What’s happening?

What are PCNs?

PCNs are groupings of local general practices that are a mechanism for sharing staff and collaborating while maintaining the independence of individual practices. NHS England has stipulated that networks should ‘typically’ cover a population of between 30,000 and 50,000 people (the average practice size is just over 8,000). There are likely to be around 1,300 PCNs across England. A single practice with a list size of over 30,000 can register as a PCN, and networks of over 50,000 will be allowed in some circumstances. Networks are expected to be geographically contiguous and co-terminous with local CCG and ICS footprints.

The networks are part of a set of multi-year changes, supported by the new 5-year GP contract published in January 2019. Neighbouring practices enter network contracts in addition to their core GP contract. Groups of practices collaborating as a network will have a designated single bank account through which all network funding – a significant proportion of future practice income – will flow. NHS England has calculated that by 2023/24 a typical network covering 50,000 people will receive up to £1.47m via the network contract.

What will they do?

The new GP contract is designed to deliver commitments made in The NHS long term plan, for example on medicines management, health in care homes, early cancer diagnosis and cardiovascular disease case finding. PCNs are the key vehicle for doing this. Once they are formed, networks will have responsibility for delivering seven national service specifications set out in the contract in return for the new funding (see Table 1).

Table 1: PCN service specifications

Service specification

Introduced from


Structured medicines review and optimisation


  • Directly tackling over-medication, including inappropriate use of antibiotics.
  • Focus on priority groups including the frail elderly.

Enhanced health in care homes


  • PCN members expected to support the implementation of vanguard models tested between 2014/15 and 2017/18.

Anticipatory care


  • Practices in PCNs to collaborate to offer more care, and more proactive care to patients at high risk of poor health outcomes.

Personalised care


  • Implementing aspects of the Comprehensive Model of Personalised Care.

Supporting early cancer diagnosis


  • Ensuring high and prompt uptake of cancer screening invites.

Cardiovascular disease prevention and diagnosis


  • The Testbed Programme will test the most promising approaches to detecting undiagnosed patients, with subsequent roll-out across PCNs.

Tackling neighbourhood inequalities


  • Approaches will be developed through the Testbed Programme and tailored to meet the specific context of PCN neighbourhoods.

The mechanism being used to channel funds to PCNs is the Directed Enhanced Service (DES). These are voluntary add-ons to the core GP contract, and have been used for several years to incentivise specific services, for example vaccination programmes, or care for people with dementia. The specific DES requirements of PCNs are set out in the Network Contract DES Specification and include the provision of extended hours (ie appointments outside the core contracted hours of 08.00–18.30, Monday–Friday). The focus of the Network Contract DES in 2019/20 is on establishing networks, with five of the seven service requirements coming in from 2020/21. Full details of the seven service requirements are yet to be published, but PCNs will be expected to deliver against an agreed set of ‘standard national processes, metrics and expected quantified benefits for patients.’

How will they do it?

PCNs will be expected to draw on the expertise of staff already employed by their constituent practices, and will receive funding to employ additional staff under an Additional Roles Reimbursement Scheme (ARRS). The work of the networks will be coordinated by a clinical director, a role that will be funded on a sliding scale depending on network size (equivalent to 0.25 of a whole-time equivalent (WTE) GP post per 50,000 patients).

The ARRS is the most significant financial investment within the Network Contract DES and is designed to provide reimbursement for networks to build the workforce required to deliver the national service specifications.

The five reimbursable roles are:

  • clinical pharmacists (from 2019)
  • social prescribing link workers (from 2019)
  • physician associates (from 2020)
  • first contact physiotherapists (from 2020)
  • first contact community paramedics (from 2021).

The ARRS is intended to cover 70% of the ongoing salary costs of these posts, except for social prescribing link workers, whose costs will be 100% covered. The remainder of the cost of employing these allied health professionals will be met by member practices within the PCN. The sum invested in the ARRS will rise from £110m in 2019/20 to a maximum of £891m in 2023/24. If a network of 50,000 patients should choose to recruit all possible reimbursable roles, it would be eligible for additional ARRS funding of £92,000 in 2019/20, rising to £726,000 by 2023/24 (see Table 2). Suggested job specifications are provided, but PCNs will have flexibility to choose which staff they want and to write job descriptions tailored to local needs.

Table 2: Projected growth in funding for Additional Role Reimbursement Scheme, 2019–2024

2019/20 (from July)





National total






Average maximum per typical network covering 50,000 people






Source: NHS England and BMA. Investment and evolution: A five-year framework for GP contract reform to implement The NHS long term plan. 2019, p.11.

How are PCNs funded?

£1.8bn of the promised £2.8bn over 5 years of additional funding for general practice will flow through the Network Contract (see Table 3).

Table 3: Revenue streams for PCNs





Clinical director

CCGs to PCNs via Primary Medical Care allocations.

£0.514 per registered patient for the period 1 July 2019 to 31 March 2020.

Calculated on the basis of 0.25 WTE per 50,000 patients, at national average GP salary (including on-costs). This will be provided on a sliding scale based on network size.

Core PCN funding

CCGs to PCNs, from core CCG allocation.

£1.50 per registered patient.

Extended hours access appointments

CCGs to PCNs via Primary Medical Care allocations.

£1.45 per registered patient.

Pro rata over 12 months (equates to £1.099 per patient from July 2019 to March 2020).

Network participation payment

NHS England to individual practices.

£1.761 per weighted patient per year.

Additional Roles Reimbursement Scheme

CCGs to PCNs via Primary Medical Care allocations.

PCNs will be entitled to claim a percentage reimbursement of either 70% (or 100% for social prescribing link workers) as set out in the Network Contract DES, and subject to a maximum amount.

The roles for which payment will be made are clearly set out in the Network Contract DES, and payment will only be made once staff have been recruited.

Some of the funding (known as the network participation payment) will be received directly by practices, with the remainder of additional funding directed to the network. In addition, some funding previously received by individual practices (for provision of extended access) will now be allocated to networks instead (see Figure 1).

Figure 1: Funding for practices and networks, excluding new roles reimbursement

Note: Extended hours payments previously received directly by practices will now be paid to PCNs. A variable ARRS sum (not shown in Figure 1) will be added to the network payment, depending on the number of staff employed.

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