The rules around ARRS funding should be changed to allow for paid GP supervision time, a think tank has argued.
In a new report on the supervision of additional roles in general practice, the Nuffield Trust found that there is ‘huge variability’ in the level and quality of support offered to clinical staff such as advanced practitioners, physician associates and pharmacists.
It also found that there is ‘little information available’ about how supervision should differ ‘depending on the career stage’ of the staff member.
The Nuffield Trust noted that current ARRS rules mean that the salary is funded but supervisor time is not, and that ARRS funding cannot currently be spent on supervision. It called for changes to ‘allow payment of senior clinicians to supervise ARRS clinicians’.
The report said: ‘The wide variation in ARRS implementation, roles and the need for individualisation makes costing supervision challenging, and there has been no published cost analysis to date.
‘However, it is important to recognise that if safe supervision is to be provided, it must be adequately funded. ARRS roles are funded by the scheme, yet supervisor time is not.’
It argued that without full funding for supervision, the ‘opportunity cost’ is lost appointments for patients – or, in the absence of effective governance arrangements, supervision ‘may not be provided adequately, or at all’.
It added: ‘The rules on the use of ARRS funding should be changed to allow payment of senior clinicians to supervise ARRS clinicians. An analysis of supervision costs would be helpful to guide the allocation of a proportion of ARRS funding to PCNs to deliver supervision.’
It also suggested that the ongoing debate around the physician associate role – which comes under the ARRS – has ‘emphasised the need for rigorous supervision arrangements’.
The researchers acknowledged that patchy supervision arrangements across the country may be caused by capacity issues among GPs and other senior clinicians.
Their report said: ‘NHS England guidance calls for ring-fenced time for supervision, which needs to be “hard wired” into the clinical rotas and job plans of supervising clinicians.
‘If supervising GPs who are already overloaded are asked to oversee ARRS clinicians, they may not be able to allocate sufficient time for safe supervision.’
But the Nuffield Trust said there need to be formal supervision standards and lines of accountability in order to reduce variation in how ARRS roles are supervised.
Its other recommendations included:
- Making PCNs formally accountable to ICBs for delivering minimum induction requirements;
- Supervision time being enshrined in job descriptions for ARRS-funded roles;
- Giving all supervising staff specific training;
- Allowing clinicians to opt out of supervision of ARRS-funded roles, if clinical capacity allows;
- Making ICBs formally accountable for assuring that minimum supervision is taking place in each PCN;
- Implementing a ‘fluid’ supervision model which covers different career stages, such as ‘entry point’, ‘transition’, and ‘steady state’.
Report co-author Rebecca Best, a public health registrar on placement at Nuffield Trust, said: ‘It’s good news that the ARRS has contributed to the recent boost in staff working in general practice at a time when primary care is under immense pressure.
‘But it’s vital that the success of this scheme in recruiting staff is bolstered with robust training and supervision standards. These are hugely variable at present.
‘There are risks with rapidly changing the makeup of the GP workforce – our recommendations are designed to mitigate some of these risks and keep patients safe.’
Another recent report found that the Government’s ‘rapid expansion’ of additional staff in GP practices has not improved patient satisfaction.
Last year, the BMA put out advice on supervising ARRS staff which said that sessional GPs should not be obliged to take on supervision responsibilities.
