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Locums can be hired via ARRS under certain circumstances, and as long as there is scope for longer-term employment, a regional NHS England body has advised.
NHS England’s regional primary care team in London issued the guidance to its ICBs on PCNs hiring GPs via the additional roles reimbursement scheme (ARRS) in October.
It clarified several questions in an FAQs document on the additional role, including that a locum could be recruited via a fixed term contract if it was with a commitment to a regular number and pattern of sessions, and with the ‘potential to turn into a longer-term commitment subject to funding’.
However, it reiterated that GPs employed through the scheme could not have been substantively employed previously, cannot be employed for ‘as and when’ shifts, and cannot be beyond the second anniversary of their certificate of completion of training.
It mentioned that a newly qualified GP who already had a salaried post would not be able to undertake the ARRS role as an additional post, as this would count as a substantive GP role. But, if a newly qualified GP has been working in short term and locum roles only, they would be able to apply for the role.
‘The intention is to increase the number of GPs in permanent substantive roles,’ the document said.
However, Pulse PCN understands that determining whether a GP has or has not been substantively employed is also subject to local discretion.
In terms of the period a GP could be employed for, the regional London document suggested this could be for less than the six months until March 2025, if a PCN wanted.
But there are also no restrictions on the length of contract that PCNs could offer to the GP, Pulse PCN understands.
While there is a promise of funding for 2024/25, NHS England previously said it would recognise this is a change to PCN operating costs and would be considered in future budget setting. Health secretary Wes Streeting also confirmed last month that the funding would continue beyond March.
Table 3c in the Network DES specification set out that the maximum funding PCNs could claim for 2024/25 for the GP role would be £95,233 for a London-based role, and £92,462 for elsewhere, including on-costs for NI and pension.
However, PCNs can top up the salaries of GPs in the same way that they can for non-GP ARRS staff, for example if doing so would help to meet local need, although the funding would not come from ARRS money Pulse PCN understands.
Pulse PCN also contacted all of the ICBs and regional NHS teams to ask if any others had issued advice to their PCNs on GPs in ARRS.
Bedfordshire, Luton and Milton Keynes ICB said they were sent FAQ documentation that was developed by the national team and has been shared with their PCNs. Shropshire, Telford and Wrekin ICB said they had also issued additional guidance to their PCNs on the scheme.
North East and North Cumbria ICB said they had not issued formal guidance to their PCNs but that their local teams ‘stay in contact with practices in the region and regularly provide support and advice to practices and PCNs in response to their enquiries’.
All other ICBs and regional teams either did not respond or said they had not added to the national guidance issued directly by NHS England via the contract document and letter.
The expansion of ARRS was introduced an ‘emergency measure’ to tackle GP unemployment in August. Full details of the scheme were not shared until the end of September when the updated PCN DES was published, with funding being available from the start of October.
Clinical directors recently told Pulse PCN that they were split on how to use the new GP role, with some looking to place the role in a hub and others considering granting one practice an extra GP.
Finance and funding
Q – How is the PCN allocation calculated?
A – £1.303 x PCN Contractor Weighted Population as of 1st January 2024 e.g. for a PCN of 50,000 the allocation is £65,000.
Q – When does the funding run until?
A – The funding is available until the end of this financial year.
Q – What is the funding mechanism?
A – ICBs should have already received the total allocation, PCNs should claim through the ARRS portal for reimbursement.
Q – Do we have any clarity on the funding arrangement for 25/26 and whether the General Medical Practitioner role will be extended?
A – No, arrangements for funding these roles and the wider ARRS roles will be discussed by DHSC and GPC during Autumn negotiations.
Q – Given the short period of time and the fact that this is an interim opportunity, some PCNs are considering apportioning the PCN financial envelope on the basis of proportionality (practice list sizes) – the thinking is that this will subsidise the salary costs of any appointments to the role that are made – would this be permissible?
A – The principle of additionality should be adhered to. The funds cannot be apportioned as suggested, but a newly recruited GP could work across the practices as long as they have been employed since 1st Oct 2024 and the role is additional.
Recruitment
Q – In what circumstances can a PCN not claim ARRS reimbursement for General Medical Practitioners?
A – a) Where General Medical Practitioners have been substantively employed as a General Medical Practitioner in general practice previously, subject to express agreement with the commissioner
b) Where the General Medical Practitioner is to be employed in a temporary capacity i.e. ‘as and when’ cover locum shifts
c) Where the General Medical Practitioner is beyond the second anniversary of their certificate of completion of training, issued by the General Medical Council, at the start of their employment or
engagement
Q – Can a locum be recruited on a fixed term contract?
A – Yes, if the PCN is offering a FTC with a commitment to a regular number and pattern of sessions, and the potential to turn into a longer term commitment subject to funding, as opposed to ‘as and when’ cover.
Q – Does the contract need to be for a minimum of 6 months?
A – No, unlike the other ARRS roles, the GP role can be employed for less than 6 months.
Q – Can we use the monies over a shorter time period, for example can we employ a GP full time for 1 month rather than across 6 months?
A – The intention of the funding is to reimburse for additional permanent roles. Any locum or short-term temporary roles should not be approved for reimbursement.
Q – Can we use third- party Locum agencies to support recruitment of appropriate candidates?
A – Yes, if they are being used to support the recruitment of substantive GPs.
Q – Can we employ several candidates e.g. 5 GPs for 2 sessions each?
A – There are no minimum sessional requirements.
Q – What assumptions might reasonably made around on-costs for the GP roles?
A – The minimum pay for salaried GPs employed on the salaried GP contract has been increased by 6% to £73,113 from 1 April 2024. Adding an additional 30% takes you to the maximum reimbursable rate.
Q – If we do not recruit until December / January, can we still use the full budget later before the end of March 2025?
A – The full allocation is available to spend until the end of March 2025.
Q – If a NQGP has a salaried post but is offered an additional GP post in a second practice, would the second post be eligible for ARRS funding?
A – No, as they have a previous substantive GP role.
Q – If a NQGP has a salaried post but is offered additional sessions to support the PCN, would the additional sessions be eligible for ARRS funding?
A – No, as they have a previous substantive GP role.
Q – Does the NQGP need to be seeing patients to be eligible for ARRS funding or can the GP be recruited to support the PCN with other things (e.g. audit work, QI projects, neighbourhood projects etc)?
A – The PCN DES states that ARRS roles are intended to be fully integrated within the multi-disciplinary team delivering healthcare services to patients.
Q – The DES does not define what it means as substantive – substantive could potentially suggest someone having a permanent contract. If this is the case, if there is a newly qualified GP already in the borough eco-system on a fixed term contract, would they ‘qualify’?
A – If a GP has only been working in short term / locum roles, they would be applicable. The intention is to increase the number of GPs in permanent substantive roles.
Operational
Q – Is there a separate workforce reporting template for the monthly claims as nothing is showing on the Primary Care Workforce Portal which is used for claiming the ARRS reimbursement?
A – The PCN should use the same portal, they should be able to select GP as a specific role.
Source: NHS England’s London regional team FAQ document
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