More than 1,250 primary care networks operate across England, according to NHS England primary care data, and those moving through 2026 are working under a substantially different set of pressures from the ones the DES envisaged. Workforce planning has become more strategic under the merged ARRS allocation, ICB expectations have hardened around outcome data, and the pending move to local provider contracts is beginning to influence how clinical directors plan the next twelve to eighteen months. Running that programme of change alongside day-to-day clinical service commitments has changed the operational picture that most PCN managers now face.
The most demanding challenges are less about individual contract requirements and more about the coordination and governance work that keeps a network operating coherently. Managing that work at scale, across member practices with different sizes, systems and priorities, is where most PCNs spend too high a share of their operational capacity.
Key takeaways
- The merged ARRS allocation has made workforce planning more strategic, but also more contested internally between practice leads with different priorities.
- ICB reporting expectations have hardened around clinical outcome data, requiring stronger data infrastructure than earlier ARRS years demanded.
- Coordinating service delivery across member practices with different clinical systems and workflows remains the most persistent operational burden.
- The pending transition to local provider contracts from 2027/28 is starting to influence workforce and governance decisions in the current contract year.
- Networks that formalise their management support tend to sustain their operations more consistently than those relying on ad hoc coordination between clinical directors.
The ARRS allocation and internal trade-offs
The merger of the GP and main ARRS pots under the 2025/26 contract restructuring removed the pot-by-pot spending rules that structured earlier ARRS decisions, and replaced them with a set of internal trade-offs that every network now has to work through. Pharmacist capacity now competes with GP hires for the same budget, physiotherapy provision competes with mental health practitioner capacity, and the network’s workforce plan has to be built explicitly rather than defaulted to by the funding rules.
For clinical directors, that raises the political dimension of ARRS decisions. Practices within a network typically have different sizes, patient list demographics and clinical priorities. A large practice with an established pharmacist team may want the ARRS allocation directed elsewhere; a smaller practice with acute recruitment gaps may push in the opposite direction. Balancing those views requires the network to have a workforce plan explicit enough to justify decisions to member practices and their partners.
Meeting ICB reporting expectations
Reporting expectations from Integrated Care Boards have grown significantly since the 2024/25 contract year. NHS Confederation guidance on PCN operations reflects that networks are now expected to submit clinical outcome data. This comes alongside activity and workforce information, with reporting cycles more frequent and the expected level of detail higher than in earlier years. That has practical implications for the data infrastructure a network needs to maintain.
Most PCNs now find that meeting ICB expectations requires either a dedicated data function within the network or an established relationship with a provider who can prepare the reporting on the network’s behalf. The alternative, which is asking clinical directors and PCN managers to compile the reporting during time that should be spent on service delivery, tends to result in either patchy submissions or reporting that reflects what can be assembled quickly rather than what the ICB wants to see.
Coordinating delivery across member practices
The mechanics of running clinical services across member practices with different clinical systems, patient list sizes and internal workflows remain the persistent operational headache for most networks. The Enhanced Access requirement, SMR delivery and any shared workforce programme all depend on coordination that has to be worked out practice by practice rather than assumed.
Working across different clinical systems
Most networks still include practices on both EMIS and SystmOne, with the practical implication that any cross-network programme has to accommodate two search structures, two coding conventions and two sets of clinical templates. That doubles the setup work for anything from an SMR recall to a QOF audit.
Standardising documentation and reporting
Documentation practices vary between member practices even where the clinical systems are the same. Where they differ across systems, the variation compounds. Networks that treat documentation standards as a network-level responsibility, with agreed templates for structured clinical activities, tend to produce more consistent reporting and less duplication of effort.
Preparing for the transition to local provider contracts
The pending replacement of the DES with local provider contracts, expected from 2027/28, is already influencing decisions being made in the current contract year. Networks that assume the DES will simply continue in its current form risk finding their workforce commitments and governance arrangements poorly suited to the successor framework.
In practical terms, 2026/27 should be used to make workforce and governance decisions that stay flexible across different contract structures. In practice, that typically means:
- Framing workforce plans on clinical outcome grounds rather than DES-specific role definitions, so the case for each post carries into a new commissioning framework.
- Documenting governance arrangements in enough detail to survive a change in commissioning entity.
- Structuring ARRS commitments to preserve flexibility across contract configurations, rather than locking into a role list that may not persist.
- Building reporting infrastructure that can adapt to whatever data the successor arrangements ask for.
Building a formal management support function
The networks that navigate this environment consistently well tend to share one operational feature: they have formalised the management support function that runs the network’s non-clinical work. The King’s Fund analysis of primary care networks and other policy commentary consistently highlight the operational significance of a defined management function within a network. Whether that support is delivered internally as a PCN manager role, provided by a lead practice or brought in from an external provider, the pattern is that the function exists as a defined responsibility rather than as something clinical directors squeeze in around their clinical time.
The transition to local provider contracts makes reviewing current management arrangements a more pressing question than it was twelve months ago. Working with an experienced provider can help formalise the coordination, reporting and workforce planning work that the network needs, rather than leaving those functions dependent on the availability of individual clinical directors.
