Health committee calls for review of ARRS funding

The Additional Roles Reimbursement Scheme (ARRS) should be reviewed to see whether any flexibility on the funding criteria could ‘reduce the drain of community pharmacists into primary care networks’, a parliamentary committee has recommended.

The review should be completed within a three-month timeframe, and its outcome shared by the government with the Health and Social Care Committee (HSCC), the influential group of MPs added.

However, Professor Aruna Garcea, chair of the NHS Confederation’s Primary Care Network, warned that a review could lead to funding cuts when ‘cash across PCNs is so tight’.

The recommendation came as part of the HSCC’s report following its inquiry into pharmacy.

It said that the ARRS, which since 2019 has provided funding to primary care networks (PCNs) to recruit additional roles – including pharmacists – to work in PCNs and general practices, was a point of controversy within community pharmacy’.

During the inquiry, community pharmacy bodies raised concerns that since 2019, many pharmacists had moved out of community pharmacy into newly created ARRS roles within PCNs.

Nearly half (£387m) of the £839m spent on ARRS roles between 2019 and 2022 was spent on the recruitment of clinical pharmacists, then health minister Neil O’Brien revealed last year.

The latest primary care workforce figures suggest that pharmacists are still the most popular ARRS role, with 5,308 full time equivalent (FTE) pharmacists working in PCNs in April 2024.

The Independent Pharmacies Association (IPA – then AIMp) suggested that the NHS-funded ARRS roles were ‘perversely out-compet[ing] community pharmacy roles’ which ‘have little to no ability to set the pricing of their services higher to fund more expensive labour’.

During the inquiry, president of the Primary Care Pharmacy Association Dr Graham Stretch said that at the time of his evidence, 3,057 of the 4,689 pharmacists supported by ARRS came from the community sector.

While this was ‘a significant number’ that had had a negative impact on community pharmacy, Dr Stretch suggested this was less than half of the total growth in the pharmacy register during that time.

But he added that there should be greater flexibility on how ARRS funding was used, with ‘ARRS moneys being used to deliver those services from wherever is best placed to deliver them’.

Mr Stretch highlighted the need for investment in community pharmacy so that it could ‘invest in the staffing, training and infrastructure needed to effectively and safely deliver on the promise described in the report’.

Community pharmacy funding should be recovered to a financial position that was tied to inflation and backdated to include inflationary rises since 2014, he added.

‘Community pharmacy has a unique, accessible place in the health and social jigsaw and must be a key partner for the NHS in delivery of primary care,’ he said.

And he added that community pharmacy should ‘have equal standing, parity of esteem and equitable investment with other providers in GP and be an integral part of PCNs’.

Professor Aruna Garcea, from NHS Confederation, said: ‘ARRS has allowed PCNs to boost their workforce and expand the range of services they can offer patients to be seen in the right place and at the right time. This has been absolutely vital for managing the rising demand and increasing complexity of care that is being seen in primary care.

‘But we recognise that there is a finite pool of staff within a system and competition risks robbing Peter to pay Paul. This is why in our recent report we highlighted the need for a fully-funded long-term workforce plan to address staffing gaps across the sector.

‘With cash across PCNs so tight we are concerned a review could lead to funding cuts when the investment already does not fully cover the costs. But we would welcome a review that lead to greater investment for primary care and supports greater collaborative work between general practice and community pharmacy.’

The HSCC report found that the Community Pharmacy Contractual Framework (CPCF) in England was ‘not fit for purpose’, had contributed to the financial pressures that pharmacies are facing, and should be ‘completely overhauled’ urgently.

It also set out recommended measures to tackle medicines shortages and ease pressure on GPs.

A version of this story was first published on our sister title The Pharmacist.