This week, I had the absolute pleasure of chairing the Transformation Theatre at The Best Practice Show in Birmingham.
Around 180 people packed into what became the busiest theatre session of the day. Standing there, I asked what I thought was a straightforward question:
“Who here has ever struggled to work with their primary care network colleagues?”
Ten hands went up.
Ten. Out of 180+
My heart sank. Had I completely misjudged this? Were people in the wrong talk?
But I pressed on. Because I was about to deliver 30 minutes on four observations, no one wants to discuss:
💡 How different money mindsets will cause conflict if you do not name them.
💡 When system structures don’t align, collaboration will be harder. This is out of a lot of people’s control.
💡Not everyone with positional power should have it 😬.
💡Sometimes the best thing is to stop collaborating.
I knew some people wouldn’t like what they were about to hear – and I needed to be comfortable with that.
The Drama We’re All In
Early in the talk, I asked people to think about their PCN dynamics as a drama. Who’s playing the hero? Who’s the villain? Who are the supporting actors?
Then the real question: What role have you cast yourself in?
We rarely cast ourselves as villains in our own stories. Yet in someone else’s version, we might be exactly that.
I named the behaviours we all recognise but don’t discuss: the clinical director who chairs meetings with the camera off. The “where’s my share?” money conversations. Staff feeling unwanted and constantly questioned about their value.
Not to shame. But to say: I see this. We all see this. Let’s stop pretending we don’t.
Standing there I knew when I said “not everyone with positional power should have it” in a room full of clinical directors, I was taking a risk.
But I think the minimal hand-raising proved my point. My presentation drew on the experiences of supporting over 300 primary care networks, and I thought, if we can’t admit to struggling in an anonymous moment in a conference room, how can we address these issues in our organisations and networks?
Day 2: Feedback
Then came the exhibition stand and the feedback began to trickle in.
- “Your talk was bang on the money”
- “Finally someone said it”
- “I didn’t raise my hand, but…”
The very people who’d sat silently were now sharing stories. The dysfunction. The financial tensions. The leadership vacuums. All those uncomfortable truths I’d named – they lived them daily.
The Bottom Line
The courage to be disliked isn’t about being difficult. It’s about caring more about genuine change than comfortable pretence.
When we see problems but don’t name them, we become complicit. But I know speaking up can come at a cost. Your relationships, your reputation, potentially your job. It’s not just about having courage. It’s about accepting that doing the right thing might make you deeply unpopular, but the people who need to hear it will find you afterwards.
What elephant in your organisation needs naming?
(This is my fourth year chairing the attending Best practice and Chairing the Transformation theatre, and I know I say this every year…. But I absolutely loved it! A HUGE thank you goes out to my colleagues Valentina Suma and Catherine Kingsbury-Smith and Liam Richardson and Robyn Carter at the Best Practice Show for making us feel so welcome and valued).
