Network Contract DES 2026/27 · Proactive Care Scheme · Winter 2026/27

The Proactive Care Scheme: £126 a patient, 0.5% of your list, and twenty weeks to do it

On 9 November 2026 NHS England changed this year's Network Contract DES to add a winter Proactive Care Scheme. PCNs are paid for finding the patients most likely to end up in hospital when it could have been avoided, assessing them properly and putting a personal care plan in place. This post explains the whole scheme in plain terms: who counts, what you have to do, what it pays your PCN, the rules to watch and the deadlines.

By Dr Yogasakaran Arjuna · 9 November 2026 · NHS England PC004_i, PC004_iii, PC004_iv · 1,298 PCNs · England

01The scheme in one paragraph

This is a short, winter-only addition to the PCN DES, worth about £40 million across England.

Each PCN picks out the people on its list at greatest risk of an avoidable hospital admission. The target is the top 0.5%, roughly 1 patient in 200. For each of them the PCN carries out a proactive, holistic assessment of what they need, agrees a personalised Proactive Care Plan with them, and puts it into action. The PCN is paid £126 per patient, up to a cap called the Proactive Care Entitlement. Work counts if it is done between 1 October 2026 and 31 March 2027. The aim, in NHS England's words, is earlier intervention, better co-ordination and a more preventative approach this winter.

02Which patients count

You choose the patients. NHS England sets the target group but not the method.

Eligible patients are those your PCN identifies as being at greatest risk of an avoidable hospital admission. The guidance gives examples, but says the list is not exhaustive:

• people living with moderate or severe frailty
• people with COPD or another severe respiratory disease
• people with heart failure
• anyone else with a locally identified factor that puts them at high risk of avoidable admission

You can use risk stratification tools, other data and your own clinical judgement and local knowledge, together or separately. The Part A guidance says you don't have to use any particular assessment tool, risk stratification method or data source. You also don't need the commissioner to approve your patient list or your plans.

03What you have to do for each patient

Three steps: assess, plan, act. The plan is the thing you are paid for, so it has to be real, documented and agreed with the patient.

Step 1 — a proactive, holistic assessment. It must involve the patient and/or their registered carer where appropriate, and reflect their needs, circumstances and preferences. The guidance says it should cover:

• personal and social circumstances, including socio-cultural factors
• past medical history and current health and wellbeing needs
• mental capacity, particularly around care planning and interventions, where appropriate
• whether an assessment under the Care Act 2014 is needed, and eligibility for NHS Continuing Healthcare
• whether the carer needs a carer's assessment and a carer support plan

Step 2 — a personalised Proactive Care Plan. There is no national template and no required headings. You can use your existing local care planning arrangements or the templates in your clinical system. The plan should record the conversations, decisions, agreed goals and the actions to be taken, in a way that makes sense to the patient. It should be proportionate and flexible, and describe the person, what matters to them, and what will make the plan work.

Every plan must meet five criteria. If the plan itself doesn't show them, there must be a record of what was done to meet them:

Step 3 — put the plan into action. The plan should list the interventions agreed for that patient. The guidance gives examples, including:

• clinical assessment and management, and medication optimisation
• care co-ordination, community service referrals and planned review and follow-up
• falls prevention and a Comprehensive Geriatric Assessment
• ReSPECT, anticipatory care planning and escalation plans
• supported self-management, social prescribing, mental health and wellbeing support, and carer support
• anything else tailored to the patient's needs, circumstances and preferences

You can bring in community services, social care, specialist services and voluntary organisations where that helps deliver the plan.

04What it pays your PCN

£126 for each patient supported, up to 0.5% of your adjusted population. Most PCNs can earn between £19,000 and £44,000.

Your Proactive Care Entitlement is 0.5% of your PCN's adjusted population as at 1 July 2026. That is the most patients you can be paid for. Below the cap you're paid for each patient you support. Above it you're not paid for any more.

* Over the 20 weeks from publication (9 November 2026) to 31 March 2027, assuming no qualifying work was done in October.

Across England. Using the 2026/27 adjusted populations for all 1,298 PCNs (63.6 million people), the caps add up to about 317,800 patients, and paying all of them at £126 comes to £40.04 million. That's almost exactly the £40 million NHS England has set aside. In other words, the budget is sized for every PCN to reach its full cap. 123 PCNs have an adjusted population under 30,000, 673 are between 30,000 and 50,000, 366 between 50,000 and 70,000, and 136 are 70,000 or larger.

How and when it's paid.

• Claims go through CQRS National.
• Payments are made monthly in arrears, once the PCN's claims are approved by the ICB, under section 10.7 of the DES specification.
• The money goes to the PCN's nominated payee, like other PCN payments. For finance teams, the paycode is NCDPCP (NCD Proactive Care Plans), subjective code 521676910.
• The work has to be recorded in the patient's record using the coding set out in section 10.7.4 of the DES specification. If it isn't coded, it can't be counted.
• NHS England has published indicative maximum allocations for each ICB. ICBs are getting more detail on allocations and the funding process.

05The rules to watch

Two conditions catch people out: double funding, and letting the scheme crowd out other work.

It's also worth knowing what the scheme doesn't require. There is no minimum number of patients, no national template, no required risk tool, and no commissioner sign-off of individual plans.

06Sign-up and deadlines

Most practices don't need to do anything to take part. Leaving, or changing your PCN's details, has a 30-day deadline.

Automatic participation. Core Network Practices are opted in automatically. A PCN with no changes to its membership or details does not need to send any sign-up paperwork. A practice that wants to opt out must tell its commissioner within the 30 days, and the commissioner will then work with the remaining practices to decide whether the PCN is still viable.

07A practical plan for the next twenty weeks

These are Arjus suggestions, not NHS England requirements. They're one simple way to turn the guidance into a weekly routine.

• This week: work out your cap (0.5% of adjusted population) and the weekly rate you need to reach it. Agree at the PCN board whether you're aiming for the full cap or a smaller, high-quality cohort.
• Find the patients: start from your risk stratification tool, moderate and severe frailty, COPD and heart failure registers, then use clinical knowledge to adjust. Keep a single PCN-level list so practices don't overlap.
• Check for double funding: compare the list against anyone already in a locally funded proactive care, frailty or virtual ward programme, and agree with your ICB what counts as additional.
• Pick one template: use one clinical-system care plan template across all member practices, with the five criteria built in, so every plan is claimable and sharable.
• Choose the workforce: the holistic assessment suits a multidisciplinary approach. Care co-ordinators, clinical pharmacists, paramedics, nurses, social prescribers and GPs can each take a part, without taking capacity from same-day access.
• Code as you go: follow the coding in section 10.7.4 of the specification, and check your CQRS National claims each month. Payment is monthly, so problems show up early.
• Look back at October: check whether any assessments and plans done since 1 October meet the requirements.