Primary Care Networks — universally known as PCNs — have been one of the most transformative structural changes in NHS general practice in a generation. Introduced in 2019 as part of the GP Contract, PCNs fundamentally changed how GP surgeries collaborate, how the workforce is planned, and how enhanced services are delivered. Whether you are a GP, nurse, allied health professional, or practice manager, understanding how PCNs work is now essential knowledge for anyone working in primary care in England.
What Is a PCN?
A Primary Care Network is a group of GP practices — typically covering a combined registered patient population of 30,000 to 50,000 people — that work collaboratively under a single network contract. PCNs were created to allow GP practices to operate at scale, pooling resources, sharing clinical staff, and delivering enhanced services that individual practices could not realistically provide working alone.
Each PCN is led by a PCN Clinical Director — a GP who takes on a leadership and strategic role for the network, typically reimbursed for protected sessions to carry out network duties alongside their clinical work.
PCNs across England as of 2025
Average registered patients per PCN
ARRS-funded staff employed across English PCNs
The Network Contract DES: The Legal Basis for PCNs
PCNs operate under the Network Contract Directed Enhanced Service (DES), an NHS England contract that sits alongside the core GP contract. Almost all practices in England have signed up, as the financial incentives make non-participation difficult to justify. The DES includes four key funding and service streams:
PCN Leadership Payment
Funds the Clinical Director role and PCN management infrastructure — typically covering 0.25 WTE CD sessions per 50,000 patients
ARRS Funding
Ring-fenced workforce budget covering full employment costs of additional clinical and support roles — the largest single PCN funding stream
Investment & Impact Fund (IIF)
Incentive payments for PCNs meeting quality indicators across the network — linked to population health outcomes
Enhanced Service Requirements
Obligations including extended access, care home services, structured medication reviews, and social prescribing at network level
What Do PCNs Actually Deliver?
The specific activities of a PCN vary by network and local priorities, but most PCNs in England now deliver some combination of the following:
- Extended hours access — appointments on evenings and weekends, often through a centralised hub serving all PCN practices
- Care home services — dedicated weekly clinical input into local residential and nursing homes, including structured reviews
- Clinical pharmacist-led medicines reviews — structured medication reviews, polypharmacy reviews, and high-risk drug monitoring
- Social prescribing — connecting patients with community support and voluntary services to address wider determinants of health
- Population health management — using patient data proactively to identify high-risk patients and address demand before it becomes a crisis
- Same-day access improvement — deploying paramedic practitioners and ANPs to manage acute demand and reduce GP appointment pressure
Who Works in a PCN?
The PCN workforce extends well beyond GP partners and traditional practice staff. Through the ARRS scheme, PCNs can employ a wide range of additional clinical roles at no direct cost to the practice:
Advanced Nurse Practitioners (ANPs) & Advanced Clinical Practitioners (ACPs)
Autonomous consultation, independent prescribing, chronic disease management — typically the highest-impact ARRS roles for releasing GP capacity
Clinical Pharmacists
Medicines optimisation, structured medication reviews, high-risk drug monitoring — capable of releasing approximately 1,500 GP appointments per year per WTE
Paramedic Practitioners
Home visiting, same-day access, minor illness — reducing GP home visit burden significantly and expanding same-day access capacity
Social Prescribing Link Workers & Health Coaches
Connecting patients to community support, reducing inappropriate clinical demand from patients with social and wellbeing needs rather than clinical conditions
Mental Health Practitioners
Primary care mental health support, brief interventions, and liaison — addressing the significant mental health demand seen across general practice
Care Coordinators
Proactive care planning, patient navigation, coordination of complex cases — freeing up GP and clinical time for direct patient care
The PCN Clinical Director Role
The PCN Clinical Director is a GP who provides clinical and strategic leadership for the network. This includes overseeing ARRS workforce planning, representing the PCN to the ICB, leading on quality improvement and population health initiatives, and managing relationships between member practices.
For GPs interested in leadership, the Clinical Director role offers genuine influence over the future of primary care in their local area — and is one of the most impactful leadership positions available to GPs outside of formal partnership.
Challenges Facing PCNs in 2025
What PCNs Mean for Your Career
For GPs, PCNs can materially reduce your individual workload through shared ARRS staff, improve the quality of care you can offer patients, and open pathways into clinical leadership and population health management.
For advanced practitioners and allied health professionals, PCNs have created thousands of new primary care roles — for ANPs, ACPs, clinical pharmacists, paramedic practitioners, and mental health practitioners — where career pathways in general practice previously did not exist. ARRS-funded roles offer competitive salaries, diverse clinical exposure, and the opportunity to work at the centre of NHS primary care delivery.
