Concerns raised after GPNs added to ARRS

The introduction of general practice nurses (GPNs) to the additional roles reimbursement scheme (ARRS) could cause ‘significant instability’ and ‘deplete’ practices of nurses, it has been warned.

The reaction comes as GPNs look set to be added to ARRS following a series of government proposals released last month. 

The scheme, introduced in 2019, also includes nursing associates, advanced nurse practitioners and pharmacists. Enhanced level practice nurses have been included in ARRS since April last year and GPs were added to the scheme in October.

In December, the Department of Health and Social Care (DHSC) announced that it had put a new GP contract for 2025/26 to the British Medical Association’s General Practice Committee for consultation.

Under its proposals, the government confirmed ARRS will expand to include practice nurses.

However, there is now concern that some practices could be left without a sufficient GPN workforce if some practice nurses leave their practice for an ARRS role elsewhere.

As part of the changes, PCNs can only use the scheme to hire practice nurses who have not previously worked for any of its constituent practices.

Patricia Marquis, executive director for the Royal College of Nursing (RCN) in England, said that increasing the GPN workforce was ‘vital’ to improving community care.

However, she warned: ‘Including GPNs in the ARRS risks splintering the workforce, with staff moving between PCNs and destabilising practice teams.

‘Consistency is key for patients and the community. Staff already face second class pay, terms and conditions, and this inconsistency disrupts the vital service they provide.’

And she reiterated the RCN’s ongoing calls for better pay and terms and conditions for all GPNs.

‘Improving conditions for general practice nursing staff starts with full Agenda for Change terms implemented as a minimum, whoever their employer, including the annual pay rises,’ said Ms Marquis.

Sandra Dyer, primary care nursing clinical advisor for Wessex Cancer Alliance, said the introduction of GPNs into ARRS could ‘help drive up’ pay and conditions in practices but could also bring other unexpected risks.

‘More likely, given the current financial position, this could deplete practices of their GPNs with nursing provided by the PCN,’ she said.

‘I can’t see this being better for patients. In cities this still provides risk of destabilising the existing workforce in my opinion.’

Ms Dyer added that the changes could also undermine the patient experience, with GPNs moving between PCNs and reducing continuity of care within specific practice populations.

‘It’s probably not going to be good for patients,’ she warned.

Dr Sarit Ghosh, clinical director at Enfield Unity PCN, said the practice nursing workforce is already ‘more challenged’ than the GP workforce, with a ‘dearth’ of staff available for recruitment.

‘The suggested change could result in significant instability as nurses potentially leave their core contract posts to fill PCN ones, although I suspect practice terms may be even better in the current market so this may not be an issue,’ he said.

Last January, a report from the Queen’s Nursing Institute (QNI) found that almost half of GPNs were expected to provide education and supervision for staff employed under ARRS, despite often being paid less and given free development opportunities.

In August, a survey by our sister title Nursing in Practice found that almost two-thirds of primary care and community nurses believe GPNs should be included in ARRS. 

It comes as a report today revealed that the NHS may have missed an opportunity to make the most of new healthcare roles within the system, after it failed to learn from previous integration of new roles.

A version of this story was first published on our sister title Nursing in Practice.