Just 26 GP practices out of the nearly 7,000 in England have chosen not to join a PCN, despite significant financial incentives set out in the five-year GP contract.
Around £1.8bn of the total £2.8bn funding package for the five-year deal is linked to the formation of networks, much of it to support the recruitment of new staff to support primary care, but with a proportion to be paid directly to practices that take part.
Meanwhile, NHS England has said that as of 21 June, a further '34 practices were in the position of wanting to join a network, but where their inclusion had not been confirmed'. A further 10 GP practices were 'not participating because of a change of contract holder', but are expected to join in future.
An update on progress with implementation of the five-year deal agreed earlier this year says the number of GP practices choosing not to join PCNs has been falling steadily - but NHS England confirmed it did not expect any change of heart among the remaining 26 practices.
Reasons for practices refusing to join a network include 'major concern over the level of additional future workload', officials confirmed. GPonline reported earlier this year that half of GP partners believed PCNs would increase workload.
Other reasons include 'unwillingness to end half-day closing', 'unwillingness to partner' and 'not wanting to grow their business and take on associated responsibility'.
The contract update document says: 'Alternative arrangements are now being put in place for their patients during 2019/20, and where nonparticipation continues, we expect those to be made permanent from April 2020.'
NHS England said it expected that it expected the 34 practices yet to join a network to dwindle to a handful by 30 June. Some cases where practices wanted to join but had been unable to complete the process were 'wicked cases' - involving, for example, 'an acrimonious partnership split in the past', a legal dispute between a practice and its 'only obvious network partners', and a case in which a practice is under investigation.
The document confirms that nearly one in 10 PCNs are smaller than the standard 30,000- to 50,000-patient range envisaged in the five-year contract agreement.
Of 1,259 PCNs set up across England, 111 have fewer than 30,000 patients, NHS England has confirmed - with 26 of these below the 27,000 mark and two with less than 20,000 patients.