ARRS has ‘potential’ but more flexible funding needed, study finds

The additional roles reimbursement scheme (ARRS) has ‘potential’ to fulfil its objectives and improve access to general practice, but issues of funding, estates and oversight need to be addressed if policy aims are to be ‘realised’, a study has found.

The research, published in the BJGP, looked at the implementation of ARRS staff across seven PCNs in England. The qualitative case study ran between July 2020 and March 2022, and collected 91 interviews and 87 hours of observation.

It found that there was widespread support for the scheme among interviewees but that there were ‘complexities’ around implementation.  

It highlighted the need for greater flexibility of funding, particularly around underspend, of which there was a ‘significant’ amount in the scheme’s first two years.

Authors said there was some ‘resentment’ among PCNs around not being able to use any underspend on alternative ways of investing in primary care.

It quoted a finance manager who said they wanted to spend the money on estates to enable them to grow their workforce. They said: ‘What you end up with is at the end of the year a massive pot of the ARRS funding that’s not been used and it doesn’t make any sense when part of the reason … probably the main reason it’s not been used is because people can’t put anyone anywhere.’

It also noted that there was often a shortfall in terms of employment costs, despite the funding being intended to cover whole salaries.

The authors wrote: ‘A few PCNs told us that there could still be a shortfall, particularly around costs for sick and maternity pay, and to cover pensions and National Insurance increases. Employing through an agency or other third party did not necessarily alleviate these problems, as they may be reflected in additional fees and expenses to be paid by the PCN.’

It also found that there were multiple different employment models in use, and often within the same PCN for different categories of staff. These included contracting through agencies, a deployment model where trusts held employment contracts, subcontracting through third-sector organisations, employing through other legal entities such as GP federations, or a distributed model with different roles employed by different practices.

Estates was also a big issue highlighted by the study, with many PCNs saying there was a lack of extra space to put the additional staff.

The authors said: ‘The majority of those interviewed, from GPs through to clinical directors, commented on the lack of a suitable room for the AR staff, and the AR staff themselves told us this was a problem. This was so significant in some areas as to be seen as a potential obstacle to the success of PCNs.’

Some interviewees also highlighted that it was ‘not always initially straightforward’ to integrate staff into teams, especially if their time was split between sites.

The authors called on future iterations of the scheme to consider these factors in order to reach its potential as a programme.

They said: ‘A number of factors were identified that need to be taken into account in further iterations of the scheme, including: the need for flexible funding models; lack of accommodation in the current primary care estate; and attention to the management and oversight of staff. Greater focus on these is suggested if policy aims are to be realised, as is clarity for the scheme post-contract end in 2024.’

It comes after the new contract added the role of enhanced nurse to ARRS.