Where does the money sit in a primary care network, who can see it, and whose is it?

(Part of the series: How Primary Care Networks work, why sometimes they don't, and lessons for neighbourhood working.)

This series takes primary care networks apart component by component, the way Ian Dunt does for Westminster, and asks what each part is actually for. The aim is to work out what neighbourhood working needs to do differently, before the same mistakes get built into the next structure.

Part one covered what a PCN is: not an organisation, a contract, signed by practices, with no legal personality of its own. Part two covered who leads it: roles carrying real responsibility with no formal mechanism behind them.

This part looks at where the money sits, who can see it and who it belongs to, rather than going through every budget line.

There is a section in Ian Dunt's How Westminster Works... and Why It Doesn't on the Treasury. His argument is that the Treasury's power does not come from statute. It comes from controlling the money. And once you control the money, everything else arranges itself around you.

In a primary care network, the practice that holds the money holds the power.

How does the money reach a network?

A PCN is not a legal entity, so its money goes to a nominated payee. In the networks I have worked with, that is usually one of the member practices. It receives the core funding, the ARRS reimbursement and most of the other network income, and then pays it out or spends it on the network's behalf. The Network Participation Payment is the exception. It goes straight to each practice.

The DES allows other options. A GP federation or another non-GP provider can be the nominated payee, or a separate bank account can be linked to the PCN. Those options change where the money lands. On their own, they do not change who sees it first.

The payee is usually chosen once, early and quickly. Whichever practice had the capacity, or the finance manager, or the willingness. In the networks I have worked with, the choice is rarely revisited.

Who can see the finances?

The payee practice can see the network's full financial position. The other practices see what they are sent. That gap is where the power sits. The payee does not need to act in bad faith for it to matter. It sees the underspend first, knows which costs are about to land, and frames the options before anyone else has the figures.

The questions I am asked most often are about how far that visibility should go. How much should the board see? Should practice managers see the finances if they are not board members? Should board members see the salaries of ARRS staff?

My answer is full transparency. In my experience, withholding information breeds distrust, and once trust breaks it affects every decision that follows. Each board sets its own rules, but I would start from the position that every practice can see what the payee sees.

Some boards do not want to see how every penny is spent, and in a network with high trust that can work.

In the networks I have governed, how much a board needed to see depended on the level of trust and the culture the network had built. I wrote about this in Whose Money Is It Anyway. When trust is low, the payee’s view of the figures becomes the only view there is, and a network cannot settle who the money belongs to when only one practice can see it.

Who does the money belong to?

How a network sees its money matters as much as where it sits.

In some networks the money comes in and goes straight out again. The network is a funnel, a mechanism for bringing money into practices. In others, the network holds the money and decides together how to spend it.

In Whose Money Is It Anyway, I described three money mindsets. 

Poolers see the funding as owned by the network. They want joint decisions, support hub-based services, and are comfortable with top-slicing for management and a contingency fund. 

Keepers see their practice list as their investment and expect a return in proportion to it. They want each practice to receive its share, and they ask where their allocation is. 

Sharers sit in between. They will back shared services as long as some of the money comes back to practices.

A proposal for a hub-based service reads as investment to a Pooler and as a deduction from their share to a Keeper. When the paper does not name that, the disagreement shows up as a question about recurrent cost when it is actually a question about ownership. If the ownership question is unresolved, no amount of financial detail will settle it.

Allocation is where the Keeper view shows most clearly. My colleague Ben Gowland describes an unwritten rule that network money is shared by list size, so the smallest practice receives the smallest share. In the networks I have worked with, it is the default, because it is simple to explain and hard to argue with.

A small practice with a complex patient cohort may be entitled to half a day a week of pharmacist time, which is too little to make a difference. Splitting by list size treats the money as belonging to each practice in proportion to its patients. A network that wants to weight for need has to agree first that some of it is spent as a network.

The same split shows up in ARRS. Some practices want the roles to help with QOF because core funding is under pressure, and network leads point out the roles are meant to be additional.

The practices are the network, so in one sense the money is always theirs. What differs is how they see the network. Keepers treat it as the sum of its parts, so each practice takes its share. Poolers treat it as more than the sum of its parts, so some of the money is spent together. How the money is allocated follows from which view the network settles on.

What does this mean for neighbourhoods?

Neighbourhood working raises the same three questions, with more organisations involved. Who holds the money, who can see it, and who it belongs to. Does the neighbourhood have a pooled budget? The answer decides where the power sits.

Without a pooled budget or income of its own, whatever authority a neighbourhood is given on paper, the arrangements will shape themselves around whoever holds the cash. That will be the organisations that already exist, with their own boards, their own priorities and their own year end. Structure will follow the money.

With a pooled budget, the questions move up a level. Under an Integrated Health Organisation, an NHS foundation trust holds a single pooled budget for a defined population and can subcontract delivery to general practice, PCNs and federations. GMS sits outside the pool. The PCN DES is expected to as well, but that has not been confirmed in writing. The host trust holds the account, and practices are the ones waiting to be told. For practices, that could mean even less control over decisions than they have in a PCN today.

This kind of arrangement has been tried before. UnitingCare Partnership collapsed in 2015, eight months into an £800 million contract. The National Audit Office found that one of the trusts had an internal business case assuming it would need over 20% more than the bid, and that was never shared with the commissioner. One organisation could see a figure the others could not.

Ask early, before the terms of reference, the membership list and the launch event. Where does the money sit? Who can see it? Whose is it? And who decides how it is spent?

Answer those and the rest of the governance becomes easier. Leave them, and you will be having the same conversation in eighteen months, with less goodwill than you have now.

Next time, representation and relationships: who speaks for each practice around the table, and why the relationships between practices do more to settle disagreements than any terms of reference.

Work with us

If your network has never agreed whose money it is, who decides how it is spent, or what every practice gets to see, that conversation goes better with somebody neutral in the room. THC Primary Care facilitates those sessions for networks, and for neighbourhoods being set up now. Details at thcprimarycare.co.uk.

Part of the series

Want to understand more about Primary Care Networks? Read our blogs;

• What is a primary care network, what is its history, and why is it so hard to run?

• Who leads a primary care network, and what authority do they hold?

About the Author

Tara Humphrey has supported over 300 primary care networks across England, providing interim PCN management, training, events and facilitation.

Tara also holds an MBA in Leadership and Management in Healthcare and has written over 300 blogs and hosted the Business of Healthcare Podcast, which has published over 370 episodes.

Facilitation Support

If your network would benefit from a neutral voice for those tricky discussions, we provide in-person facilitation.

Contact admin@thcprimarycare.co.uk to discuss the support you may need.

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Sources

• Dunt, I. (2023) How Westminster Works... and Why It Doesn't. London: Weidenfeld & Nicolson.

• NHS England (2026) Network Contract DES: Contract specification 2026/27, PCN requirements and entitlements. Published 26 March 2026.

• NHS England (2026) Network Contract DES guidance for 2026/27: Part B Guidance, Non Clinical. Published 30 April 2026. Sections 10.2 and 10.3.5, nominated payee.

• THC Primary Care (2026) What has changed in the PCN DES 2026/27? 27 March 2026.

• THC Primary Care (2025) Primary Care Network Funding: Whose Money Is It Anyway? 28 September 2025.

• THC Primary Care (2026) Integrated Health Organisations: Risk and Gain Contracts Explained. 22 September 2026. https://www.thcprimarycare.co.uk/post/integrated-health-organisations-what-the-risk-and-gain-contract-inside-them-actually-means

• National Audit Office (2016) Investigation into the collapse of the UnitingCare Partnership contract in Cambridgeshire and Peterborough. HC 512, 14 July 2016.