The Latest NHS Policies and Guidance Affecting Primary Care Networks - The March 2026 Update

3 days ago
5 min read

At THC Primary Care, we create resources for primary care leaders.

This quick update captures the latest developments affecting primary care networks (PCNs) as of 9th March 2026, keeping you up to speed.

1. The GP Contract 2026/27

Published 24 February 2026. Total contract investment increases by £485 million to £13,863 million, a 3.6% cash increase, or 1.4% in real terms.

GP Reimbursement Scheme — CAIP is removed

The £292 million Capacity and Access Payment (CAIP) has been removed from the Network Contract DES. This is being repurposed into a new practice-level GP reimbursement scheme, enabling practices to recruit additional GPs or fund more sessions from existing GPs to support same-day urgent access.

What this means for PCNs

Funding that previously flowed at PCN level now goes directly to practices. It’s time to have a conversation to see how these changes affect your network.

ARRS: GPs no longer restricted to recently qualified

The restriction limiting ARRS GP recruitment to recently qualified GPs has been removed. The maximum reimbursement rises to the top of the salaried GP pay range plus on-costs. PCNs may also recruit a broader range of ARRS roles, where agreed with the commissioner.

What this means for PCNs

Your ICB may start looking more closely at how the ARRS spend maps to role mix, utilisation, and impact on access and capacity, so workforce decisions should be made with that visibility in mind. Broader role recruitment also requires commissioner agreement, so have those conversations early.

Access requirements

Clinically urgent requests must be dealt with on the same day.

The practice determines what is clinically urgent. Practices must not ask patients to call back on another day.

For non-urgent contacts, an appropriate response is required by the end of the next working day. Online consultation systems must not cap requests during core hours. Where unwarranted variation is identified, practices must engage with ICB support.

What this means for PCNs

ICBs are explicitly required to identify practices struggling to deliver access and plan support or intervention accordingly. The national targets are 90% same-day appointments for all clinically urgent patients and year-on-year improvement in patient experience of access.

Individual practice performance shapes how the entire network is understood by the ICB , not just that practice.

For a fuller picture, read The GP Contract 2026/27 and the Neighbourhood Health Delay: Piecing Together What We Know, which places the contract letter from Dr Amanda Doyle alongside the HSJ's reporting that neighbourhood provider contracts won't arrive until 2027–28 at the earliest.

QOF, neighbourhood alignment and care home vaccinations

QOF gains 18 additional points (c.£25 million), with new obesity, diabetes and heart failure indicators. A new improvement threshold for childhood vaccination QOF indicators allows practices to earn points by improving against their own baseline, useful for practices in more deprived areas that may not reach absolute thresholds.

PCNs are required to work with their ICB on greater alignment between PCN registered lists and neighbourhood boundaries where these do not match — applying only in limited circumstances, not as a signal of widespread reconfiguration ( supposedly .

PCNs must ensure eligible care home residents are identified and offered seasonal and routine vaccinations. The obligation is to have arrangements in place, not necessarily to deliver vaccinations directly.

2. GPC Rejects the Contract Proposal

Published 27 February 2026. Three days after the contract changes were announced, the BMA's GPC England committee overwhelmingly rejected them. The committee's primary objections centred on the requirement for same-day access for clinically urgent patients and the prohibition on capping online consultation requests when practices are at full capacity.

GPC chair Katie Bramall described the proposals as impossible to implement given current pressures, citing the loss of over 6,000 GP partners, around 28 per cent since 2015 and declining continuity of care.

The committee called on the Government to return to direct negotiations rather than imposing a contract.

A ballot of all GPs and GP registrars in England ran from 4 to 25 March 2026. The Government confirmed the changes will be imposed from 1 April 2026, regardless of the outcome.

Context for PCN Leaders

The contract changes in Section 1 are those that the GPC rejected.

Monitor the ballot outcome as it may affect how practices engage with the new access requirements from April, particularly same-day urgent care.

3. NHS England Direct Commissioning Update

Published 2 March 2026. This update sets out how NHS England will transfer its direct commissioning responsibilities to ICBs as NHS England is abolished.

For primary care, this is less of a structural change than it may appear. GP, dental, pharmacy and ophthalmic services were already delegated to ICBs in 2022 and 2023. What changes is that delegation becomes full legal accountability.

A number of primary care functions will transfer not to ICBs but to the Department of Health and Social Care, including the Performers List for England, responsible officers, controlled drugs, capital expenditure, and national support services.

Offices for Pan-ICB Commissioning (OPICs)

For other services transferring from NHS England, one Office for Pan-ICB Commissioning will be established per NHS region, hosted by a single ICB. NHS England regional staff transfer into OPICs from April 2027. ICBs must identify their regional host ICB by end of April 2026.

What this means for PCN Leaders

Your ICB is becoming the full legal commissioner for your contract. Whether or not it hosts the OPIC, the commissioning relationship that matters most for PCNs is now squarely at the ICB level.

Understanding how your ICB is developing its commissioning capability and where neighbourhood health sits in its priorities is importnt if your want influence.

4. What ICBs Will Actually Be Tracking

At present, there is no nationally published matrix for how ICBs will assess PCN performance. But the picture is forming.

The Strategic Commissioning Framework and Medium Term Planning Framework both signal a shift towards more active primary care oversight — ICBs are being told to undertake risk-based assessment, apply contractual levers, and intervene where necessary.

The contract changes in Section 1, and the commissioning shift in Section 3 sit within this context.

The message to practices

When your management team asks for data or raises questions about access or the workforce, this is the backdrop.

Based on the frameworks, ICBs are likely to assess PCNs across six areas:

Area	What ICBs will look at
Access	Same-day urgent, mode of contact, continuity
ARRS	Spend, role mix, utilisation, impact
Priority cohorts	Utilisation, admissions, costs for frail/housebound/care home/end of life
Collaboration	Partnership maturity, integration, place-based contribution
Quality signals	Complaints, incidents, feedback trends
Contract delivery	Enhanced access, DES requirements, digital adoption

PCN performance is collective. If one practice is underperforming, it affects the whole network, financially and strategically. Your performance shapes how the entire network is understood by the ICB.

Beyond the data

ICBs won't rely on numbers alone. The frameworks require triangulation with complaints data, 'You and Your General Practice' intelligence, Freedom to Speak Up reports, Patient Safety Incident Response Framework data, and feedback from patients and staff. If your ICB only knows you through data submissions, they will draw their own conclusions.

Evidence your performance and build the relationship.

We hope this helps.