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This explainer was updated in March 2026.
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 not 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.
How are they formed?
Although GP practices are not mandated to join a network, over 99% of general practices 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). In 2024/25 this was changed 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 integrated care boards (ICBs). 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 before 2026/27 the Capacity and Access Support Payment, which incentivised improvements in access.
The 2026/27 GP contract sees a significant reduction in scope and funding for PCNs, reflecting a shift of resources back to practice level. Key funding streams include the following:
Core PCN funding based on a weighted calculation of the number of registered patients covered by the PCN, which also includes funding for PCN leadership and management.
Additional Roles Reimbursement Scheme (ARRS) payments: reimbursement of the salary for new roles recruited into general practice (eg, clinical pharmacists, physiotherapists) along with certain other costs such as employer pension and national insurance contributions. From October 2024 ARRS was extended as an emergency measure, reflecting concerns about GP unemployment, to allow PCNs to employ newly qualified GPs, and from 2026/27 it will be further extended to include experienced GPs.
Enhanced access payments: payments for PCNSs providing extended hours services.
In 2026, the £292 million that previously made up the Capacity and Access Support Payment (CAIP) was removed and instead will be paid directly to practices to support the recruitment of GPs or additional sessions for existing GPs.
Network Participation Payment for practices that are part of a PCN based on weighted population of their practice.
Investment and Impact Fund: payments based on performance against two indicators (learning disability health checks and the use of faecal immunochemical testing (FIT) in cancer referral pathways).
Care home premium: payments per care home bed covered by the PCN to help cover the additional cost of providing services to patients in care homes.
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 GPs, 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.
The ARRS scheme was not intended to be used for core general practice staff such as GPs and practice nurses. However, in 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. This was extended in 2026/27 to include experienced GPs.
What next?
The focus of PCNs has been changing, from a move towards at-scale provision of primary care services towards wider neighbourhood health. The NHS long-term plan has clear emphasis on neighbourhood health services, with primary care at the heart, and 42 neighbourhood health pilots were announced in 2025. Guidance on ‘model neighbourhoods’ was due in late 2025, together with new contracts (single and multi-neighbourhood provider contracts) but these have been delayed. With this move in focus towards neighbourhood health services, and the transfer of nearly £300 million from PCNs back to individual practices, there is growing uncertainty about the role of PCNs in their existing form.
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