Just like buses, you wait months for clarification on the future direction of Primary Care and then two crucial documents drop at once! As we move into the 2026/27 financial year, the des Directed Enhanced Service (DES) and the Fit for the Future guidance arrive just in time to fill in some gaps.
For PCN Clinical Directors and Operations Leads, 2026/27 is a transition year. While the DES provides the immediate operational framework, the Fit for the Future blueprint sets out the likely destination. While there is much that still needs clarifying the direction of travel seems to be the evolution into Single Neighbourhood Providers (SNPs).
Here is a breakdown of the definitive changes for 2026/27 and how they frame the shift toward an integrated neighbourhood health model.
Changes To The Additional Roles Reimbursement Scheme (ARRS)
The 2026/27 Network DES Additional Roles sets out the newest changes to the Additional Roles Reimbursement Scheme (ARRS). This year ARRS remains a PCN’s most significant financial lever. The scheme moves further away from a restrictive list toward a broader clinical team model, mirroring the Integrated Neighbourhood Team (INT) ambition.
Key Changes:
- GP Integration: The 2026/27 contract formally incorporates General Medical Practitioners into the ARRS framework (with a salary maximum of £118,759 plus on-costs). This is a strategic move to bolster core capacity and move away from emergency recruitment.
- Nursing Flexibility: Greater freedom to recruit across nursing bands allows PCNs to build blended teams that span both specialist and generalist care.
- The Funding Hook: The ARRS sum is now calculated at £27.668 multiplied by the PCN Contractor Weighted Population.
The Neighbourhood Context:
The Fit for the Future guidance envisions a Single Neighbourhood Provider holding a unified contract for a population of 30,000–50,000. By bringing GPs and a wider nursing cohort into the ARRS now, is NHSE effectively ‘pre-loading’ the workforce that will eventually sit within new SNP entities?
Streamlining for Clinical Autonomy (and Accountability)
The DES sets out ‘streamlined’ service requirements. But, it’s crucial to note that this isn’t a reduction in workload, it’s a shifting focus toward population health outcomes.
Key Changes:
The 2026/27 Network DES mandates four core functions that align directly with the new Neighbourhood Health Framework:
- Coordinating Shared Resources: Improving operational efficiency across the network.
- Population Health Outcomes: A sharp focus on CVD prevention and Early Cancer Diagnosis (FIT testing remains a top priority).
- Targeted Resource Allocation: Proactive care for frailty and Structured Medication Reviews (SMRs).
- Collaboration: Formalising links with non-GP providers to form the backbone of INTs.
The Neighbourhood Context:
The changes align with the government’s stated aims of giving PCNs the clinical autonomy needed to adapt to local needs. Owning the outcome for your specific geographic and population region will help ease the shift to neighbourhoods.
Enhanced Access and Standard Hours
Enhanced Access has been a hot topic, and a common theme running through all published documents this year, from the GP contract to the DES. The new Network Agreement adds some practical guidance on how to achieve this with the introduction of a “Network Standard Hours” model, providing the predictable capacity required for a neighbourhood-level service.
Key Changes:
- Capacity: A minimum of 60 minutes of additional appointment time per 1,000 adjusted patients per week.
- Standardisation: Delivery must occur between 6:30 PM – 8:00 PM (weekdays) and 9:00 AM – 5:00 PM (Saturdays).
- Funding: Set at £8.903 per adjusted patient.
The Neighbourhood Context:
Under the Fit for the Future blueprint, the SNP will eventually be the accountable provider for “out-of-hospital” care in a neighborhood. Standardising access now, opens the gates to the more complex integrated pathways (like community diagnostics and mental health) that will follow in 2027/28 and beyond.
Simplified Financial Entitlements
The Investment and Impact Fund (IIF) has been radically simplified, reducing administrative noise but increasing the pressure on remaining targets.
Key Changes:
- Two Core Indicators: LD Health Checks and Cancer FIT testing are the survivors of the IIF cull.
- Point Value: Each point is now worth £198.00.
- Core PCN Funding: Fixed at £3.059 per patient.
The Neighbourhood Context:
The move to fewer, high-value indicators is likely a precursor to the Outcome-Based Contracts described in the blueprint. NHSE is moving away from micro-managing individual tasks and toward rewarding providers who can demonstrably improve the health of their 50k population.
2026/27 – The Year of Alignment
PCN leaders should view the 2026/27 DES not as another set of rules, but as a potential readiness test.
The “Fit for the Future” guidance confirms that the neighbourhood is now the official organising unit of the NHS. While much of the detail regarding the final SNP contracts is still being refined, the direction of travel seems set.
The strategic priority for this year seems to be alignment. PCNs need to ensure their governance, their ARRS workforce deployment, and their data sharing are robust enough to transition into a permanent provider entity.
For Medacy partners, the focus is on governance, adaptability and centralised management of decentralised teams. By leveraging the 2026/27 flexibilities today, you are building the infrastructure for the neighbourhood health model of tomorrow.
For a detailed consultation on how to align your 2026/27 DES delivery with the Fit for the Future blueprint, contact the Medacy team today.
