PCN DES 2026/27: A Practical Guide for Practice Managers
- Holly Laurence
- 4 days ago
- 4 min read
What you need to know, and what you need to deliver from 1 April
The PCN DES 2026/27 reinforces a clear direction for primary care:
Greater accountability, tighter governance, and delivery at scale
For Practice Managers and PCN leaders, this is not just guidance, it is a contractually binding framework that must be operational from 1 April 2026.
This guide breaks down the key changes by section, with a clear focus on:
What’s changed
What it means
What you need to do
1. Participation & Eligibility (Sections 3–4)
Key Changes
Automatic participation continues unless practices formally opt out
Participation rolls forward into future DES cycles and in-year variations
Clearer rules for:
Joining/leaving PCNs
New PCN formation
Commissioner-led allocation
Impact
Practices are committed by default
Less flexibility mid-year
Increased administrative oversight
What You Need To Do
Confirm participation via CQRS
Ensure contract variation is signed
Review PCN membership stability
Align Network Agreement with current structure
DES requirements are now part of your core contract obligations
2. PCN Structure & Governance (Sections 5–6)
Key Changes
Reinforced requirements for:
30,000–50,000 population size
Defined Network Area
Alignment with ICS and neighbourhood teams
Increased commissioner powers to intervene
Impact
PCNs must operate as system-aligned delivery units
Less informal collaboration, more formal accountability
What You Need To Do
Validate PCN size and footprint
Ensure alignment with ICS strategy
Update Network Agreement
Confirm Clinical Director accountability
3. Additional Roles Reimbursement Scheme (Section 7)
Key Changes
Continued expansion and reliance on ARRS-funded roles
Defined minimum role requirements and eligibility
Roles must support core DES delivery areas
Impact
ARRS is now critical infrastructure, not optional support
Increased scrutiny on utilisation and outcomes
What You Need To Do
Audit current ARRS workforce
Identify gaps (especially pharmacists and technicians)
Ensure roles are aligned to:
SMRs
Medicines optimisation
Access delivery
Underutilised ARRS = lost funding and delivery risk
4. Service Requirements (Section 8) — What You Must Deliver
This is the most operationally critical section of the DES.
Success or failure in 2026/27 will largely depend on how effectively this is delivered.
Core Service Areas
1. Enhanced Access (Extended Hours)
Requirement:
Weekdays: 6:30pm–8:00pm
Saturdays: 9:00am–5:00pm
Impact:
Must be delivered consistently across the PCN
Focus on utilisation, not just availability
Actions:
Finalise PCN-wide rota
Ensure workforce coverage
Track utilisation and DNA rates
2. Structured Medication Reviews (SMRs)
Requirement:
Delivery of clinically appropriate, coded SMRs
Focus on high-risk and complex patients
Impact:
Increased focus on quality and volume
Direct link to QOF/IIF and workload reduction
Actions:
Define target cohorts
Ensure pharmacist capacity
Monitor activity and coding accuracy
3. Medicines Optimisation & Prescribing Support
Requirement:
Ongoing delivery of:
Prescription queries
Reauthorisations
Medicines reconciliation
Safety audits
Impact:
Must be delivered at scale across the PCN
Actions:
Standardise processes across practices
Allocate dedicated clinical resource
Track workload and GP time saved
4. Enhanced Health in Care Homes (EHCH)
Requirement:
Structured, proactive care for care home residents
Impact:
Increased expectation for planned, MDT-led care
Actions:
Confirm care home allocation
Assign clinical leads
Implement regular review schedules
5. Integration with Neighbourhood Teams (INTs)
Requirement:
Alignment with wider system partners
Impact:
PCNs must operate within integrated care models
Actions:
Engage with community and ICS teams
Align services with system priorities
The Real Shift in 2026/27
Across all services, the DES is moving towards:
1. Accountability
You must demonstrate delivery, not just capacity
2. PCN-Level Consistency
Standardised delivery across all practices
3. Measurable Outcomes
Activity must be tracked, coded, and reported
Common Risks
ARRS roles in place but underutilised
Poor coding → lost income
Inconsistent delivery across practices
Weak rota planning for Enhanced Access
What Your PCN Must Have in Place (From April)
✔ Workforce plan aligned to services
✔ Clear delivery model across the PCN
✔ Activity tracking and reporting
✔ Named lead for DES performance
5. Contract Management & Compliance (Section 9)
Key Changes
Increased commissioner oversight
Clear escalation and intervention routes
Impact
Higher performance expectations
Reduced tolerance for under-delivery
What You Need To Do
Track performance across all DES areas
Maintain evidence of delivery
Ensure strong communication with commissioners
6. Network Financial Entitlements (Section 10)
Key Changes
Continued funding streams:
Core PCN funding
ARRS reimbursement
Incentive-based payments
Strong emphasis on:
Coding and validation for payment
Role of Nominated Payee
Impact
Income is directly tied to:
Delivery
Coding accuracy
Reporting
What You Need To Do
Review payment flows
Ensure accurate coding across all services
Track income vs activity monthly
Identify and address funding leakage
If activity isn’t coded, it won’t be paid
7. Data Sharing & Operational Readiness
Key Changes
Mandatory:
Patient record sharing
GDPR compliance
Respect for patient opt-outs
Impact
Data readiness is required before service delivery
What You Need To Do
Confirm data sharing agreements
Ensure system interoperability
Validate compliance processes
Final Checklist: Ready for 1 April 2026
✔ DES participation confirmed
✔ PCN structure compliant
✔ Network Agreement updated
✔ ARRS workforce fully utilised
✔ Service delivery model operational
✔ Coding and reporting in place
✔ Data sharing compliant
✔ Financial tracking established
Final Thought
The PCN DES 2026/27 is not introducing entirely new services, it is tightening expectations around:
Delivery
Consistency
Accountability
For Practice Managers, success this year will come down to one thing:
Having the right workforce and operational model in place from day one.
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