Last week, the Government announced it was ‘cutting red tape’ by allowing GPs to be hired through the ARRS. Here, Eliza Parr, sets out what we know (and don’t know) about the new policy.
Amidst everything going on across general practice – and, indeed, the country – last week’s announcement on the Additional Roles Reimbursement Scheme (ARRS) feels a long time ago.
But it was an important, if slightly complicated, policy change for NHS England. Just five months ago, the national primary care director stated clearly that GPs cannot be added to the ARRS as they are ‘not additional’.
Now, they are gearing up to do just that. Of course, since March there has been a change of Government. The new Labour health secretary Wes Streeting is keen to ‘reset the relationship’ with GPs, and he emphasised that the expansion of ARRS to GPs is a sign that his new Government listens to the profession’s concerns.
Whether GPs agree with this ARRS policy or not, most will want to take advantage of any extra funding to hire more staff. But many may also be left wondering how exactly this will work. It made a nice headline for Mr Streeting (on the eve of collective action, no less), but the devil is in the details…
Pulse’s explainer sets out they key questions around this new policy, and it will be updated as new details emerge.
Will the Government increase ARRS funding and what will it cover?
The Government has agreed to fund the ARRS with an extra £82m to allow PCNs to hire GPs. This funding is intended cover the cost of 1,000 extra GPs.
NHS England later revealed that the £82m will be ‘ring-fenced’ solely for the employment of GPs, to ensure the reimbursement of existing ARRS staff ‘is not impacted’.
But another question is whether the funding will cover just salaries, or ‘on-costs’ – other costs involved in taking on an employee, such as superannuation and National Insurance. Medical accountant Andy Pow believes the expansion of ARRS to GPs is the ‘wrong solution’ altogether, but he also warns that the ‘maths doesn’t work’. Responding to the news on X, he said that ‘£82m will not fund 1,000 GPs including add-on costs’.
There has been no clear answer to this. The Department of Health and Social Care (DHSC) said further information on on-costs would be communicated by NHS England shortly. And NHSE was not able to answer Pulse’s question.
Which GPs will be eligible?
The policy is explicitly aimed at tackling the ‘immediate issue of GP unemployment’ and the extra ARRS funding is for ‘newly-qualified GPs’.
It’s clear Mr Streeting has taken on board the serious concerns GPs have raised about unemployment over recent months, and particularly the fact that GPs qualifying this summer are struggling to find roles.
But there has been no clarity on the exact definition of ‘newly-qualified’. Does this mean GPs obtaining their certificate of completion of training (CCT) this August? Or will there be an eligibility window which covers all those who finished training in the last two years? Or will there be no stipulation at all, leaving PCNs with autonomy to direct the funding as they see fit?
NHS England declined to clarify the definition of ‘newly-qualified’, and Pulse understands it has also shared no further details on this with the BMA.
DHSC also had no answer to this. But in the initial announcement, the department said: ‘It’s thought hundreds of newly qualified GPs could be without a job this summer in England. But thanks to this intervention, they will be able to be hired by the end of the year.’
Given the strong focus on potential unemployment for new GPs this summer, it’s likely the new contract arrangements will stipulate a short eligibility window. But in the absence of a clear definition, GPs struggling to find work in the first year or two of their career may wonder if this shiny new announcement will benefit them.
Do GPs have to be ‘additional’?
It is not yet clear how GPs might now be considered ‘additional’, when NHS primary care leaders were so emphatically opposed to this, as recently as March.
NHSE stated last week that PCNs will be required to ensure ‘GPs employed are in addition to the existing GP workforce employed by practices’. Of course, this may just mean that practices cannot re-hire existing GPs under the ARRS to save money. But there could also be further stipulations around ARRS GP roles in order to ensure they are indeed ‘additional’ – for example, what about ongoing vacancies?
This detail is likely to form part of any amendments to the network direct enhanced service (DES). But in the meantime, NHSE – you guessed it – declined to answer Pulse’s question.
DHSC did confirm however that PCNs will have flexibility to recruit GPs to meet the needs of their local population, which suggests they might avoid strict role requirements.
When does the scheme start (and end)?
This has been badged an ‘emergency measure’ for 2024/25, meaning the funding situation beyond March 2025 is not yet clear. But both the Government and NHS England have sought to reassure the profession that they will work on ‘longer-term solutions to GP unemployment and general practice sustainability’. These wider changes would form part of ‘future contract reform discussions’ and would be announced at ‘the next fiscal event’.
To allow PCNs to hire GPs, NHS England needs to make changes to the network DES, which will be developed in consultation with the BMA’s GP Committee England ‘over the coming weeks’. Following this, the revised ARRS entitlements will be communicated to PCNs which will clarify the ‘separate ring-fenced element that is available to GPs’.
While it is not yet clear when these details will be finalised, NHS England has confirmed that funding will be available from October.
What are the risks around a short-term expansion of the ARRS?
WIthout a guarantee of continued funding beyond March 2025, PCNs may only be able to hire GPs on six-month contracts.
Of course, the Government has been clear that this is an ‘emergency measure’ and longer-term solutions are in the works. But short-term contracts may leave newly-qualified GPs in much the same position in April as they are now. And some experts have pointed out potential legal issues for PCNs.
A law firm for GPs, DR Solicitors, has highlighted the risk around redundancies. The lawyers argued that if GPs are hired on the BMA model salaried terms, which ‘normally grant continuity of service for certain NHS previous experience’, there could be ‘quite significant cost implications’ if redundancies are required in March.
They suggest a number of measures PCNs can take to mitigate this risk, which include leaving this continuity of service clause out of contracts (and thereby diverging from BMA model terms) or recruiting via PCN-owned companies where there is limited liability for costs.
Mr Pow agrees that short-term GP contracts are ‘tricky’ and that this is the ‘difficulty’ of the ARRS expansion.
He thinks DR Solicitors clearly sets out the risks, telling Pulse: ‘From a PCN perspective the big risk is around employment risk – not the funding and what happens at the end of the funding period.
‘With the rest of ARRS there is an underlying position from the NHS that funding will continue and you can only assume that will happen here but it’s a big assumption to take.’
What does the BMA think?
In response to these concerns, the BMA emphasised that it expects ‘any GP to be employed on the salaried GP model contract or equivalent terms’. GPC England chair Dr Katie Bramall-Stainer and sessional GP chair Dr Mark Steggles told Pulse that it is ‘important’ ARRS GPs ‘are not left in the same position down the line’ when the scheme comes to an end.
They expressed concerns with the new policy, arguing that merely ‘adding floating GPs’ to the ARRS for a large PCN population, rather than practices, is a ‘desperate short-term fix’.
‘We fear it will not mitigate the underlying issues driving GPs to take collective action,’ they said.
Instead, they want to see a ‘practice-level reimbursement scheme for recently qualified GPs’ which allows GPs to be ‘embedded in practices’.
Did GPs ask for this change to the ARRS?
You might be wondering why the BMA is criticising a new policy they seemingly lobbied for – particularly since the Government stressed how ‘hard-fought’ it was. But GP leaders are now careful to point out that adding GPs to the ARRS ‘has never been GPC England policy’.
Dr Bramall-Stainer and Dr Steggles argued that it was simply a ‘suggestion’ to the previous Government, and ‘was always intended as an emergency, short-term measure’.
Given that over 11,000 people signed a petition calling for GP practices to be ‘allowed to use ARRS funding’ to employ GPs as well as practice nurses, it seems fair for Mr Streeting to claim he has listened to the profession. But England’s GP leaders are clear that longer-term solutions are crucial, allowing for ‘more flexible and efficient uses of funding’.
Where does this leave GPs?
Until the new DES is published, some key questions about how this scheme will work may go unanswered. NHS England has so far declined to provide any more details in response to Pulse’s queries. As such, PCNs – and, of course, those newly-qualified GPs struggling to find work – might be left speculating for some weeks.
Further details on the ARRS scheme – including eligibility, on-costs, and any specific role requirements – won’t solve the long-term underfunding of general practice. And, as the BMA suggests, this new policy certainly won’t stop GP collective action, as Mr Streeting might have hoped. But more clarity is sorely needed so that PCNs and practices can properly plan for the rest of the year.
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Currently being offered a contract with no paid CPD, no NHS days when calculating annual leave, no recognition of prior NHS service for redundancy pay, no clear cap on house calls, expectation to supervise staff with no extra money. Oh and there is a claw back clause to repay costs for all training if I leave within 12 months. Did I mention 6 months probation period despite the fact they already know me? They also prohibit me from working elsewhere despite not offering me full time.
This is a further ploy to destroy core general Practice which will continue to benefit the self-interest and financial gains /greed of PCN CDs to the cost of their fellow GPs and continue to support the government /NHSE agendas of dismantling core General Practice .
It is a disgrace that PCN CDs (with exceptions) have allowed their colleagues/ newly qualified GPs to be reduced to additional role status and a deplorable state of affairs facilitated by PCN CDs in my view with no conscience.
How many PCN CDs have been on negotiating panels and how many have followed NHS policy on conflicts of interest and declared their PCN CD conflicts in terms of financial gains sometimes in hundreds of thousands of pounds in PCN CD payments they have received since the inception of the PCN farce with their own additional staffing gains often significantly greater in selected PCN CD practices in my experience.
The dysfunctional NHS we now see has not been created by chance.
It has been created in my opinion by increasing numbers of self-indulgent dysfunctional leaders (with exceptions becoming rarer) whether within government, PCN CDs , NHSE managers and ICB managers.
On a weekly basis, we see this group with elevated egos, often decidedly overpaid self-selected group often simply undertaking simple secretarial /admin work /unnecessary meetings paid at professional clinical rates 9warranting administration or lower management hourly rates) whilst pushing out destructive erroneous policies, pilots ,U Turns with no regulation of their folly in my opinion..
The population is demanding a top to bottom review of the NHS, but this is impossible without recognising that the leaders who have caused this decline over decades within the NHS remain in place and move from board-to-board wreaking havoc.
We need a top to bottom clear out of these NHSE,PCN, ICB leaders who have presided over these failures often with huge personal gains at detriment to patients ,colleagues and the wider NHS.