This week, I’m delivering a session alongside Dr Hussain Gandhi on the topic of building general practice influence for primary care leaders in Staffordshire.
Hussain is a GP Partner, health tech guru and has built a YouTube channel with millions of views, so he knows a thing or two about positioning oneself as a key person of influence.
In preparing for our session, I’ve been reflecting on what actually creates influence in primary care, and wanted to share some thoughts that might be helpful whether you’re in the room with us or not.
The Perceived Problem
I know many leaders who feel they do not have a voice, speaking up is pointless, and nobody listens.
However, what I see is that your practice and ICB colleagues are listening.
What you lack isn’t their attention—it’s your alignment.
When you speak with five different voices, the system doesn’t ignore you.
The system learns quickly: wait them out, they’ll disagree amongst themselves, and we can crack on with our agenda.
What Influence Requires
Influence without positional power needs three things:
1️⃣ Demonstrated unity: The system sees you as one voice, not many
2️⃣ Strategic focus: Saying no to most things so you can deliver on a few
3️⃣ Consistent delivery: Following through repeatedly until you’re reliable
Most leaders get stuck at step one. Not because they can’t agree, but because they’ve never systematically worked through what alignment actually requires.
The Questions You’re Avoiding
These aren’t comfortable conversations:
- Who are we together, beyond organisational labels?
- What’s our actual collective purpose?
- What 2-3 priorities will demonstrate our value?
- Where do we need to release control to move faster?
- What actions build or destroy our credibility?
Avoiding them doesn’t make the problems disappear. It just ensures you remain fragmented.
The Bridge Question
Once you’ve aligned internally, you face the critical bridge question that determines whether your influence actually works:
“What are we proposing, and how does this help them?
Most influence attempts fail because they’re framed as “here’s what we want” rather than “here’s how this solves your problem.” The perspective shift from inward-looking to outward-facing can transform alignment into influence.
The test of clarity:
- Can you articulate your proposal in two sentences?
- Can you explain whose problem it solves (other than yours)?
- Can you show how it makes their job easier, their metrics better, their pressures lighter?
If you can’t answer these clearly, you’re not ready to influence. You’re just making noise.
Two Models of Influence
Depending on where you sit in healthcare, you might be building one or both:
Collective influence: Primary care leaders aligning to shape system decisions.
Individual influence: What I’ve built through 350+ podcast episodes and years of writing—reaching thousands despite having no NHS employment, no formal authority. Just consistent contribution that’s created influence in some circles.
Both matter. Both work differently. Both require the same foundation: consistent presence, demonstrated value, and solving problems others cannot solve alone.
The principle is identical whether you’re one person or twenty primary care networks. Influence comes from solving problems others cannot solve alone, showing up consistently, and building trust over the years. The difference is scale and coordination complexity, but the fundamentals don’t change.
The Paradox Nobody Mentions
You need enough alignment to act strategically. But too much alignment kills the creative tension that produces better decisions.
The most influential leaders hold this well: they stand for something clear whilst remaining genuinely open to challenge. Not conformity. Confident diversity.
In my own work, I’ve learnt that influence grows when you actively seek perspectives that challenge your assumptions and people who share your purpose but question your approach, who see patterns you miss, who bring different expertise.
This applies equally to individual thought leadership and collective primary care influence.
Why This Takes Longer Than You Think
Influence compounds slowly, then suddenly..
You show up consistently. Contribute thoughtful input. Connect people. Deliver on commitments. For months, maybe years, it feels like nothing is happening.
Then someone quotes your idea in a strategy document. You’re invited into conversations you weren’t previously part of. A decision reflects thinking you introduced six months ago.
The boring work matters most. Monthly meetings that feel pointless. Strategic conversations where nothing seems decided. Relationship-building coffees. This is where influence compounds—slowly and somewhat invisibly.
The Authority Trap
If your influence depends entirely on your professional title, you’re vulnerable. Real influence outlasts your position because it’s built on:
- Demonstrated expertise people seek out
- Trusted relationships built over years
- Track record of delivery
- Ideas that solve problems
Again.. this takes time. It’s time-consuming. There are no shortcuts.
And worth noting: influence is morally neutral. You can influence towards better decisions or worse ones. Towards collaboration or fragmentation. What matters is what you choose to do with it.
What Actually Works
Get your house in order internally first. Align on what matters. Create space for constructive challenge. Show up consistently. Build relationships before you need them. Deliver on commitments even when nobody’s watching.
Then engage the system from strength rather than survival.
The system doesn’t need more voices—individual or collective. It needs leadership that’s earned the right to be heard through consistent presence, demonstrated value, and solutions that work.
Whether you’re aligning a group of general practices, your departmental team or building influence as an individual contributor, the fundamentals don’t change.
Question for reflection: What are you proposing, and how does it help the people you’re trying to influence?
This Week of the Business of Healthcare podcast
I recently sat down with Dr Dan Mullarkey , a GP turned medical director at Skin Analytics .
We explored clinical validation, why regulation matters, and what healthcare leaders should ask before adopting new technology.
Listen on the Business of Healthcare podcast: https://bit.ly/THCSKINA
Dan shares:
The long game – Skin Analytics was founded in 2012, didn’t hire marketing until 2022, spent years on clinical validation and regulation first. Another example of influence compounding slowly.
Building influence without authority – Dan went from NHS GP to medical director of a health tech company. He’s had to influence 30+ NHS trusts to adopt their technology without any positional power. Real-world example of earned influence.
The reality of NHS adoption – What actually stops technology adoption (it’s rarely the tech itself). Why change management capacity matters more than clinical validation. The honest challenges of getting “yes” in the NHS.
What questions to ask before adopting tech – Dan flips the script and explains what healthcare leaders should ask when evaluating any technology. Useful whether you’re buying or selling.
The data problem – Why we don’t measure current pathway performance well enough, which makes it hard to justify change. How to think about risk management differently.
Regulatory clarity matters – Why leaning into regulation (even when it’s harder) builds more credible influence than avoiding it. Counterintuitive but valuable.
