The Kings Fund - Primary care networks PCNs explained

What are primary care networks?

Primary care networks (PCNs) are groups of GP practices that work together, and with other health and care providers, to deliver a wider range of services to the local population than might be possible within an individual practice.

While many GP practices have worked with others over many years - for example, in super-partnerships, federations, clusters and networks - the NHS Long Term Plan and the five-year framework for the GP contract, published in January 2019, formalised this way of working through an optional extension to the national GP contract. This extension is known as Directed Enhanced Services (DES) and provides funding specifically for services delivered through a primary care network1.

1. Footnote 1

   Directed Enhanced Services are nationally agreed services that holders of almost all GP contracts can provide if they choose to opt in and PCNs have been formed by the Network Contract DES.

How are they formed?

Although GP practices are not mandated to join a network, over 99% of general practices have signed up to the DES and are part of a PCN. Across England, there are around 1,250 PCNs covering populations of, on average, 50,000 people - although this varies significantly, with more than a third of PCNs covering more than 50,000 people. In some cases, a single practice that has met the size requirements of a network is also able to function as a network.

Most networks are geographically based, although there are some exceptions - for example, where there were already well-functioning networks of practices that are not entirely geographically based.

What do primary care networks do?

PCNs were designed to support general practices in the face of growing pressures, to bring general practices together with other primary care and community services, and to improve primary care through the introduction of additional services and an expanded multidisciplinary workforce.

The funding attached to the DES enables PCNs to provide a more extensive range of primary care services to patients, primarily by funding a wider set of staff roles than might be feasible in individual practices - for example, first contact physiotherapy, enhanced support to care homes and social prescribing. When PCNs were created, it was proposed that they would be responsible for the eventual delivery of a set of seven national service specifications (with two more subsequently added). The latest contract for 2024/25 has changed this to a simpler overarching specification, with a separate specification for enhanced access services.

PCNs are focused on service delivery, rather than on the planning and funding of services, which remain the responsibility of commissioners and integrated care systems (ICSs). However, primary care representation within ICSs is strengthened through the establishment of PCNs, with the accountable clinical directors from each network being the link between general practice and the wider health and care system in the area.

How does funding for primary care networks work?

The DES contract is held between the integrated care board (ICB) and individual GP practices, but receiving DES funding is contingent on being part of the network.

Most of the investment into PCNs comes through the Additional Roles Reimbursement Scheme, which, to date, has enabled the recruitment of over 34,000 new patient-facing staff. Some funding is also provided for extended hours access services, which pays practices to provide consultations outside core hours. PCNs also receive payments from financial incentives schemes such as the Investment and Impact Fund, which rewards networks for delivering high-quality care, and from the Capacity and Access Support Payment, which incentivises improvements in access.

The full details of the PCN DES for 2024/25 can be found here but key funding streams include:

Practices are accountable to their commissioner - the integrated care board - for the delivery of PCN services. Practices sign a network agreement, a legally binding agreement between the practices, setting out how they will discharge the network's responsibilities. PCNs can also use this agreement to set out the network's wider objectives and record the involvement of other partners, for example, community health providers and pharmacies, although these partners are not part of the core network, as that can only be entities that hold a GP contract.

What is the Additional Roles Reimbursement Scheme?

The Additional Roles Reimbursement Scheme (ARRS) provides funding for a wide range of additional roles, including clinical pharmacists, social prescribing link workers, nursing associates, community paramedics, care co-ordinators, health coaches, and many others. PCNs have the flexibility to decide how many of each of the types of staff they wish to employ and their salary costs (some pension and tax costs are also covered). Additional costs such as supervision, training or related capital costs are not funded through the scheme.

Mental health practitioner roles are also funded under the scheme, but the funding for these is different. It is split between the PCN, which contributes via its ARRS entitlement, and a mental health provider, which uses specific funding for the transformation of community mental health services. The intention is that PCNs and mental health providers work together to design mental health pathways for their populations.

The ARRS scheme was not intended to be used for core general practice staff such as GPs and practice nurses. However, in August 2024, in order to address rising concern about unemployment among newly qualified doctors, the government announced an allocation of £82 million specifically to allow PCNs to include recently qualified GPs in the ARRS scheme for 2024/25.

What next?

Evaluations of PCNs have revealed varied progress and have noted that those practices with pre-existing relationships and good managerial support are likely to fare best working together to deliver services and meet incentive targets. The development of PCNs has also been affected by rapidly rising demand, workforce shortages, inflation pressures and deteriorating public perception of general practice.

In 2022, NHS England published Next steps for integrating primary care, also known as the Fuller stocktake report, which suggested two major shifts for primary care networks. The first was for them to become the basis for the development of integrated neighbourhood teams, where teams from across primary care, secondary care, social care and community services work together in multidisciplinary teams. ICBs will need to ensure appropriate infrastructure is in place, including estates, data, intelligence, quality improvement, HR and organisational development.

The second major shift suggested in the Fuller stocktake report was developing system-wide approaches to managing urgent care and same-day access across PCNs. In May 2024, NHS England announced that seven ICBs would identify test sites to develop insights into at-scale operating models. The test sites will be given additional funds over the next two years to develop these models.

The capacity and capability within ICBs to support PCNs in their development and in incorporating these shifts is also very variable and will likely be affected by the ongoing headcount reductions in ICBs. PCNs seem to be an established principle for the future, although their form and contractual mechanisms may change if the overall GP contract is renegotiated.