Of potholes and PCNs

Our new columnist, health journalist Andy Cowper, considers the rush to fill ARRS roles before the funding disappears

Potholes and PCNs might not appear to have much in common. Potholes arise in an underfunded environment as the result of heavy stress, uneven design and repetitive demand pressure – and are made bigger by the prevailing climate. PCNs, on the other hand…

I’m kidding. Well, up to a point.

But the financial year-end affects road maintenance, and it’s also currently affecting PCNs. The cut-off of 31 March drives local authorities into a frenzy of roadworks at the end of each financial year: an underspent maintenance budget is a budget that won’t get refilled the next financial year.

Almost a decade ago, the National Audit Office observed that ‘the current pattern of funding, combined with the need to spend money within the financial year, means that most road maintenance is carried out between September and March … it is less efficient than carrying out the work at other times of year because materials can be difficult to handle in cold and wet conditions, and daylight hours are shorter. As a result, almost all highways authorities need extra capacity from the market at the same time, making it less likely that they will obtain value for money’.

Knowing your ARRS from your elbow
Yes, that does sound familiar. PCNs are facing a comparable situation in their urgent need to recruit to the additional roles reimbursement scheme (ARRS) before the end of the GP contract period.

Expanding the primary care team is obviously a good move: pressures on the sector have been ridiculous for years. The multidisciplinary roles in ARRS could make a significant difference, both to the feasibility of primary care jobs and to patient access and care.

NHS England director of primary and community care Dr Amanda Doyle told an NHS Confederation webinar last November that the national funding for those in ARRS roles at the end of March 2024 (the end of the current GP contract period) will become ongoing funding in the new GP contract. She emphasised, however, that unspent ARRS money would be a different story.

Tick-tock, tick-tock
It’s currently March 2023: that gives PCNs just a year to locate, hire and train ARRS staff. That’s not loads of time. We are in a tight labour market and any recruitment campaign sees a certain amount of natural erosion.

This time last year, NHS England was trumpeting the hiring of 10,000 people under ARRS. That is not nothing, but the target is 26,000 by 2024.

Last April, speaking at Pulse PCN’s London Live event, BMA GP Committee deputy chair Dr Kieran Sharrock suggested that to help address recruitment challenges, PCN workforce leads need to ‘think flexibly’ and put existing staff forward for further training when trying to fill ARRS roles.

I wish everybody a smooth recruitment drive, but do keep an eye on the road surface.

Andy Cowper is the editor of Health Policy Insight and a columnist for the BMJ and Civil Service World