Primary Care Networks launched in 2019 as the structural reform that would save general practice. Groups of neighbouring practices — typically covering 30,000–50,000 patients — would collaborate, share workforce, and deliver services at scale that individual practices couldn't.
Several years in, the verdict is mixed. Some PCNs are genuinely transforming local primary care. Many are administrative shells that exist primarily to access ARRS funding. A few have actively harmed the practices within them through dysfunction, inequitable resource allocation, or clinical director burnout.
Here's what the evidence and experience show across the key dimensions.
What's working
ARRS recruitment. The Additional Roles Reimbursement Scheme has delivered real workforce growth in primary care — pharmacists, physiotherapists, paramedics, social prescribers, physician associates, and mental health practitioners who would not otherwise exist in primary care. For practices that have successfully integrated these roles, the impact on GP workload is tangible. Clinical pharmacists handling medication reviews and acute prescribing queries, first contact physiotherapists seeing MSK presentations, and social prescribers addressing non-medical complexity all free GP capacity for the work that only GPs can do.
Shared capacity for smaller practices. PCNs have given smaller practices access to workforce (particularly clinical pharmacists and social prescribers) that they couldn't afford individually. A single-handed GP with 4,000 patients can now have a pharmacist for 2 sessions per week — funded through the PCN, not the practice budget. This is a genuine structural improvement.
Collaborative vaccination and extended access. COVID vaccination delivery through PCN-coordinated sites was the model's most visible success. Extended access hubs — providing evening and weekend appointments across PCN footprints — have improved patient access metrics, though GP opinions on the clinical value of these appointments are divided.
What's not working
The supervision burden. ARRS roles require GP supervision. A clinical pharmacist working independently on medication reviews needs a GP available for queries. A physician associate seeing undifferentiated presentations needs co-signing and clinical oversight. The time GPs spend supervising ARRS staff partially offsets the capacity those staff create — a reality that workforce modelling consistently underestimates.
Inequitable resource distribution. In many PCNs, the ARRS staff gravitate to the larger, better-organised practices — leaving smaller practices contributing to the cost but receiving less benefit. The "rising tide lifts all boats" theory works poorly when the boats are different sizes and some have holes.
Clinical director burnout. The PCN clinical director role was designed as approximately one session per week. The reality for most CDs is 2–4 sessions of administrative work: managing ARRS staff, attending ICB meetings, negotiating service specifications, handling HR issues, and mediating between practices with competing interests. The stipend has improved but remains inadequate for the actual workload. CD turnover is high and accelerating.
The DES specifications. PCN service specifications (the DES — Directed Enhanced Service) have been a source of persistent frustration. Requirements change annually, timelines are tight, and the administrative overhead of demonstrating compliance often exceeds the clinical value of the services delivered. The structured medication reviews, anticipatory care, and personalised care adjustments mandated by the DES are clinically sound in principle but bureaucratically onerous in practice.
IIF and target fatigue. The Investment and Impact Fund — PCN-level targets with financial incentives — has driven some useful activity (flu vaccination rates, learning disability health checks) but has also created perverse incentives. Practices report spending disproportionate time on hitting IIF targets that generate modest income while neglecting core clinical work that doesn't have a target attached.
What GPs actually think
Survey data and informal polling consistently show:
Most GPs support the concept of at-scale primary care collaboration. The opposition isn't to PCNs as an idea but to PCNs as currently implemented.
The most common complaints: too much bureaucracy, insufficient funding, the sense that PCNs are a mechanism for NHS England to impose targets on general practice without adequate resourcing, and the fear that PCNs are a stepping stone toward dismantling independent contractor status.
The GPs most positive about PCNs are typically those in well-functioning networks with a strong, competent clinical director, equitable resource sharing, and a genuine collaborative culture. The GPs most negative are those in dysfunctional networks where the CD is overwhelmed, the practices don't trust each other, and the ARRS roles haven't been properly integrated.
Where PCNs go from here
The trajectory depends on several unresolved questions:
Will ARRS funding continue to grow, plateau, or be cut? The funding has been the primary tangible benefit of PCN participation. If it's withdrawn or frozen, many PCNs lose their reason to exist.
Will the DES become simpler or more complex? The current direction is toward more requirements with more reporting — which risks turning PCNs into compliance vehicles rather than clinical improvement vehicles.
Will PCN-level commissioning replace practice-level contracting? This is the structural question that makes many GPs anxious. If services are increasingly commissioned at PCN level rather than practice level, the independent contractor model erodes — and with it, the GP autonomy that many consider non-negotiable.
The honest assessment: PCNs have delivered some real benefits (workforce, scale, collaboration) while imposing real costs (bureaucracy, supervision burden, political complexity). Whether the net effect is positive depends entirely on local execution — which is another way of saying that the model is only as good as the people running it.
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