Explainer: The new ARRS additions

The additional roles reimbursement scheme (ARRS) is changing once again.

In her plan for patient access announced last week, health secretary Thérèse Coffey confirmed new roles would be added to practice teams, with a number of additional changes teased.

Then, in a letter sent to PCNs on Monday, NHS England confirmed a series of updates to the ARRS intended to further support general practice through the winter.

Here, we look at some of the incoming changes…

New roles

In last week’s patient plan, the Government stated it would be ‘freeing up funding rules to widen the types of staff’ in practices, which it expects will open up one million appointments.

It was later confirmed to Pulse that this would include GP assistants (GPAs) and digital and transformation leads, employable from October, with advanced nurse practitioners set to join the scheme at a later date. However, no further information was given on their roles in practice.

NHS England has now outlined how these roles will fit into general practice.

GP assistants

GPAs will offer ‘clinical and administrative support’ to GPs, freeing up their clinical time to ‘focus on patient care’, NHS England has said.

The role will be subject to maximum reimbursement equivalent of an Agenda for Change band 4 level. The outline will be based on Health Education England’s competency framework.

NHS England has also said PCNs can start recruiting to the role ‘immediately’, predominantly through trainee positions.

It says that GPAs can be trained in-practice, with on-the-job development led by GPs. They will also have access to HEE’s accredited training route.

Digital and transformation leads

Capped at one per PCN, NHS England has said the digital and transformation lead will help adopt or optimise ‘new technology and other initiatives’ across the network.

Some responsibilities include leading an ‘improvement approach to change’, such building capability or introducing ‘system wide approaches to problem solving’.

They will also be expected to ‘build relationships’ and ‘facilitate collaboration’ between practices and the wider system, and will also be charged with reviewing a PCN’s digital maturity.

NHS England has also said they must use data to: improve patient access and staff experience; support population health management; understand the ‘type and intensity’ of training needed; and facilitate clinically led innovation.

The maximum reimbursement rate will be equivalent to the Agenda for Change band 8a.

Advanced nurse practitioners

In a press release published prior to Dr Coffey’s statement, the DHSC stated there will be ‘more advanced nurse practitioners’ coming to general practice.

It is not known when this will occur or even how this will work with the ARRS, with the DHSC confirming it will happen at a later date.

Updates to existing roles

Firstly, the ARRS maximum reimbursement rates for 2022/23 will be increased to account for the Agenda for Change uplift.

NHS England also confirmed they will increase the current cap on hiring advanced practitioners (APs) under the ARRS, from one to two per PCN (double for those with more than 100,000 patients).

They will also remove the 0.5 FTE restriction on clinical pharmacists once they have finished their 18 month training, or have been granted equivalence or exception from the PCPEP pathway.

They will also contractually permit equivalent entry routes to PCEP for pharmacy technicians.

And finally, training time for nursing associates to become registered nursing in general practice will be reimbursed. NHS England has said this will let PCNs offer a career path for nursing associates. From April next year, they will consider support for senior nurses within PCNs.