PCNs split on how to use ARRS GP role

PCN clinical directors (CDs) are divided on how they are going to make use of the new GP ARRS role, with some looking to place the role in a hub and others considering granting one practice an extra GP.

The government added GPs to ARRS with a ‘ring fenced’ £82m budget in August as part of an emergency measure. The scheme is intended to fund 1,000 GPs across England’s PCNs, with funding to be made available from October.

The details of the implementation of this role have not yet been announced beyond the intention that it will be for newly-qualified GPs who face unemployment, with a revised Network DES specification expected to be published in the coming weeks.

PCN CDs therefore remain unsure as to how this role will be used.

Dr Dan Bunstone, CD at Warrington Innovation Network PCN (WIN), said his PCN was ‘considering’ employing a GP to ‘support the PCN’. He said it would likely support the PCN’s hub model of working.

‘It would effectively work in the capacity of a consultant to have a smaller personal clinic but support the other roles with advice and guidance across the PCN,’ said Dr Bunstone.

‘The role could be interesting for the right GP and support real diversity in their work plan,’ he added. ‘We’re keen to do things differently in WIN, and as our name suggests, innovation is what we are all about.’

Dr Sarit Ghosh CD at Enfield Unity PCN, also said they would most likely place the GP in hub sites.

‘We are yet to discuss it formally, but it’s likely we will go out to recruitment and place the GP in hub sites in the PCN for practices to book into, to reinforce current operational models,’ he said.

‘That’s the only fair way to allocate the resource as it stands, seeing as the funding will not sustain a practice-based approach.’

He added that ‘more GP capacity is always helpful for PCNs and GP practices’, but that the £82m did not seem enough to recruit 1,000 full time GPs, especially in London.

CD at SMASH PCN in Cheshire, Dr Neil Paul, added that his PCN are considering options, one of which would be to let one practice have the GP money and boost the other practices ARRS money to compensate.

‘My PCN’s philosophy has always been to push as much of the PCN money as possible back to the practices for them to do with as they want – within the rules and as long as we deliver the contract,’ he said.

‘For example, we don’t as a PCN have any shared clinical ARRS staff – all staff are employed by practices or by outside third parties. As such we have been puzzling what to do with probably less than 1FTE freshly qualified GP. The money isn’t a lot, and we haven’t really felt that splitting a person into seven and having them wander around would be a good use of anyone’s time.’

He added: ‘We probably aren’t interested in a shared person – it’s against our philosophy – however it’s going to be hard to split the money, so I guess we might do a deal to let one practice have the GP money and the others have more ARRS money.’

Another option they are considering is a palliative care or nursing home visiting service, or a ‘floating backfill service’, but he is unsure if this would be a rewarding job for a newly qualified GP.

‘I’d rather there was incentives to practices to employ newly qualified GPs – with support for mentoring/ supervision/ oversight. We are a training practice and while some of our trainees are amazing, all find that their first year in practice is a hard one,’ he said.

Although the BMA called for GPs to be added to ARRS in January 2024, they last month also called for the funding to be given directly to practices rather than PCNs, as the latter would not provide GPs ‘with the desperately needed stability required’.

Dr Manu Agrawal, CD at Cannock North PCN, said that it would be more challenging for PCNs to recruit GPs than for practices.

‘I think it can be more difficult for PCNs to recruit GPs rather than individual practices, and that’s mainly because as a GP I would not want to work across seven practices or five, or even four practices. I would want consistency of service and continuity for patients as well, which you will not get as a GP in a PCN,’ he said.

‘My bigger concern is there is no assurance around the continuity of funding and there’s lots of unknowns in terms of contracts,’ he added. ‘By the time we get clarity and by the time practices and PCNs go out to recruitment, we’re probably looking at the end of the year or early next year, which only leaves three months of funding left.’

Dr Dean Eggitt, CEO of Doncaster LMC added that the ARRS GP role was an ‘unmitigated disaster’.

‘Sadly, the genie is now out of the lamp and the Department of Health and Social Care and NHS England have the opportunity to reshape general practice by defining the role of a GP, including the terms of service including pay,’ he said.

‘With PCNs becoming the go to choice for GP employment, PCNs will have the workforce and opportunity to inherit the key role of provider of primary care services.’

However, Dr Jeremy Carter, CD at Herne Bay PCN, said that distributing this £82m of funding to practice level rather than PCN level would ‘dilute’ the money too much.

‘In principle, assuming this is a finite pot, perhaps non recurrent, for a limited number of GPs across the country, with restrictions on who can even be paid for with the funding, I would suggest distributing the money to practice level will result in such a dilution as to make employment of individuals impossible,’ he said.

‘If a PCN is functional at cross-organisational working and collaboration, I would think that adding to the PCN workforce, and seeing PCN patients across the PCN footprint will enable employment of the smaller number of individual selected GPs suggested, for more substantive terms of contract, to deliver the care across the PCN footprint.’

But he said the policy was ‘extremely short-termist’ and will give no certainty to GPs looking for work. He also said it was important to ensure the funding ‘is not then robbed from another pot surreptitiously’.

It comes after the latest ARRS data showed that pharmacist numbers continue to rise in the scheme, while social prescribers have taken a slight decline.