Primary Care Networks are entering 2026/27 with a clearer and more ambitious role than ever before. The direction set through the GP contract and PCN DES is consistent:
- Improve access
- Make better use of multidisciplinary teams
- and deliver care at scale for local populations
Alongside this, there is an increasing emphasis on responsiveness, patient experience, and prevention.
While these priorities are well understood, the reality on the ground is more complex. Many PCNs are finding that the challenge is no longer about agreeing the vision, but about translating it into something that works operationally across multiple practices. The question is shifting from “what do we need to deliver?” to “how do we actually deliver this consistently across a network?”
One of the most significant barriers to this is the way access is currently managed. Despite the move towards network-level thinking, most access models remain rooted in individual practices. Demand is still largely handled separately, workflows vary between sites, and patients experience different routes into care depending on which practice they are registered with. This creates variation, inefficiency, and limits the ability of PCNs to truly function at scale.
This becomes particularly evident when looking at workforce utilisation. PCNs now have access to a wide range of roles through the Additional Roles Reimbursement Scheme (ARRS), including pharmacists, paramedics, physiotherapists and social prescribers. However, without a consistent way of managing incoming demand, it is difficult to ensure patients are directed to the most appropriate professional. In many cases, patients continue to default to GP appointments, while reception teams manually redirect requests, creating additional workload and reducing the impact of the wider workforce.
A similar challenge exists in relation to enhanced and extended access. While capacity may exist across a network, it is often not visible or easily accessible to patients. Without a shared approach to managing demand, practices continue to operate in silos, and opportunities to utilise capacity more effectively at PCN level are missed. This can lead to situations where one practice is overwhelmed while another has availability, simply because there is no mechanism to balance demand across the system.
At the same time, expectations around access and responsiveness are increasing. Practices are expected to respond to urgent need on the same day, offer online consultation routes throughout core hours, and improve overall patient experience. When layered onto existing ways of working, this creates significant pressure. Many teams are now trying to manage telephone demand, online requests, walk-ins and messaging simultaneously, often without a clear or consistent model underpinning how these routes work together.
This is where the concept of the “front door” becomes critical. Across most PCNs, patients now have multiple ways to access care, including telephone, online consultation tools and app-based routes such as the NHS App. However, these routes are rarely joined up. Patients may use more than one channel for the same issue, urgent requests can be hidden within digital queues, and there is often no single view of total demand across the network. This makes it extremely difficult to manage workload effectively or to deliver care in a coordinated way.
To address this, PCNs need to move towards a more consistent, network-level approach to access. This starts with establishing a shared triage model, where all requests are assessed in the same way regardless of how or where they enter the system. A consistent approach to prioritisation and routing enables patients to be directed to the right professional or service first time, supporting better use of the multidisciplinary team and reducing unnecessary GP appointments.
Alongside this, there is a need for greater visibility of demand. Understanding what is coming into the system, when it is arriving, and how it is being managed is essential for effective capacity planning and workforce deployment. At PCN level, this insight becomes even more important, as it allows networks to identify variation between practices and take a more coordinated approach to managing workload.
There is also a clear need to move beyond practice-level thinking. Delivering the ambitions set out in PCN DES requires networks to consider how access can be managed across a population, rather than within organisational boundaries. This includes exploring shared access models, developing consistent patient experiences, and creating mechanisms for routing demand across practices and services where appropriate.
Digital tools can support this shift, but only when they are aligned to a clear operational model. When used effectively, they can help to structure incoming demand, support consistent triage, enable communication with patients, and provide visibility across teams and organisations. Platforms such as those developed by Engage Health Systems are designed with this type of approach in mind, bringing together triage, communication and workflow management into a more unified system. However, the technology itself is only one part of the solution. The real impact comes from how it is used to support a consistent and scalable model of access.
Looking ahead, this challenge will only become more significant as the NHS continues to move towards neighbourhood working. The ambition is to deliver care across organisations, with shared responsibility for defined populations and a greater focus on prevention and proactive care. To achieve this, there needs to be a coherent and coordinated way for patients to access services, alongside the ability to manage demand across a wider system.
Alongside this, there is a need for greater visibility of demand. Understanding what is coming into the system, when it is arriving, and how it is being managed is essential for effective capacity planning and workforce deployment. At PCN level, this insight becomes even more important, as it allows networks to identify variation between practices and take a more coordinated approach to managing workload.
There is also a clear need to move beyond practice-level thinking. Delivering the ambitions set out in PCN DES requires networks to consider how access can be managed across a population, rather than within organisational boundaries. This includes exploring shared access models, developing consistent patient experiences, and creating mechanisms for routing demand across practices and services where appropriate.
