The PCN DES
A plain-English guide to the Network Contract Directed Enhanced Service for 2026/27
What is the PCN DES?
In one sentence:The Network Contract DES is the contract that defines what your Primary Care Network must deliver, how it's funded, and what additional staff it can recruit.
Every PCN in England signs up to the DES. It sits on top ofyour individual practice contract (GMS/PMS/APMS) — it's additional funding for additional services delivered at network level. Your practice can't be forced to join, but opting out means losing access to ARRS staff, Enhanced Access funding, the IIF, and the participation payment.
Why this matters for partners
- ARRS funding — the staff your PCN recruits (pharmacists, physios, paramedics, and now any GP) come through the DES
- Enhanced Access — evening and weekend appointments are funded here
- Care home requirements — now includes vaccination coordination
- New for 2026/27: Continuity of care and neighbourhood alignment are now core PCN requirements
- £292m CAP removed — moved to practice-level GP Reimbursement Scheme. CASP and CAIP are gone.
Your practice contract isn't affected
The PCN DES is an overlay, not a replacement. Your GMS/PMS/APMS contract continues unchanged. The DES adds services and funding at network level — it doesn't change your core contractual obligations as a practice.
How PCNs Work
A PCN is a group of GP practices working together, typically covering 30,000-50,000 patients. The structure is straightforward:
Clinical Director
A GP (usually) who leads the PCN. Responsible for strategy, coordination between practices, representing the PCN to the ICB, and overseeing DES delivery. Funded through the PCN DES.
Core Network Practices
The GP practices that make up the PCN. Each practice signs a Network Agreement and participates in the DES. All practices share responsibility for delivery, though workload can be divided by agreement.
ARRS Staff
Additional staff recruited through the Additional Roles Reimbursement Scheme — pharmacists, physiotherapists, social prescribers, paramedics, mental health practitioners, and now any GP.
Non-Core Network Members
Other organisations that work with the PCN but aren't GP practices — community trusts, mental health providers, voluntary sector, social care. They support delivery but don't hold the DES contract.
The Mandatory Network Agreement
Every practice in the PCN signs the Mandatory Network Agreement — the legal document that governs how the network operates. It covers:
- Decision-making: How the PCN makes decisions and resolves disagreements between practices
- Funding distribution: How DES money (ARRS, Enhanced Access, IIF, participation payments) is shared
- Workload sharing: Which practices deliver which services — not every practice has to do everything
- Dispute resolution: What happens when practices disagree
This agreement must be updated for 2026/27 to reflect the new requirements. If you haven't reviewed it recently, now is the time.
Automatic continuation
If your PCN participated in 2025/26, you continue automatically for 2026/27 — no action needed unless you're changing membership or opting out. Any changes must be notified to your ICB by 30 April 2026.
What Your PCN Must Deliver
The DES defines six main service areas. Two are new core requirements for 2026/27 (continuity of care and neighbourhood alignment):
Enhanced Health in Care Homes
Aligned care home support — weekly check-ins, structured medication reviews, personalised care plans, and now vaccination coordination for eligible residents.
Cancer Early Diagnosis
Improving referral quality against NICE NG12 guidelines, safety-netting with electronic tools, and promoting screening uptake across the PCN population.
Continuity of Care
New for 2026/27 as a core requirement. Using risk stratification tools to identify patients who benefit most from seeing the same clinician, and prioritising continuity for those cohorts.
Vaccination
Coordinating seasonal and routine vaccinations across the PCN. Collaborative delivery now permitted for flu and COVID-19. Care home residents must be identified and offered eligible vaccinations.
Enhanced Access
Providing bookable appointments outside core hours — evenings and weekends. Funded through the Enhanced Access Payment within the DES.
Neighbourhood Alignment
New for 2026/27. Working with your ICB to align PCN boundaries with neighbourhood footprints where geography doesn't currently match local communities.
You don't have to do everything yourself
The DES requirements apply to the PCN as a whole, not to every individual practice. Your Network Agreement should set out how workload is divided. One practice might lead on care homes, another on Enhanced Access. The PCN is collectively responsible, but the delivery can be distributed.
Enhanced Health in Care Homes
One of the most significant DES requirements. Your PCN must provide structured, proactive care to residents of aligned care homes — not just reactive visits when someone is unwell.
What you must deliver
- Weekly check-ins: A named clinician providing regular reviews — not waiting for care home staff to call you
- Structured medication reviews: Systematic review of all medications, deprescribing where appropriate, reducing polypharmacy risks
- Personalised care plans: Every resident should have an up-to-date care plan that covers their needs, preferences, and advance care planning
- MDT coordination: Working with community nurses, pharmacy, social care, and the care home team
New for 2026/27: Vaccination coordination
Your PCN must now ensure that eligible care home residents are identified and offered seasonal and routine vaccinations in line with national guidance.
You don't have to deliver the vaccinations yourself — but you must ensure arrangements exist. This could be:
- The resident's registered practice
- Another practice in the PCN
- A subcontracting arrangement
The key is that no eligible care home resident falls through the gap because nobody took responsibility.
Care Home Premium
The DES includes a Care Home Premium— additional funding to support EHCH delivery. This is paid to the PCN, not individual practices. Ensure it's being used effectively and that the practices doing the bulk of the care home work are appropriately funded from it.
Vaccination
The DES has two important vaccination changes for 2026/27:
Collaborative seasonal vaccination (new flexibility)
The restriction that prevented PCN practices from collaborating on flu and COVID-19 vaccination delivery has been removed.
Previously, each practice had to deliver its own seasonal vaccination programme. Now, practices within a PCN can work together — running joint clinics, sharing staff, or designating one practice to deliver on behalf of the network.
This is a practical change that could improve efficiency and uptake, particularly for smaller practices that struggle to run viable vaccination clinics alone.
Care home vaccination coordination
As above — PCNs must ensure eligible care home residents are offered seasonal and routine vaccinations. This is a coordination responsibility, not necessarily a delivery one.
Discuss with your PCN
Collaborative vaccination is optional — the restriction has been lifted, but you don't have to change your approach. If your current practice-level delivery works well, keep doing it. But if you've been frustrated by small, inefficient clinics, this is the opportunity to organise differently.
Cancer Early Diagnosis
The cancer requirements have been strengthened for 2026/27 with clearer expectations around referral quality and safety-netting:
What's changed
- Referral quality: Explicit expectation to review referral quality against NICE Guideline NG12 (suspected cancer: recognition and referral). This means auditing your 2-week-wait referrals, not just making them.
- Safety-netting strengthened:The DES now expects electronic safety-netting tools — systems that flag patients who haven't had expected follow-up after a referral, investigation, or “watch and wait” decision
- Screening uptake: PCNs should be promoting cancer screening (bowel, cervical, breast) across their population, particularly in under-screened groups
- IIF indicator CAN04: Amended to reflect updated NICE guidance and additional safety-netting wording
Practical action
If your practice doesn't have electronic safety-netting in place, raise it at your PCN meeting. This is about systems, not individual clinicians remembering to follow up. Most clinical systems (EMIS, SystmOne) have safety-netting functionality — it may just need configuring and switching on.
ARRS (Additional Roles)
The Additional Roles Reimbursement Scheme is one of the most significant parts of the DES — it funds your PCN to recruit additional clinical and non-clinical staff. The 2026/27 changes are substantial:
ARRS roles — relative recruitment demand across PCNs
| Role | What they do in your PCN |
|---|---|
| Clinical Pharmacist | Structured medication reviews, chronic disease management, care home support, medicines optimisation |
| Social Prescribing Link Worker | Connecting patients with community support — loneliness, housing, debt, social isolation, wellbeing |
| First Contact Physiotherapist | Assessing and managing MSK problems directly, reducing GP appointments for backs, knees, shoulders |
| Physician Associate | Supporting GPs with same-day appointments, chronic disease reviews, and clinical triage |
| Paramedic | Home visits, urgent same-day assessments, care home reviews — taking pressure off GP home visit lists |
| Mental Health Practitioner | Assessing and managing common mental health problems in primary care, reducing referrals to secondary MH |
| Dietitian | Diabetes management, weight management, nutritional support for chronic disease |
| Podiatrist | Diabetic foot assessments, wound care, reducing foot-related hospital admissions |
| Occupational Therapist | Falls prevention, frailty support, home assessments, enabling independent living |
| Advanced Nurse Practitioner | Independent clinical practice — same-day access, chronic disease, minor illness. Mandatory accreditation dropped for 2026/27 |
| GP (any — new for 2026/27) | Additional GP sessions via ARRS. 2-year qualification restriction removed. Max reimbursement £118,759 (£120,921 London) |
The big change: any GP is now eligible
Until this year, ARRS GP funding was restricted to recently qualified GPs (within 2 years of CCT). That restriction is gone. Any GP can now be recruited through ARRS, subject to one rule: they must not have been substantively employed as a GP in a core network practice of your PCN in the previous 12 months.
This means you can recruit experienced GPs — sessional GPs, portfolio GPs, returners — not just newly qualified ones.
| Non-London | London | |
|---|---|---|
| Maximum salary reimbursement | £118,759 | £120,921 |
| Maximum total (salary + employer on-costs) | £152,900 | £155,698 |
Broader role flexibility
PCNs can now recruit a broader range of roles from the ARRS budget where agreed with the commissioner. This includes non-direct patient care roles — data analysts, project managers, quality improvement leads — if the PCN can make the case that they support DES delivery.
ARRS funding for 2026/27
ARRS funding continues into 2026/27 at £197 million full-year for cohorts recruited 2024/25-2025/26. This is reimbursement funding — you recruit the staff, submit the claims, and get reimbursed up to the role maximum.
The 12-month rule
Even though any GP is now eligible, they must not have been substantively employed in a core network practice of your PCN in the previous 12 months. You can't use ARRS to fund an existing salaried GP — it's for genuinely additional capacity.
How the PCN DES is Funded
DES funding comes through several streams. Some go to the PCN, some to individual practices:
Approximate proportions based on published funding allocations. Click any segment to see what it funds:
| Funding stream | What it's for | Paid to |
|---|---|---|
| Core PCN Funding | Running costs — management, coordination, Clinical Director time, PCN-level operational costs | PCN |
| Enhanced Access Payment | Providing bookable appointments outside core hours (evenings/weekends) | PCN |
| Care Home Premium | Additional payment for Enhanced Health in Care Homes delivery | PCN |
| ARRS Reimbursement | Salary reimbursement for additional roles recruited through the scheme (£197m full-year for 2024-26 cohorts) | PCN |
| IIF (Investment and Impact Fund) | Performance-based payments for meeting quality indicators — cancer, access, prevention | PCN |
| PCN Participation Payment | Per-patient payment to each practice for participating in the DES | Practice |
What happened to the £292m CAP?
The Capacity and Access Payment (CAP) — £292 million of PCN-level funding — has been retired. Both sub-payments (CASP and CAIP) are also gone.
That money has been repurposed into the new practice-level GP Reimbursement Scheme. The key shift: this is now practice money, not PCN money. Individual practices apply for it to recruit additional GPs or increase existing GP sessions, specifically to support same-day urgent access.
If your PCN employed GPs through CAP funding, those GPs are eligible to transfer to the new scheme.
Follow the money
The CAP-to-GP Reimbursement switch is the biggest financial change in this year's DES. If your PCN was receiving significant CAP income, understand where that money has gone and what your practice can now claim directly. The funding hasn't disappeared — it's changed hands from PCN to practice.
What's Changed for 2026/27
A summary of everything that's new, changed, or removed:
New core requirements
- Continuity of care: PCNs must use risk stratification to identify and prioritise patients for continuity — this is now a core DES expectation, not optional
- Neighbourhood alignment:PCNs must work with ICBs to align boundaries with neighbourhood footprints where geography doesn't match. Not intended to disrupt well-functioning PCNs
- Care home vaccination: Coordination responsibility for ensuring eligible residents are offered vaccinations
- Staff survey: Mandatory participation in the General Practice Staff Survey
- Portal registration numbers: Professional registration numbers must be included on the online ARRS portal
| What was removed | What replaced it |
|---|---|
| Capacity and Access Support Payment (CASP) | Merged into new practice-level GP Reimbursement Scheme |
| Capacity and Access Improvement Payment (CAIP) | Merged into new practice-level GP Reimbursement Scheme |
| Recently qualified GP restriction (ARRS) | Any GP now eligible (12-month rule still applies) |
| CCT within 2 years requirement | Removed — timing no longer relevant |
| Flu/COVID-19 excluded from collaborative delivery | Removed — PCN practices can now collaborate on seasonal vaccination |
| Mandatory ANP accreditation | Dropped — advanced practice nurses no longer require mandatory accreditation |
| Weight Management Enhanced Service | Replaced by new QOF obesity indicators (OB004/OB005) |
Cancer and IIF updates
- Referral quality audit: Explicit expectations around NICE NG12 compliance
- Electronic safety-netting: Strengthened requirement
- IIF CAN04: Amended for updated NICE guidance and safety-netting wording
Key dates
March 2026
Updated PCN DES specification published by NHS England (PRN02355). Part A (clinical) and Part B (non-clinical) guidance released.
1 April 2026
New specification takes effect. PCNs with 2025/26 sign-up continue automatically — no action needed unless changes to membership or opting out.
30 April 2026
Deadline for: PCN membership changes notification to ICB, opt-out notification, opt-in notification. Contract variation must be agreed by all participating practices.
During 2026/27
ARRS expanded GP recruitment live. GP Reimbursement Scheme (replacing CAP) operational at practice level. Continuity of care and neighbourhood alignment become core PCN requirements.
April 2027
New neighbourhood provider contracts (SNP, MNP, IHO) expected to go live. PCNs remain the foundation but may operate within new contracting structures.
Glossary
PCN and DES jargon decoded:
PCN
Primary Care Network
A group of GP practices working together, typically covering 30,000-50,000 patients. PCNs are the building block of neighbourhood health and the vehicle through which the Network Contract DES is delivered.
DES
Directed Enhanced Service
A nationally specified enhanced service that ICBs must commission. The PCN DES (Network Contract DES) is the largest — it defines what PCNs must deliver and how they're funded.
Network Agreement
Mandatory Network Agreement
The legal agreement signed by all practices in a PCN. Sets out how the network operates, how decisions are made, how funding is distributed, and how workload is shared. Updated annually to reflect DES changes.
Clinical Director
CD
The clinical leader of the PCN — usually a GP partner from one of the member practices. Funded through the DES. Responsible for PCN strategy, ICB liaison, and overseeing service delivery.
ARRS
Additional Roles Reimbursement Scheme
Funding within the DES for PCNs to recruit additional staff. Covers salary reimbursement for a defined list of roles. From 2026/27, any GP is eligible (previously restricted to recently qualified). £197m full-year for 2024-26 cohorts.
IIF
Investment and Impact Fund
A performance-based incentive within the DES. PCNs earn payments for meeting indicators across cancer, access, prevention, and quality improvement. Similar to QOF but at PCN level rather than practice level.
Enhanced Access
Bookable GP and other clinical appointments provided outside core hours — typically evenings and weekends. Funded through the Enhanced Access Payment within the DES. The PCN decides how to organise delivery across its practices.
EHCH
Enhanced Health in Care Homes
The service requirement within the DES for PCNs to provide proactive, structured care to care home residents. Includes weekly check-ins, medication reviews, personalised care plans, and (from 2026/27) vaccination coordination.
Core Network Practice
A GP practice that is a signed-up member of the PCN and participates in the DES. All core practices share responsibility for DES delivery and must sign the Mandatory Network Agreement.
CAP
Capacity and Access Payment
A PCN-level payment (£292m) introduced in 2023/24 for improving access. Retired from 2026/27 — replaced by the practice-level GP Reimbursement Scheme. CASP and CAIP sub-payments also removed.
Safety-netting
Ensuring patients who may have cancer but don't yet meet the urgent referral threshold are followed up appropriately. The 2026/27 DES strengthens this requirement with electronic safety-netting tools.
Risk stratification
Using data to identify patients at higher risk of poor outcomes — typically using tools that combine age, diagnoses, medications, and utilisation data. Now a core DES requirement for prioritising continuity of care cohorts.
SNP
Single Neighbourhood Provider
New contract type from April 2027 serving ~50,000 population. Can be held by GP practices building on existing PCN structures. PCNs are the natural foundation for SNP contracts.
Neighbourhood footprint
The geographical area served by a neighbourhood team — typically 30,000-50,000 population, often aligning with PCN boundaries. The 2026/27 DES requires PCNs to work with ICBs on boundary alignment where needed.
PCN Readiness Checklist
Things to check, discuss at your PCN meeting, or raise with your Clinical Director. Not everything needs action today — but awareness is the first step.
Where to focus first
- Network Agreement: Get it updated for the new requirements by 30 April
- Care home vaccination: Ensure arrangements are in place — someone needs to own this
- ARRS GP recruitment: If you need GP capacity, the barriers are now lower than ever
- CAP transition: Understand the shift from PCN to practice-level funding
Sources:
PCN Network Contract DES from April 2026 (NHS England, March 2026) | GP Contract 2026/27 | Network Contract DES Specification 2026/27 (Part A & Part B) | BMA GP Contract Changes
Built by an NHS GP. Last updated: April 2026.