The PCN DES (Primary Care Network Directed Enhanced Service) is the contractual framework that governs how Primary Care Networks receive funding for delivering specific healthcare services. It sets out requirements for workforce planning, service delivery, quality standards, and reporting that networks must meet to maintain funding and avoid financial penalties.
For network managers coordinating these requirements across multiple independent practices, each with different clinical systems and operational pressures, compliance can be challenging. Understanding the most common compliance mistakes and how to prevent them helps networks maintain their obligations whilst focusing on patient care.
ARRS Claims Errors
Additional Roles Reimbursement Scheme claims errors represent one of the most frequent compliance issues facing networks. Monthly claims require precise information about employment dates, salary costs, working patterns, and the specific ARRS role categories under which reimbursement is being claimed.
Problems typically arise when claims lack complete supporting documentation, fail to properly account for staff working across multiple PCNs, or include staff who don’t meet the eligibility criteria for their claimed role category. These discrepancies between submitted claims and employment records trigger payment delays or clawback requirements that create unexpected budget pressures.
Preventing Claims Problems
Effective claims management requires discipline and clear processes:
? Implement monthly reconciliation that verifies all claim details against employment records before submission
? Designate one person responsible for ARRS administration to ensure consistency
? Maintain comprehensive documentation including employment contracts, job descriptions, timesheets, and evidence of role-specific qualifications
This documentation provides the audit trail needed when Integrated Care Boards review or challenge claims.
Missing Service Delivery Deadlines
PCN DES specifications include numerous deadlines throughout the contract year for service implementation, reporting submissions, and achievement milestones. Networks miss these for various reasons: inadequate tracking systems, communication gaps between practices, or underestimating the preparation time required.
The financial impact can be substantial. Achievement payments have specific claiming windows, and missing these means forfeiting income for that entire contract year.
A compliance calendar that maps all deadlines helps networks maintain visibility. This should include internal milestones for preparation, review, and approval processes, not just final submission dates. Monthly compliance meetings allow network managers and clinical directors to review upcoming requirements, assess progress, and identify risks. Including practice representatives in these meetings ensures network-wide awareness of obligations.
Documentation Failures
Many compliance problems stem from inadequate documentation rather than poor service delivery. Networks may provide good patient care but struggle to demonstrate this through proper records during audits or performance reviews.
Common documentation weaknesses include:
? Incomplete patient records for DES-specified services
? Missing evidence of clinical governance processes
? Inadequate workforce planning documentation
? Poorly maintained records of network meetings and decisions
Clear documentation standards across all member practices addresses this issue. Standards should specify what information needs recording, in what format, and required retention periods. Where practices use different clinical systems, protocols for information sharing and consolidation prevent gaps in compliance reporting.
Quarterly documentation audits identify problems whilst there’s time to address them, rather than discovering gaps during year-end reviews when rectification is more difficult..
Strategic Workforce Planning Gaps
PCN DES requires networks to demonstrate workforce planning aligned with population health needs. Some networks approach ARRS recruitment opportunistically, hiring available candidates without systematically analysing whether their skills address the network’s priority service gaps.
This approach creates problems during Integrated Care Board reviews and can result in staff having insufficient appropriate work, reducing both cost-effectiveness and job satisfaction.
Building Evidence-Based Plans
Effective workforce planning begins with population health needs assessment. Networks should analyse:
? Patient demographics across member practices
? Prevalence data for key conditions
? Service utilisation patterns
? Existing workforce capacity and identified gaps
This analysis should inform targeted recruitment decisions. Job descriptions and service specifications for ARRS positions need to clearly articulate how each role addresses specific identified population health needs.
Communication Breakdowns Between Practices
PCN compliance requires coordination across independent practices, each with their own operational priorities. Communication failures commonly occur when practices don’t understand their specific responsibilities for network-wide commitments.
Sometimes practices assume network managers handle all compliance activities, whilst network managers assume practices are implementing required changes locally. This creates gaps where nobody takes ownership of specific requirements.
Clear governance structures help address this. Written terms of reference should explicitly state compliance responsibilities at both network and practice levels. Regular communication through multiple channels ensures information reaches relevant parties:
? Steering groups for strategic oversight
? Practice manager forums for operational coordination
? Clinical meetings for service delivery planning
? Written updates for formal documentation
For critical compliance requirements, using at least two communication channels increases the likelihood that information is received and understood across the network.
Specification Misinterpretation
PCN DES specifications are detailed documents requiring careful interpretation. Networks sometimes misunderstand specific requirements, leading to non-compliant service delivery despite good intentions. This might involve confusion about which patient groups qualify for services, what data collection is required, or how to implement services that meet specification criteria.
Structured reviews of all service specifications at the start of each contract year help prevent misunderstanding. These reviews should involve clinical leads, network managers, and practice representatives who will deliver the services. Different perspectives help identify potential ambiguities early.
Creating plain-language summaries of complex specifications ensures everyone understands what’s required. These translate technical specification language into practical operational terms for frontline staff. When interpretation remains unclear, seeking clarification from Integrated Care Boards before implementation prevents problems that are harder to rectify later.
Inadequate Financial Monitoring
Networks without robust financial monitoring systems sometimes face unexpected budget shortfalls when achievement payments aren’t received or expenditure exceeds available funding.
Monthly financial reviews should track all PCN DES funding streams separately:
? Claimed and received payments
? Committed expenditure for ARRS and other roles
? Achievement payment eligibility and progress
? Projected year-end financial position
Regular monitoring identifies problems early enough to enable corrective action, whether adjusting service delivery plans, managing expenditure more carefully, or addressing compliance issues affecting payment eligibility.
Maintaining Compliance Effectively
PCN DES compliance becomes manageable when networks implement systematic approaches to understanding requirements, planning delivery, maintaining documentation, and monitoring progress. Most compliance problems are preventable through clear processes, defined responsibilities, and regular oversight. This allows networks to maintain their contractual obligations whilst focusing on improving patient care and population health outcomes.
