Should GPs be added to the ARRS scheme?

The additional roles reimbursement scheme (ARRS) has always been controversial and it remains a hot topic among PCN managers and clinical directors.

The scheme, introduced in 2019, was intended to increase GP capacity by offering patients an alternative route to care from members of the wider general practice team, and it now includes more than 30 different job roles.

While its success has been variable in practice, the NHS Confederation Report: Assessing the impact and success of the Additional Roles Reimbursement Scheme highlighted that it has beaten 26,000 additional roles target.

NHS England has confirmed ARRS will remain and even wants ‘to extend the success’ of the scheme, however, the petition titled Allow ARRS funding to be used for practice nurses and GPs, now closed, received just over 11,000 signatures calling for GP practices to be able to use this money to pay for practice nurses, salaried and locum GPs who are currently excluded from scheme.

The rationale for this petition is that excluding nurses and GPs from ARRS funding is contributing to their shortage, with some practices short of funds now relying on ARRS-funded roles.

However, NHS England says GPs cannot be added as they are a core profession not additional but let’s explore the pros and cons of adding GPs and nurses.

Pros of opening the scheme to GPs and nurses

1. More ARRS funding is used. Where PCNs are struggling to recruit and spend their full ARRS allocation opening it up to GPs and nurses would help.
2. General practice feels heard and listened to if the petition is successful. This is often a criticism of the Network DES, that its been imposed and not had enough input from the frontline.
3. If services are kept at the PCN level, this could promote more buy-in from practices and a more collaborative approach to PCN work, for example, more clinical leads to embed into PCN DES and less of the ‘us versus them’  relationship between the PCN ARRS team and practice teams.
4. Increased understanding from patients if GPs and nurses communicate that they are part of the network and not just their individual practice.
5. More understanding from GPs and nurses on the complexities of navigating multiple practices.
6. It may be easier to fill enhanced access hubs with GPs and nurses.
7. Reduced financial pressures on practices in the short term.

Cons of opening up the scheme to GPs and nurses

1. It doesn’t address the long-term issues relating to recruitment, staff retention, increasing demand and negative media coverage.
2. It won’t help address the other issues having a negative impact on practices. For example, the 2% pay increase, the drive for increasing access, constraints relating to estates.
3. It could further bring into question the future of the partnership model.
4. It could really disadvantage some of the roles that are currently part of the scheme in favour of maintaining the status quo. However, I do understand and appreciate that the disinvestment in general practice is contributing to some practices not being able to maintain their core services.
5. It could further exacerbate the PCN and general practice two-tier workforce issues that have emerged with PCN staff being paid more than general practice colleagues. If the payment thresholds for GPs and nurses were more attractive than general practice salaries, more movement between general practice and PCN structures could emerge, causing more tension. Alternatively, this may motivate more networks to divide the ARRS funding based on list size and use the funding for current general practice colleagues, with each practice responsible for its own recruitment. This would also disadvantage smaller practices and result in inequalities. If salary reimbursement were lower than the accepted market rate, again, this would result in tensions and frustrations.

To conclude…..

Year after year, there has been an ARRS underspend, so it makes sense for us to review how and what we spend this money on, but having looked at the pros and cons, I think it would be unwise to open it up to include GPs and nurses as a long-term solution or even a quick fix. If the scheme were to open up it would be difficult to restrict to guard against negative implications which could, ultimately, destabilise general practice rather than support it.

Without stable GP surgeries, obviously, the network structure that sits around them cannot succeed, and while I understand the call to include GPs I think we need to see a long-term workforce modelling of what this would look like and how it would play out before extending the scheme.

Tara Humphrey is CEO of THC primary care, which provides interim management training to PCN leaders and has supported more than 120 PCNs.