Bottom line: ARRS is a force for good

PCNs and ARRS roles are proactively delivering care before patients reach crisis point

The phone rings in Norwich. Dorothy thinks ‘Who could that be?’. No one really calls her. She makes it to the phone – it takes a while. It’s someone called a care co-ordinator asking how she’s doing, wanting to check on her COPD and formulate a plan to help her manage it. (See our profile of Norwich PCN.)  

In Dagenham, Essex, Lina sees a video in her native language explaining why she should get a cervical smear test. It’s given her pause for thought. (See our roundtable on early cancer diagnosis.)

Jake’s mum makes sure her son takes his inhaler but he’s been using it in the wrong way. That’s fixed now, thanks to the nurse who came into school.

Plagued by hot flushes and insomnia, Sarah attends a group clinic on menopause and receives 90 minutes of expert advice and forms bonds with other people who are experiencing the same thing. (See our ‘How to’ guide to group consultations.)

Primary care at scale, PCNs and ARRS roles are proactively delivering care before patients reach crisis point. For the patients it’s a game changer. 

However, our investigation found that the unspent ARRS money is not all being reallocated to PCNs and that there is variation in the way PCNs are able to access that underspend. 

While there is markedly less underspend than in previous years – 6% of the total budget compared with 40% in 2020/21 and 2021/22 – 6% is still £64m, which could make a significant difference to PCNs and patients. 

PCNs and their parent integrated care boards (ICBs) need to be fighting with NHS England to retain that money. Preventing ill health and helping people manage their conditions in the community are far better ways to approach healthcare than waiting for an emergency. But arguments about the DES are already brewing as we head into the final iteration of the GP contract. 

We know some of the DES plans, thanks to sister title Pulse, which revealed in February that the investment and impact fund (IIF) will increase from £260m to £305m. This will include £246m for a capacity and support indicator, which covers patient experience and patients being seen within two weeks. There will also be £59m for clinical indicators such as cancer and flu.

There will be the usual call from the BMA GP Committee for practices to not sign up. However, as we’ve seen in previous years, nearly all practices will as they won’t refuse a major income stream they’ve already had for four years. 

It will be imperfect. The ARRS roles will remain restrictive. The estates and training issues will remain. Many of the IIF indicators will be difficult to achieve, and some won’t make sense. 

But the rhetoric and ire about the DES will impact the clinical directors (CDs) who remain enthused about the changes they are making. Perhaps like our new columnist Dr Sian Stanley, CDs can feel insulated by the PCN and maintain focus on delivering patient care supported by ARRS roles. 

Because for the real Dorothy, Lina, Jake and Sarah, PCNs are a force for good – a proactive health service, instead of a reactive sickness service.