demonstrable action:
Get in a room together. Literally. Virtual meetings won't build the trust needed.
Find a collaboration project. What service or initiative can you deliver together that proves you can work as one? This becomes your evidence of collaborative capability.
Start with shared problems. Common problems create a common cause.
Agree on one vision. You need one aim everyone can rally behind.
Put patients at the centre. When organisations argue about territory, bring it back to: ‘What's best for our patients?’
The North Star: Patients drive everything
Every decision, every strategic choice, every partnership should answer one question: How does this improve outcomes for people we serve?
When you walk into any room with a united primary care voice and a clear patient-centred vision, you become indispensable.
The hard truth
If you can't collaborate with your primary care neighbours, why would an integrator trust you as a key partner? Organisations that thrive will demonstrate they've done the difficult work of building consensus.
But those who can prove they bridge divides and create unity become the partners integrators depend on for answers, insights, and implementation.
It's not Game Over— It's Game On
The shift toward neighbourhood health isn't a threat—it's an opportunity to redefine healthcare leadership. You don't need the integrator title to have impact. You need to be indispensable.
While others compete for the integrator role, ask yourself: How can we become so valuable, so trusted, and so aligned that whoever gets chosen can't succeed without us?
That's not consolation thinking, it’s strategic positioning for long-term influence.
Tara Humphrey is CEO of THC Primary Care, which provides interim management training to PCN leaders and has supported more than 120 PCNs.