Primary Care Networks (PCNs) form a key part of the future of primary care. First developed within the NHS Five Year Forward View published in 2014, they are part of a model of care in which commissioners and providers work together in different ways to achieve closer integration of services locally.
PCNs are a core component of the NHS Long Term Plan and as such are key to the delivery of digital services at scale. PCNs will need to ensure IT system interoperability and data sharing to enable the vision of delivering proactive, coordinated care, through greater collaboration between primary care and other services.
PCN staff IT needs are now aligned with and included in the GP IT revenue and capital allocations as per the GP IT operating model.
PCNs provide services according to the Network Contract DES (Directed Enhanced Service) Specification which sets out their entitlements and requirements. This and further supporting guidance is set out on the NHS England GP contract website.
A PCN is a group of GP practices working closely together, aligned to other health and social care staff and organisations, providing integrated services to their local population. A PCN covers a patient population, of 30,000 – 50,000 patients, although by approval of the commissioner, this may be lower in rural and remote areas, and higher where it is appropriate.
NHS England believes it is at around this size that networks will best keep the features of traditional community-based general practice. The vision is to offer a balance between effective and efficient care provision within the local population whilst enabling the delivery of patient-centred care to meet the needs of individuals and the wider community.
There are around 1,250 PCNs in England, with over 99% of practices signed up to deliver the DES. Whilst practices are not mandated to join a PCN, they will lose out on significant extra funding if they do not. Figures published in May 2020 showed that very few practices had chosen not to be part of a PCN. Those that do not sign up to a network need to be aware that 100% of their patients will still have access to network services via neighbouring practices, GP federations and other member organisations.
Benefits of PCNs
The benefits of PCNs and of working at scale include:
- allowing practices to share resources, expertise, and services
- forming an entity that can tender for services
- recruitment and retention of shared staff under the Additional Roles Reimbursement Scheme (ARRS)
- improved integration of services across practices and the wider health and care system
- improved access and proximity of care for patients
- increase in the breadth and range of services available to patients
- enhanced integration between primary care and community services
- sustainability of smaller GP practices (as they can share resources with other practices within their PCN)
- better management of financial pressures and resources
- better management of estates pressures
- opportunities for a collective response to political pressure on service provision
- reduction of health inequalities
- enhanced health and wellbeing of the local population
PCNs and integrated care systems (ICS)
A group of PCNs in a defined geographical area sits within a corresponding integrated care system (formerly ‘sustainability transformation partnerships’ or STPs).
An ICS brings together NHS providers, commissioners, local authorities, and voluntary community sector (VCS) partners together to collaboratively plan and organise how health and care services are delivered in their local area. They serve populations of around 1-3 million people, with the health and social care partners from different sectors in that geographical area coming together to set strategic direction and to develop economies of scale for cost efficiencies.
GP practices become a core network practice by signing up to the network contract DES which is an extension of the core GP contract and sets out the requirements and entitlements for a PCN.
Other organisations, such as community pharmacies, community service providers, mental health providers, and voluntary sector organisations, may also be members of the PCN.
Each PCN will have a network agreement which sets out the arrangements between the core network practices of the PCN, including how they will deliver the DES requirements and how any liabilities will be shared. Other members of the PCN will also sign up to the relevant parts of the network agreement which apply to the wider members.
In addition to the network contract DES specification, PCNs are also supported by the PCN Development Programme.
Not all practices sign up for DES and its service requirement. GP practices who do are referred to as ‘core network practices’ and are defined as the ‘contractor’ in their existing primary medical care contract.
A practice that chooses to sign up to the network agreement but not the DES is referred to as a ‘member’. They receive a share of network funding but not enhanced payments for DES service delivery.
Every PCN must have a clinical director who will provide strategic and clinical leadership. The requirements for the clinical director are set out in the DES.
There are a number of financial entitlements under the network contract DES. These include:
- a core PCN payment of £1.50 per registered patient
- clinical director contribution
- extended hours funding, payment per registered patient
- care home premium, payment per care home bed within the network
- ARRS workforce reimbursement, provided to recruit additional staff to work across the network
- investment and impact fund (IIF) a voluntary incentive scheme linked to networks rather than individual practices. The fund has a number of performance indicators, including incentivising the number of online consultations received across a PCN
The IIF scheme is focused on supporting PCNs to deliver high quality care to their population, delivering objectives, including NHS Digital First Primary Care aspirations as set out in the NHS Long Term Plan. Guidance can be found here, current at the time of writing.
Practices signed up to the DES are also entitled to a network participation payment, paid to individual practices.
The DES sets out further information about the funding entitlements available to PCNs.
To support PCNs, the Additional Roles Reimbursement Scheme (ARRS) provides funding for up to 26,000 additional staff working across networks to create bespoke multi-disciplinary teams.
It entitles PCNs to access funding to support recruitment across fifteen reimbursable roles. The intention of the scheme is to grow additional capacity through new roles, and by doing so, help to solve some of the workforce shortage in general practice.
Reimbursement through the new scheme is only for demonstrably additional people.
Whilst there are benefits for patients and practices in expanding the range of roles employed in a PCN, many of these are new to general practice and require significant support, training, and development. Consideration also needs to be given to the practicalities of accommodation and workspace for additional staff.
Standardisation of working practices is encouraged for these roles. Practices are also encouraged to collaborate on mentoring, professional development, and performance appraisals.
The links below give detail for the role, support for recruitment and employment, as well as guidance on current funding:
- Clinical pharmacist
- Pharmacy technician
- Social prescribing link worker
- First-contact physiotherapist
- Physician associate
- Health & wellbeing coach
- Care coordinator
- Nursing associate
- Occupational therapist
- General practice assistant
- Mental health practitioner
- Advanced practitioner
Further detail on the training requirements can be found at E-learning for Health. The content also contains links to:
- workforce planning and training
- ARRS job descriptions
- role of the training hub for the new primary care roles
- links into role specific training and development
Under the terms of the DES, PCNs are required to deliver a set of service requirements. Three of these service requirements started in 2020/21 and a further two phased in from October 2021:
- structured medication reviews and medicines optimisation
- enhanced health in care homes
- early cancer diagnoses
- social prescribing service
- cardiovascular disease (CVD) prevention and diagnosis
- tackling neighbourhood health inequalities
A further two services followed in 2022:
- anticipatory care (with community services)
- personalised care
PCN service requirements for 2022/23 can be found on the NHS England website (Annex A and Annex C have useful summaries for primary care).
The core characteristics of a PCN are:
- practices working together, and with other local health and social care providers, around natural local communities that are geographically aligned, to provide coordinated care through integrated services and service providers
- typically composed by a defined patient population of at least 30,000 and tend not to exceed 50,000
- the provision of care in different ways to meet individual needs of patients, including flexible access to advice and support services for healthier population groups, and integrated care for those with multi-morbidity, chronic and complex conditions
- a focus on prevention and personalised care, supporting patients to participate and make informed decisions about their care and look after their own health, by connecting them with the full range of statutory and voluntary community services
- the use of data and technology: to assess population health needs and health inequalities; to inform, design and deliver practice-and population-scale care models; support clinical decision making, and monitor performance and variation to inform continuous service improvement
- making best use of collective resources and collaborative working arrangements across practices and other local health and care providers to allow greater resilience, more sustainable workload and access to a collaborative working multi-disciplinary team
Working proactively and effectively within their ICS enables PCNs to contribute to the sustainable delivery of health and social care services and reduce geographic health inequalities within population groups and local communities.
Related GPG content
- National NHS context for digital primary care
- GP contract
- Video consultation tools – to follow
Other helpful resources
- Kings Fund, guide to PCNs
- NHS England, information about PCNs
- NHS England, YouTube video about PCNs (3.05mins)
- NHS England, PCN frequently asked questions (3rd iteration)
- Health Education England, guide to planning and developing new roles in primary care
- NHS Providers, guidance for governors on ICS and the new system
- NHS Providers, Five-year framework for GP contract reform
- NHS England, guidance on the information governance framework for shared care records
- NHS England, guidance on information sharing in multidisciplinary teams (MDTs)
- NHS England, guidance on sharing information with the voluntary sector