The Primary Care Network Directed Enhanced Service (PCN DES) Changes

The Primary Care Network Directed Enhanced Service (PCN DES) has undergone a significant and unexpected update for 2026/27. While funding remains nationally set, Integrated Care Boards (ICBs) can now locally vary parts of the PCN DES through a formal Local Variation Arrangement (LVA).

This change alters how the DES may operate in practice and represents one of the most important shifts in the GP contract in recent years.

What Has Changed?

Under the revised PCN DES, ICBs may now request approval from NHS England to locally vary elements of the DES, including:

• Service requirements
• The Additional Roles Reimbursement Scheme
• Certain financial payments and provisions

The PCN DES has moved from being a national specification to something more flexible and locally driven.

Why This Matters

This change formalises what many were already moving towards: local commissioning outcomes delivered through PCNs, but without the need to create entirely new contracts.

It aligns closely with emerging neighbourhood working models and creates what has been described as a LES DES hybrid: national funding, local specification. This may be the most significant evolution of the PCN DES since its introduction.

Are Single Neighbourhoods Now Being Delivered Through the DES?

Not explicitly, but in practice this is increasingly likely.

Most PCNs already sit at a single neighbourhood footprint of around 30,000 to 50,000 patients. The ability to locally vary services and workforce deployment allows ICBs to use the PCN DES to achieve outcomes that might previously have required:

• A Single Neighbourhood Provider contract, or
• A new locally commissioned enhanced service

In the short term, this may reduce the likelihood of new SNP contracts emerging, as ICBs can now achieve early neighbourhood change through the DES itself.

For PCNs, this increases both opportunity and responsibility.

How does this impact GP practice finances?

One of the most important issues raised by this change is where PCN money sits.

Practices should be considering:

• What proportion of our income currently depends on PCN DES funding?
• What happens if PCN income shifts away from individual practices?
• Could LES income follow the same path?
• Are ARRS staff deployed in a way that remains sustainable if funding flows change?

PCN and enhanced services income typically represents 30% of total revenue for a GP practice. A shift in funding control could, over time, affect both profitability and viability if not planned for.

Are PCNs Organised for This Next Phase?

PCNs are now expected to:

• Manage larger and more complex funding streams
• Employ or host multidisciplinary teams at scale
• Deliver locally tailored services
• Act as credible partners with ICBs

For some networks, particularly those that delayed structural decisions while waiting for clarity on neighbourhood contracts, incorporation or the use of an established federation model may now merit serious consideration.

This is not about rushing into change, but about recognising that the PCN role is becoming central.

Practical Actions to Consider Now

While many details will continue to evolve locally, there are some sensible steps practices and PCNs can take now:

1. Review financial exposure: identify reliance on PCN and LES income, and assess the worst-case scenario.
2. Revisit PCN governance arrangements – Ensure decision making, financial controls and risk sharing are clearly documented and understood.
3. Engage early with ICBs – ICB reorganisations have created gaps. This is often when future direction is set by those who engage first.

This change will inevitably feel unsettling to some. It arrives during a period of wider system reorganisation, adding another layer of uncertainty for general practice. However, it also creates opportunity.

Practices and PCNs that understand their numbers, have clear governance, and approach this strategically will be better placed to influence what happens locally rather than react to it.

For more information, please contact a member of the BHP healthcare team.