How to hire and use an ARRS GP

When the Government announced an emergency measure to add the role of GP to the ARRS budget, PCNs responded with mixed feelings. The £82 million scheme, which is intended to fund around 1,000 GPs in England is something that they had been pushing for.

But with the GP business rules now published, PCNs have to face the practicalities of how to hire an ARRS GP, make the role sustainable and make effective use of them across their practices. Only GPs in the first two years of their career are eligible and questions have been raised about whether the funding attached to the role is enough.

We ask three PCNs how they are approaching the task and what their plans are after March 2025.

‘We felt we had to move quickly’

Dr Laura Mount, clinical director of Central and West Warrington PCN said they realised they would have to move quickly if they were to make use of the ‘finite pool of people’ who would be eligible to fill the role.

But there was a snag. The funding allocated would not cover the cost of employing a GP when indemnity and fair rates of pay were taken into account. ‘There is the ethics of them spending all this time training to be a GP and then us saying your pay is now 25% less than you expected. But also if you pay less, then you’re quickly going to lose people.’

With seven medium to large sized practices in the PCN, they have also learned over time that moving people around multiple practices does not work. Instead, practices have buddied up to share an ARRS GP, and they will take responsibility for managing their time and supervision. It is a change from how they would normally do central recruitment and management for ARRS staff.

‘My practice, for example, is 10,200 patients and there’s another practice down the road with 10,500 and we’ve employed one salaried doctor between the two of us who is getting paid for around two and a half days. She is quite happy with that, because she’s got a locum job one day a week.’
One of the candidates did drop out but now everyone has found someone, she adds. The flurry of emails they received initially from GP candidates asking to be considered has tailed off suggesting that most of that workforce is now hired.

The strategy also allowed them to be more flexible on pay after an initial lack of agreement. ‘We decided on a range, that we wouldn’t pay less than a certain amount or above a certain amount, so that people could adapt it depending on whether it was somebody developing extra skills or was really serving a more specialist niche in a practice or more difficult practice. Additional funding is coming from the capacity and access pot.

Yet despite this relatively smooth sailing, lack of clarity over what happens after March is very unsettling, she says. You are investing in staff but without knowing if they will leave or if new ARRS GPs be needed to fill that gap. ‘We have absolutely no idea what we’re facing from the first of April, and we’re having to make quite big and important decisions based on newspaper interviews and House of Commons questions and that’s not really very good way to run your business.’

She has said to GPs taking up the role that if they are offered a permanent or salaried position, they must take it. If this money had been offered two years ago you would have seen PCNs thinking about the position more innovatively, Dr Mount believes, rather than grappling to fill the role to avoid wasting funding that has been made available.

‘There hasn’t been scope for that and some PCNs may have made them into cancer development leads or trained them up in care home delivery or nurtured them into something that could have worked across the PCN. But this sort of smash and grab, money for a few months, means you can’t really do anything constructive.’ ‘

There’s a portfolio of work we want them to do’

In Oldham East PCN, the board has just agreed a proposal for the ARRS GP after a second meeting. Clinical director Dr Bal Duper said they had to think carefully about whether each practice – there are six spread across a large patch from rural countryside to the inner city – takes their share or whether the PCN takes on the full role to use more thoughtfully. They have opted for the second after deciding the first was impractical.

‘There is a portfolio of roles that we want that PCN GP to do that would include extended access hours, urgent care – which is a priority within our PCN – and also perhaps covering holiday leave and gaps in recruitment as well as other clinical need.’

But he is also cognisant that these are new GPs who will need support and there are issues around continuity. When it comes to extended access, the role will have to be used in a ‘measured way’, he says. But equally, ‘if this GP is very good, we want to make sure that this is a sustainable offer and they stay’.
Across his practices, the case mix, deprivation and patient population is incredibly varied. It makes for a challenging proposition. Yet they have seen the benefit of working at scale in the ARRS scheme. ‘I think the practices have seen benefits of us having one doctor who might work half the time in some urgent care surgery for all of us, then the rest of the time supporting the ARRS.’

They already had a PCN-wide hub for any practice to book patients into clinics, which this year was transformative for Covid vaccinations, he says.

Yet the ARRS GP role does not appear to have been designed with practical input or with early year career development in mind, he adds. ‘Thinking through who is going to come into this role, what will they do, then by the time you recruit it is January and you can’t offer anything past March. It is really unfortunate.’
To make their life easier they intend to use one of the recruitment agencies offering the full package of an ARRS GP – recruitment, indemnity, DBS checks all taken care of. ‘I think short term, for the end of March, we’re going to have to see what the market can offer. I haven’t got time in my very limited sessions to do recruitment, supervision, appraisal. We need to think practically.’

‘We want the best candidate not the fastest’

As a single practice network, Dr Matthew Prendergast, clinical director of Southampton North PCN is fully aware he is in a much easier position than many to make good use of an ARRS GP. They have two sites, but it has taken away the complexity that would come with having to share the role between multiple practices, he notes.

‘It does mean from our perspective it is quite good. But there are a number of challenges, including where we put them, how do we support them, but also what is your liability as a practice going forward.’

His PCN did decide to advertise at a premium rate rather than the lower rate renumerated by the ARRS funding but even with that, there is an inequality in the role compared to the benefits other salaried GPs have, such as long-term stability for example, he says . They had five candidates apply who they are in the process of assessing but they want the best person not just the one who comes forward first, he explains. ‘Some of them are only available from February and some more quickly but we’re going to consider them all. I would be interested to know what PCNs get if they advertised with the minimum rather than the [above ARRS] premium rate.’

The lack of clear detail on future funding or plans means some practices will be having to make difficult decisions, Dr Prendergast believes. His PCN could find sessions for the GP should the situation change so it felt like a ‘no brainer’ but other practices are on a much more unstable financial footing, he says. ‘What is your liability? I don’t think that’s been sketched out. I would be quite cautious if I was in that situation.’
Practices are in a situation where they have some control but not full control over GPs they are hiring.

‘Wes Streeting has said it will carry on but there’s nothing to support that other than the words in an interview so that’s uncertain. What’s the responsibility going forward? Practices need to understand what responsibility they are taking on and the Government needs to spell that out.’

Given the supervision needs, it is also not equivalent to hiring an experienced GP. They will give their ARRS GP longer appointment times to start with no remote working. ‘I’d want to see them but that brings challenges with finding them space to work because we’re already fit to bursting.’