What Really Drives Decision Making in General Practice Embedded Conversations With Andy Pow. Ep 4

In this episode of Embedded Conversations, Scott McKenzie is joined by Andy Pow, a specialist medical accountant who has spent many years working with GP practices and primary care networks across the UK.

Andy works closely with General Practice leaders to help them navigate the financial, contractual and operational realities of running modern primary care. In this conversation, he brings a candid perspective on how funding structures, contracts and financial pressures shape behaviour inside the NHS.

The discussion explores how GP contracts actually work in practice, why many well-intentioned transformation programmes struggle to gain traction and how financial incentives influence decisions at practice and network level.

Andy explains why Local Enhanced Services have become a critical income stream for many practices, why funding cycles can create instability and how neighbourhood models and system reforms may shift financial risk across primary care.

This is a grounded, experience-led conversation for anyone trying to understand how decisions are really made in General Practice.

If you work with the NHS from pharma, medtech, consultancy or industry, this episode will give you a clearer understanding of the financial and contractual context that shapes behaviour on the ground.

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