Say no to ‘No’ – the simple solution to successful NHS negotiation

When you’re hit between the eyes with a challenge or you fundamentally disagree with the direction of a piece of work you’re being asked to contribute to, what do you do?

Do you go in with an open mind, fully prepared to compromise until you reach a workable solution? Or do you sit in your trench, shaking your head and only willing to plonk a firm ‘no’ on the table?

For an organisation as big and unwieldly as the NHS, disagreements and differing views on the best way forward are a daily occurrence. And often NHS providers, Pharma, MedTech and Devices companies are stuck in the middle of these arguments, with the benefits they could bring lost in the noise. So what’s the best way to deal with these clashes and still keep everybody happy?

Always drive for the best case scenario

I was recently approached with a piece of work involving two practices that were not getting on particularly well. They had reached the point where the only answer either was prepared to give the other was ‘no’ – even though ‘no’ was a really bad outcome for all concerned.

The commissioner of the integrated care system wanted me to see if I could bring along some insight and do something about the situation.

I told them there were lots of different things we could do and the starting point had to be – if ‘no’ isn’t an option, what would we do? In an ideal world, what would our solution look like? This gets them looking at the best possible outcome rather than simply refusing to engage.

The benefits of an 80/20 mindset

Let’s be honest – general practice, primary care networks, GP federations and the big super-practices face challenges all the time. But when it comes to negotiation to try to find a solution, people often turn up with an entrenched position.

I’ve been in negotiations and watched people dig a hole, bury a JCB digger and then dig another hole and bury another JCB digger just for good measure!

What they actually need is an 80/20 mindset. If you are prepared to negotiate and compromise on 20% of the things that you’re presented with, then you’re going to get precisely the outcome you came for 80% of the time.

If you come at it hard and fast in narrow straight lanes and you’re not prepared to think outside the box, you have negotiations that very quickly break down.

I’ve been fortunate in this regard. One of my business mentors taught me very early on never to be the one to walk away from a negotiation. His view was that there’s always room for negotiation or compromise so avoid being that party that pulls the plug.

Look for the win/win scenario

He always told me to be the one to say: “Let’s not stop, let’s continue to explore, let’s continue to think, let’s continue to see if there’s another way to try and create that win/win.”

And that’s what I’ve been impressing during these current delicate negotiations I’m involved in – we have to create a win/win scenario. Because when you create a win/lose scenario the people that feel they’ve lost in the negotiation will simply spend as much time as they can trying to inflict pain and misery on the people they feel have won.

The best negotiations are where everybody gets up from the table feeling like they’ve won something from the deal.

If you’re prepared to negotiate and compromise on the 20% and you can work on the basis that breakdown isn’t an option and you’re striving for the ideal outcome, then through negotiation and compromise you should be able to get close to it.

Be prepared to bend on everything – except price

There is a note of caution here – you can only negotiate on workload, never price. So when it comes to a service contract for example, you have to cost your contract fully and appropriately, and then be prepared to negotiate and compromise on workload.

In other words, if somebody tells you that what you’re suggesting is too expensive, go back and ask them which amount of workload you can get rid of to reduce the price.

The danger is if you want £100 and they try to negotiate you down to £75, they may try to push you further beyond that and all of a sudden you’re in a real mess facing the prospect of losing money.

Or you can negotiate on volume. For example: “My price is £100 but actually, if you do 100 of them, I can make it £95. If you do 200 of them, I can make it £90,” and so on.

So my encouragement to everybody is that when you’re faced with a challenge – whether it’s a difficult conversation, negotiating on a service contract or talking to a commissioner – come at it with an 80/20 mindset and 80% of the time, you’ll get exactly what you want.


The alternative to negotiation is that everybody loses – and what’s the point of that?

Scott McKenzie helps GPs, PCNs and GP federations build sustainable and resilient practices and organisations that thrive and supports pharmaceutical, medical technology and device firms to increase revenue by getting their products and services in front of the right NHS decision makers. If you want to know how to double your revenue, Scott can share these processes with you too.