A primary care network, or PCN, is not itself a separate legal entity. It is a group of GP practices bound together by a contractual Network Agreement, operating under the NHS Network Contract Directed Enhanced Service, and it is that Network Agreement, not any wider concept of “the PCN”, that determines each practice’s legal rights and obligations. Understanding this distinction matters, because it shapes everything from liability to decision-making to what happens if a member practice wants to leave.
This guide sets out what a PCN is in legal terms, what the Network Agreement commits your practice to, and where the current wave of NHS reform is changing the picture for 2026/27 and beyond.
What a Primary Care Network Actually Is
PCNs were introduced under the Network Contract DES from 2019 as a mechanism for grouping neighbouring GP practices together to deliver services collaboratively across a defined geographic footprint. NHS England guidance sets a minimum registered population of 30,000 patients per network, with most PCNs sitting between 30,000 and 50,000, though commissioners can waive the minimum in rural areas with low population density. A PCN has no separate legal personality of its own. It cannot hold property, employ staff directly, or enter contracts in its own name unless the member practices choose to set up a separate vehicle, typically a limited company, to do some of that on the PCN’s behalf. We cover that route in PCN Incorporation: The Why and the How.
Instead, the PCN operates through the collective action of its member practices, each of which remains individually responsible for delivering its share of the Network Contract DES obligations under its own underlying GMS, PMS or APMS contract, while also being bound to the other member practices through the Network Agreement.
The Network Agreement: Your Practice’s Actual Legal Commitment
Every PCN operating under the Network Contract DES must have a Network Agreement in place between its member practices. NHS England publishes a mandatory template Network Agreement each contract year, most recently updated for 2026/27, which practices can adapt within defined parameters but cannot depart from on the core mandatory terms. Reviewing and negotiating these terms is the kind of work we do through our NHS regulatory compliance practice, alongside more general partnership agreement drafting for the member practices themselves. This is the document that actually governs how the PCN functions day to day: how decisions get made, how funding and Additional Roles Reimbursement Scheme (ARRS) staff are allocated between member practices, how disputes between member practices are resolved, and what happens if a practice wants to leave the network or a new practice wants to join.
The Network Agreement sits outside the definition of an NHS contract in the way that the underlying GMS, PMS or APMS contracts do. This has a practical consequence: disagreements between member practices about how the Network Agreement operates are generally not something NHS Resolution’s standard NHS contract dispute mechanisms are designed to handle, which means PCN member practices are often left to resolve disputes through ordinary contractual and commercial routes, via dispute resolution, rather than NHS-specific dispute procedures.
Governance: The Clinical Director and Decision-Making
Every PCN must appoint an accountable Clinical Director, a role that comes with significant responsibility for leading the network’s clinical direction and representing it in dealings with the Integrated Care Board, but with governance that is often less clearly defined than a partner’s role within an individual practice. The template Network Agreement leaves the fine detail of how decisions are taken, whether by unanimous agreement, majority vote, or a defined combination of the two, to be recorded in a schedule agreed locally between the member practices.
This flexibility is useful, but it is also where things go wrong if practices do not think it through properly. A Network Agreement that leaves decision-making vague, or that does not clearly separate the Clinical Director’s authority to bind the network from decisions that require the sign-off of every member practice, creates exactly the kind of ambiguity that leads to disputes. Sector commentary from healthcare lawyers has repeatedly flagged that PCN member practices can face genuine financial exposure and disputes if the underlying Network Agreement is not watertight, particularly around funding allocation, staff employment liabilities under the ARRS, and what happens if a member practice underperforms against network-wide targets that affect shared funding.
| Structural option | Legal effect | Typical use case |
|---|---|---|
| Standard Network Agreement between member practices | Contractual joint working arrangement, no separate legal entity, individual practices retain their own contracts and liabilities | Default model used by the great majority of PCNs |
| Lead practice model for employing ARRS staff | One member practice employs network staff on behalf of the others under sub-contracting arrangements | Networks with a practice willing to take on employer responsibility |
| PCN limited company | Separate legal entity that can employ staff and hold some liabilities directly, subject to Companies Act 2006 duties | More mature networks looking to reduce liability concentrated in one lead practice |
What’s Changing for 2026/27
The Network Contract DES for 2026/27 reflects a deliberate shift of resource and responsibility back towards individual practices and away from network-level structures. NHS England’s 2026/27 contract specification and accompanying explanatory notes confirm a reduction in the scope and funding attached to network-level schemes compared to previous years, with funding that had previously supported network-wide capacity and access initiatives redirected to support recruitment and additional GP sessions at practice level. A variation to the Network Contract DES specification and Part B guidance took effect from 1 May 2026, and the mandatory Network Agreement itself has also been updated for the year, including changes to how collaborative delivery of vaccination services is treated.
For member practices, this matters in two ways. First, funding flows that a practice may have built into its financial planning around PCN-level delivery may reduce or disappear, and the Network Agreement’s provisions on funding allocation need to be checked against the current specification rather than assumed to be unchanged from prior years. Second, as more responsibility moves back to individual practice level, the interaction between a practice’s own GP partnership agreement and its PCN obligations becomes more, not less, important. We cover what a partnership agreement should say about PCN involvement in GP Partnership Agreements: What Every Partner Should Know.
PCNs and the Neighbourhood Health Framework
The Department of Health and Social Care’s Neighbourhood Health Framework, published on 17 March 2026, represents the most significant structural change to primary care organisation since PCNs themselves were created in 2019. It is reasonable for practices to ask whether PCNs have a long-term future as the primary vehicle for network-level collaboration once Integrated Neighbourhood Teams and neighbourhood health centres become the dominant structure through the framework’s implementation period to March 2029. We explore this question directly in Do PCNs Have a Future Under the Neighbourhood Health Framework?, and set out the framework’s requirements for practices more broadly in The Neighbourhood Health Framework: What It Means for Your GP Practice.
Practical Steps for Member Practices
Whatever stage your PCN is at, there are a few things worth checking now rather than waiting for a dispute to force the issue. Confirm your Network Agreement has been reviewed against the current year’s mandatory template rather than left unchanged since 2019. Check that decision-making authority, particularly the Clinical Director’s authority to commit the network to spending or staffing decisions, is clearly defined. Make sure your practice’s own partnership agreement reflects the practice’s PCN obligations, including how PCN income and any associated liabilities are treated within the partnership. And if your practice is considering a more formal structure such as a PCN limited company, take specialist advice before signing anything, since incorporation changes the liability picture significantly.
What This Means for Your Practice
PCN structures sit at the intersection of NHS contract law and ordinary commercial partnership law, which is exactly the kind of overlap that catches practices out if it is not looked at properly. We act for GP practices on Network Agreement reviews, PCN governance disputes, and the wider partnership issues that PCN membership creates. If this affects your practice and you would like to talk it through, get in touch with our healthcare team or call us on +44 207 566 1188. You can also reach us by email at info@gurvelegal.com.
