Is the 26/27 GP Contract the Beginning of the End for PCNs?
- 5 days ago
- 5 min read
Is the GP Contract the Beginning of the End for PCNs?
Tara asked Ben Gowland, Director of Ockham Healthcare, former CCG chief exec, and one of the most experienced voices in primary care, this question directly. His answer was neither a clean yes nor a reassuring no.
"PCNs are not ending. But the version of PCNs that sits at the top of the primary care hierarchy .....that version is changing. And most PCNs haven't registered it yet".
This week's blog summarises the conversation Tara recently had with Ben on the Business of Healthcare Podcast.
Let's jump in!
This is what Ben had to say.
What the 26/27 GP contract letter actually signals
The financial headlines are not good. The uplift is roughly half of last year. The capacity and access payment is moving directly to practices, which will hit hardest the PCNs that were using it most creatively and collaboratively.
But the more significant signal is structural. Ben's reading of the letter is clear: there is a deliberate positioning of neighbourhoods above PCNs. The language asks PCNs to align to neighbourhoods, not the other way around. That is not an accident. It reflects where national thinking is heading.
The 10 Year Plan frames the neighbourhood as the organising unit of health and care. Not the PCN. The neighbourhood includes GPs and their PCN, but it also includes community trusts, social care, the voluntary sector, and acute providers, all working collectively around the needs of a local population rather than the priorities of any single organisation.
"PCNs represent GP practices working in a neighbourhood area. But in that area, you also have the community trust, social care, the voluntary sector, and a whole range of providers. The neighbourhood is asking whether all of those can organise care around patients rather than around organisations. That is a really important distinction".
The geographical footprint may look the same. The scope of what sits inside it is entirely different.
So is this the end of PCNs?
Ben does not think so, and his reasoning is worth understanding. NHS England does not want to return to individual practices working in isolation within neighbourhoods. The PCN structure still serves a function. GP practices working collectively still matter.
But the primacy is shifting. The question is no longer whether PCNs will exist. It is whether your PCN will have a meaningful role in shaping what the neighbourhood becomes, or whether it will be one small component in a structure that someone else has designed and is leading.
That distinction is everything.
"PCNs, as part of neighbourhoods, feel like the future. PCNs as the future — that is less certain".
Ben sees that the PCNs most at risk are not the ones that will be abolished. They are the ones that will find themselves on the receiving end of decisions made by ICBs, community trusts, or acute providers who moved faster, convened earlier, and established themselves as the natural leaders of the neighbourhood before anyone else did.
The neighbourhood leadership gap and why it matters now
Here is the practical problem. The neighbourhood is not yet a formal entity in most parts of the country. There is no neighbourhood board, no neighbourhood contract, no neighbourhood leader. That gap will not stay empty for long.
Ben's observation from working with PCNs across the country is that most neighbourhood relationships, where they exist at all, are bilateral and project-based. A PCN has a relationship with someone at the community trust because they are working on a specific project. A separate relationship with someone in the voluntary sector for a different project. Those relationships do not interact. There is no collective.
What is missing, and what Ben argues PCNs should be actively creating, is a neighbourhood forum. Not a project group. A genuine coming together of the leaders of all the organisations working in a local area to ask: what are the real problems for our population, and what do we think needs to happen?
"If you convene the neighbourhood, you become the default leader of it. That will matter more in the future than it might feel like it matters right now".
That act of convening is strategic as much as it is practical. It establishes the PCN's voice. It builds the cross-organisational relationships that will be essential when neighbourhood contracts and structures are formalised. And it means that when ICBs or national bodies look for who should hold a neighbourhood contract, there is already an answer.
The risk of waiting
The uncertainty of this moment makes waiting feel reasonable. The neighbourhood framework is still being defined. The contract is disappointing, but the full picture is not yet clear. Why commit to a direction before the destination is known?
Ben's response to that instinct is direct. Waiting is not a neutral position. It is a choice, and it has consequences. Every month spent watching from the sidelines is a month in which other organisations are building the relationships and the credibility that will determine who leads when the structures are formalised.
"The information is not going to get cleaner. The picture is not going to get clearer before you need to act. A bad decision is still better than no decision".
The leaders who will thrive in the neighbourhood era are not the ones who wait for certainty. They are the ones who made a calculated decision to move, knowing the risks of acting and knowing that the risks of not acting are just as real.
Three things PCN leaders should do now
Ben's practical advice distils to this:
Convene your neighbourhood. Get the leaders of the organisations working in your patch into a room, not around a project, but around a question. What are the biggest problems for our population, and what could we do together about them? Do this before someone else does.
Build the right relationships. Not with organisations, with individuals. Find out who in the community trust, the local authority, and the voluntary sector is credible, senior, and willing to engage. Ask people who have been in the system a long time who the right people are. Then go and meet them.
Think about redesign, not just delivery. The centre is not looking for PCNs to deliver the same care in a cheaper setting. It is looking for genuinely different models, where the majority of follow-up activity, for example, happens outside the hospital with expert support rather than in outpatients. PCNs that bring ideas about what that could look like in their neighbourhood will find more appetite than those asking about contract vehicles.
Listen to the full podcast here:
PCN Plus Live 2026 Is Coming...
We’re also excited to announce that PCN Plus Live 2026 is just around the corner.
This year’s event will focus on one of the biggest questions facing primary care: How do we move from networks to neighbourhoods?
Hear Ben Gowland speak at PCN Plus Live 2026 in Nottingham on 22 April, alongside leaders from across the country sharing what is actually working on the ground.
In-person and online tickets available.
About Us
THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network Management and the creator of the Business of Healthcare Podcast. With over 20 years in the industry, we've supported more than 200 PCNs through interim management, training, and consultancy.
Our expertise spans project management and business development across both private and public sectors. Our work has been published in the London Journal of Primary Care, and we've authored over 250 blog posts sharing insights on primary care networks.
Check out our facilitation services here: https://www.thcprimarycare.co.uk/primary-care-network-facilitation
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