NHS England has published a variation to the Network Contract Directed Enhanced Service (DES) Specification 2026/27 and Part B guidance, effective from 1 May 2026. The update allows Integrated Care Boards (ICBs) to request local variations to the Network Contract DES, creating greater flexibility to tailor arrangements to local circumstances where existing contractual routes may not be sufficient.
Alongside the updated specification, NHS England has also published an explanatory note outlining the changes introduced from May 2026.
While the headlines focus on Primary Care Networks (PCNs), the implications for individual practices could be significant.
Traditionally, locally commissioned services and enhanced services have largely sat at practice level. This change potentially creates a new route for commissioners to commission services directly at PCN level instead.
For practices, that presents both opportunity and risk.
A potential opportunity for delivery at scale
For many years, practices and PCNs have tried to find practical ways to deliver certain services at scale where that makes operational and clinical sense. In some areas, PCNs have already coordinated delivery of locally commissioned services across member practices, but contractual and payment arrangements have often still needed to flow back through individual practices.
These local variation arrangements may now provide a more formal mechanism for commissioning services directly at PCN level where appropriate.
For some networks, this could create opportunities to:
- Deliver services more efficiently across a larger population
- Reduce duplication across practices
- Build shared workforce models
- Develop more sustainable delivery arrangements for services that are difficult to provide at individual practice level
- Strengthen the role of the PCN as a provider vehicle within the local system
Where services genuinely benefit from being delivered collaboratively, this change could help remove some of the contractual complexity that has previously limited innovation.
But there are also risks practices should consider
The flip side is that commissioning at PCN level could alter the balance between practices and their network.
If services are commissioned directly through the PCN, practices will want to understand:
- How decisions about service delivery will be made
- Whether all member practices will participate equally
- How funding flows will operate
- How activity and workload will be distributed
- What governance arrangements will apply
- Whether some services could move away from individual practice delivery altogether
In some cases, practices may be concerned that work traditionally delivered — and funded — at practice level could be consolidated elsewhere within the PCN structure.
That makes early engagement and alignment across member practices particularly important.
Conversations practices should be having now
Although local variation arrangements will depend heavily on individual ICB approaches, practices and PCNs would be well advised to start discussing:
- Which services genuinely lend themselves to PCN-level delivery
- What principles should underpin decision-making
- How income and workload should be shared fairly
- Whether existing PCN governance arrangements are robust enough
- How to ensure all practices have a voice in future discussions with commissioners
For GP partners and practice managers, this is likely to become an important strategic conversation over the next 12 months.
The changes may ultimately provide a more practical contractual route for collaborative service delivery at scale — but the success of these arrangements will depend heavily on how aligned practices within each PCN are, and how proactively they engage with the opportunities and risks involved.
Related Webinar
These DES changes also connect to wider conversations around PCN structures, neighbourhood working and commissioning at scale.
We recently hosted a legal and financial webinar exploring the opportunities and risks associated with different PCN models, including companies, VAT exposure, workforce liability and future neighbourhood contracts.
For GP Partners, Practice Managers and PCN CDs, it provides useful context alongside these latest Network Contract DES changes.
Join the Enhanced Primary Care Facebook group to watch the full recording, access the slides and continue the discussion.