PCN DES 2026/27: A Practical Guide for Practice Managers

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

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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 

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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

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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

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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.

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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

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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

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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

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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

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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

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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

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Common Risks

• ARRS roles in place but underutilised

• Poor coding → lost income

• Inconsistent delivery across practices

• Weak rota planning for Enhanced Access

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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

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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

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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

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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

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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

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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.