The Removal of the Capacity and Access Payment: What PCN Leaders Can Still Choose to Do

I appreciate this view may not be popular, but the removal of the Capacity and Access Payment (CAP) from the PCN budget does not have to be an all-or-nothing story.

The contract has taken the money away, but nothing stops a network and its practices from deciding together what to do next, and I want to talk about what networks can still choose to do inside that reality, as this does not mean automatically staff will be made redundant and services will be cut.

Let's jump in!

What the Capacity and Access Payment was being used for

The guidance was permissive, and PCNs used it differently. Across the networks I have worked with over the years, four uses came up repeatedly.

The first was topping up salaries above the ARRS maximum reimbursable rate. When NHS pay uplifts landed, and the maximum claimable rate did not move at the same pace, CAP bridged the gap. Without it, some PCNs face a choice between absorbing the shortfall, reducing hours, or risking turnover.

The second was tools, technology, and digital infrastructure. Triage platforms, population health management dashboards and online consultation tools. None of these sits inside an ARRS role or a specific DES requirement, and there is no direct replacement for them in 2026/27.

The third was admin and coordination with projects part-funded through CAP, particularly in smaller networks where core funding was not enough on its own.

The fourth example, the CAP, went straight back to practices. For those practices, the new arrangement does not require additional money; it is the same pot routed directly rather than through the PCN.

The new PCN financial envelope

None of what follows is meant to minimise the reduction. But CAP did not exist in isolation, and neither should your planning. The rest of the contract has moved too, and the picture at a network level depends on where.

Core PCN Funding has increased to £3.059 per patient, up from £2.999. Enhanced Access has risen to £8.903, from £8.427. The care home premium has been uplifted. The ARRS sum has increased from £26.631 to £27.668 per adjusted population, and the GP reimbursement ceiling has risen from £105,882 to £152,900.

These uplifts do not replace what CAP was doing. But for individual networks with headroom in their ARRS budget, the GP ceiling uplift alone may reduce or eliminate the salary top-up problem CAP was previously solving.

Reforecast every funding line against your current commitments before you make decisions about staffing, tools, or services. The national picture and your local picture are not the same.

There is precedent for practices choosing to pool money

In a lot of the talks I give, I use the example of networks where practices agreed to put their practice participation money into the PCN pot, with the arrangement that anything unspent at the end of the year was handed back to practices. A contingency, in effect. Nothing in the contract required them to do that. They chose to, because the pooled money made something possible that they could not have done individually.

That principle still stands. Practices will receive their share of the CAP funding directly. Nothing stops a network, where practices agree, from redirecting a portion back to PCN level. It does not have to be all of it. A proportionate contribution from each practice may be enough to protect a shared coordinator role, a clinical system, or the salary supplements keeping a valued post in place.

The harder conversation is about visibility and impact

This is where it gets difficult. Some of what CAP was funding, whilst supporting the practices, may not be directly felt by the practice.

Data management tools, PCN leadership capacity, shared infrastructure. The PCN benefits, the network-level work improves, and practices benefit indirectly from better data or more coordinated services. But they are not the visible recipient of the spend, and that is what makes the conversation difficult.

Persuading practices to put money back into roles and tools they do not directly experience is the part that will take real leadership. It is not enough to say the spend is valuable. You have to make the case in a way that shows the practice what it gains, even if what they gain is not felt in the consulting room the following week. That is a harder conversation than redistributing a salary top-up, and it is the one worth preparing for first.

Where this leaves PCN leaders

The networks that treat this as a planning exercise rather than a loss will be better placed, not only for this financial year but for the contracting changes coming in 2027. The flexibility CAP gave you can, in large part, be recreated. It requires a conscious decision, a transparent conversation, and the kind of collective leadership good networks already have.

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