Clinical directors are personally accountable for the governance of their primary care network, and that accountability now sits on top of a Network Contract Directed Enhanced Service (DES) specification for 2026/27 that took effect on 1 April 2026. Getting the basics right, the mandatory Network Agreement, a clinical director in post at all times, clear financial oversight of Additional Roles Reimbursement Scheme (ARRS) funding, and clarity on who is actually the CQC-registered provider, is no longer optional housekeeping. It is the difference between a network that can demonstrate compliance if challenged and one that cannot.
This article sets out the governance obligations that matter most for clinical directors and PCN boards right now, what changed under the 2026/27 DES specification, and where the legal risk tends to sit in practice.
The legal architecture of a PCN
A PCN is not, in itself, a separate legal entity unless the member practices choose to incorporate it as one. It is a collaboration between GP practices, formalised through two documents: the Network Contract DES, which each member practice signs up to as a variation to its GMS, PMS or APMS contract with NHS England, and the mandatory Network Agreement, which sets out how the member practices will work together, including decision-making, funding distribution and dispute resolution.
Because the PCN itself usually has no separate legal personality, contractual and regulatory responsibility falls on the individual member practices unless and until they incorporate. We have covered the mechanics of that decision in detail in our companion article, PCN Incorporation: The Why and the How, and the wider legal framework for PCNs in Primary Care Networks Explained: A Legal Guide for GP Practices. Governance duties do not disappear if a PCN incorporates, but they change shape, since the incorporated entity then takes on its own compliance obligations.
What changed in the Network Contract DES for 2026/27
NHS England published the updated Network Contract DES specification and Part A (clinical) and Part B (non-clinical) guidance for 2026/27 on 26 March 2026, taking effect from 1 April 2026. Practices already signed up in 2025/26 continue automatically, but any PCN with changes to its membership or arrangements had to notify its commissioner by 30 April 2026 to seek approval.
The principal governance-relevant changes for 2026/27 are:
- ARRS flexibility. The restriction limiting ARRS-funded GP roles to recently qualified GPs has been removed. Eligibility now applies to any GP who has not been substantively employed as a GP in a Core Network Practice of the PCN at any point in the previous 12 months. The maximum salary reimbursement for GPs recruited via ARRS rises from £82,418 in 2025/26 to £118,759 in 2026/27 (£120,921 in London), reflecting the top of the salaried GP pay range, with proportionate employer on-costs added on top, giving annual equivalent maximums of £152,900 outside London and £155,698 including London weighting. Total ARRS GP funding for 2026/27 is £197 million.
- Continuity of care. It is now a core requirement for PCNs to use risk-stratification tools to identify and prioritise cohorts of patients for continuity of care.
- Vaccination oversight for care homes. PCNs must ensure eligible care home residents are identified and offered seasonal and routine vaccinations, even where the PCN does not deliver the vaccinations itself.
- Cancer and screening requirements. Stronger expectations on referral quality, safety-netting and responsibilities for supporting eligible patients through screening.
- Staff survey participation. Practices and PCNs must now participate in the General Practice Staff Survey, including sharing staff contact details with the ICB.
- Neighbourhood alignment. PCNs are required to work with their ICB to align PCN list boundaries with neighbourhood geography, though NHS England has been explicit that this is intended for limited cases of geographic mismatch, not to disrupt well-functioning PCNs.
Amendments to the specification and both guidance documents are highlighted in yellow within the published versions, which is worth checking directly if your PCN is unsure exactly what has changed since 2025/26. Because the DES specification forms part of each member practice’s underlying NHS contract, we would also recommend a wider review against your NHS regulatory compliance obligations, not just the PCN-specific documents.
The Clinical Director role: legal status and accountability
Every PCN must have a named, accountable clinical director in post. This is a contractual requirement under the Network Contract DES, not simply good practice, and NHS England guidance and the BMA’s PCN Handbook both confirm that a PCN should have a default succession process in place so the role is never left vacant, whether by nomination and election, rotation, or another agreed mechanism.
The clinical director’s governance responsibilities typically include providing strategic and clinical leadership, chairing or overseeing the PCN board, and acting as the accountable point of contact for the commissioner. Because this role sits on top of the individual’s existing GP contract, the additional duties and remuneration for acting as clinical director should be governed by a separate written agreement, distinct from that individual’s underlying GMS, PMS or salaried GP contract. Leaving this informal creates real risk: if the clinical director’s terms, time allocation and liability are not documented, disputes about scope of authority (for example, whether the clinical director had the mandate to commit the PCN to a particular ARRS recruitment decision or third-party contract) become far harder to resolve.
Board structure and decision-making
Most PCN boards comprise a representative from each member practice, alongside the clinical director and, commonly, the PCN manager. The board’s core governance functions are:
| Governance component | What it should cover | Where it should be documented |
|---|---|---|
| Decision-making process | Voting thresholds, quorum, how deadlock between practices is resolved | Network Agreement |
| Financial oversight | Budget ownership for Core PCN Funding, Enhanced Access Payment, ARRS reimbursement and Care Home Premium | Network Agreement, plus internal finance protocol |
| Clinical governance | Audit cycles, risk registers, incident reporting across ARRS-employed staff working across multiple practices | PCN clinical governance policy |
| Employment and HR responsibility | Which practice is the formal employer of each ARRS role, and how liability and management responsibility are shared | Network Agreement, employment contracts |
| Data sharing and information governance | Data processing and data sharing agreements for shared records and multi-practice working | Data Processing Agreement, Data Sharing Agreement (published alongside the DES) |
The employment position for ARRS-funded staff is a particularly common source of governance confusion: one practice is usually the formal employer on behalf of the network, while the staff member works across some or all member practices. Getting this wrong, or leaving it undocumented, is one of the most frequent sources of dispute we see. We deal with this in detail in ARRS Employment: Avoiding the Legal Traps, and our employment law team regularly advises PCNs and member practices on getting these arrangements right from the outset.
Do PCNs need to register with the CQC?
This is one of the most persistent points of confusion for clinical directors, and the answer depends entirely on the PCN’s legal structure. The CQC’s own guidance is clear on the underlying principle: only a legal entity carrying on a regulated activity needs to register, and it is the legal entity, not the location or collaborative arrangement, that registers.
In practice, this means:
- If the PCN is not a legal entity, and each member practice is already CQC-registered for the regulated activities it delivers as part of the network (including extended access), the PCN itself does not need to register separately.
- If the PCN has become a legal entity but does not have ongoing direction and control over the delivery of regulated activities, for example because it only supplies staff to assist member practices in delivering their own registered activities, it still does not need to register.
- If the PCN is a legal entity and does have ongoing direction and control over the delivery of a regulated activity, it will need to register with the CQC in its own right.
This is a critical question to resolve before, not after, a PCN incorporates or before it takes on a service delivery role (for example, running an enhanced access hub directly rather than through member practices). Getting the registration status wrong exposes the PCN, and potentially individual clinical directors as directors of an incorporated PCN, to the risk of operating a regulated activity without registration.
Practical compliance checklist for clinical directors
| Area | Question to answer |
|---|---|
| Network Agreement | Has it been reviewed since the 2026/27 DES changes, and does it reflect current membership and funding arrangements? |
| Clinical Director terms | Is there a written agreement covering remuneration, time commitment and succession, separate from the individual’s core GP contract? |
| ARRS employment | Is it clear, in writing, which practice employs each ARRS role and how cross-practice management responsibility works? |
| CQC registration | Has the PCN’s legal status been assessed against CQC’s scope of registration guidance, particularly if incorporation is planned? |
| Data governance | Are data processing and data sharing agreements in place and up to date for 2026/27? |
| Notification deadlines | Were any changes to PCN membership or arrangements notified to the commissioner by the 30 April 2026 deadline? |
What This Means for Your Practice
Governance failures in a PCN rarely show up as a single dramatic event. They tend to surface as funding disputes between member practices, uncertainty about who actually employs a member of staff, or confusion about who is accountable when something goes wrong with a shared service. Reviewing the Network Agreement, the clinical director’s terms and the PCN’s CQC position against the 2026/27 DES changes now is considerably cheaper than untangling a dispute later, and it reflects the kind of governance discipline commissioners increasingly expect to see.
We act for GP practices and PCNs on both sides of these arrangements, drafting and reviewing Network Agreements, advising on incorporation, and resolving disputes between member practices. If your PCN’s governance documents need a health check ahead of the next contract year, get in touch with our healthcare team or call us on +44 207 566 1188, or email info@gurvelegal.com.
