Practices have been advised to carefully consider employment law if they are planning redundancies to hire more GPs through the additional roles reimbursement scheme (ARRS).
The Government’s contract deal for 2025/26, agreed in principle with the BMA, will remove the ringfence around funding for ARRS GPs, meaning PCNs can use the full funding pot to hire roles as they see fit.
This will likely result in a ‘shift’ in the skill mix, according to NHS England, with PCNs preferring to recruit more GPs via the scheme.
But the BMA advised GPs to ‘take stock first’ and heed employment law before restructuring their teams in light of the contract changes.
In a video to the profession on Friday, GP Committee England chair Dr Katie Bramall-Stainer said there is now a ‘single ARRS pot’ for all roles – including GPs and nurses – and told PCNs to ‘split it equally’ between practices.
She continued: ‘Spend it on the roles you need. If you decide in the future that you want to restructure your teams on the back of this, then please follow strong HR principles and sound employment law. The BMA can and will help, but just take stock first and don’t rush.’
YORLMC medical secretary Dr Brian McGregor also urged caution when taking advantage of the looser ARRS restrictions, advising GPs to ensure they follow employment law.
In an update to local practices on Monday, he said of the changes: ‘So yes, every practice could have a GP if you free up funds by other staff leaving/redundancies. (Make sure you follow employment law!)’
Leicester, Leicestershire and Rutland LMC CEO Dr Grant Ingrams told Pulse that GP employers ‘like any employers’ can change their team structures ‘if they need to’.
But he said there may be inevitable gaps left by both staff leaving of their own accord and potentially physician associates.
Dr Ingrams said: ‘Obviously one of the big problems I think – I don’t know how many are actually employed – would be the physician associates. Because if it follows through, the college position is that there should be no physician associates in general practice – that’s going to leave a hole. And then on top of that you’ll have people leaving.’
Nils Christiansen, managing partner at DR Solicitors, warned that the process of restructuring will not be ‘entirely straightforward’ because of the way PCNs are set up.
He told Pulse every PCN is organised differently, and ARRS resources are ‘typically spread in lots of different places’, for example in their own companies or with federations.
Mr Christiansen continued: ‘If you’re going to restructure, that means it’s not going to be entirely straightforward, because you can’t just look at a single pool of resource and say “this is how we get to do it”, because you don’t have them all in the same place, controlled by the same people, with the same terms and conditions. So it won’t be a straightforward process to restructure.’
On the potential pitfalls of this for PCNs, he added: ‘If you restructure, you have to usually go through some form of redundancy process, and that’s difficult enough when you have all of the resources in the same place, under the same management.
‘But in PCNs, that’s often not the case. And so the risk is that you get it wrong and you end up in an employment tribunal.’
NHS England has also recognised that the ‘balance’ of ARRS roles might shift towards GPs after the ringfence is removed.
At a webinar for GPs on Monday, national primary care director Dr Amanda Doyle said the idea behind the policy change is to ‘move away from central control of your skill mix and let you determine it locally’.
She continued: ‘And so there are no restrictions in the numbers. You can use all of the money for non-GP or nurse staff if you want to, or you can shift in the balance and have more GPs and perhaps nurses.
‘And probably what we’ll see is, as time goes on and turnover of staff happens, that the balance shifts, and it may be in some places, we know that it’s difficult to recruit specific staff, so it also gives you the flexibility around recruiting who’s available locally.’
NHSE has so far held back from publishing the number of GPs already hired via the ARRS, while the primary care minister has suggested that the data needs to be verified to ‘establish its reliability’.
I can see some practices telling their PCNs that they no longer want some of their other allocated ARRS staff, and htey want a GP instead, which they appear perfectly entitled to do;
but this could leave the PCN needing to supply more GP sessions, and ending up with a glut of excess other staff types at PCN level that nobody wants.
The PCN would have the employer responsibility, and face possible employment tribunals! not the GPs. But then, how would that differ from a locum nursing agency that finds a shift in the demand from one year needing to supply lots of RMNs, amd the next year needing more RGNs, but less RMNs to cover what the client hospitals need. I don’t see anyone threateneng the nursing agencies with employment tribunals over THAT.