The ARRS GP conundrum

With the highly anticipated additional role reimbursement scheme (ARRS) GP business rules now available we, as primary care networks, are placed in a conundrum.

What is a newly qualified General Practitioner worth, does the DES treat them fairly and crucially, how do we respond?

This cohort of GPs entered training at a time of high workforce demand and were led to believe that positions in primary care with plentiful and renumerated fairly.

Now, I have had recently qualified GPs telling me they have had as little as three locum shifts in two months. Due to rising cost pressures many practices have had to cut back on locum use.

Added to this salaried GP adverts are few and far between, meaning positions are tough to obtain.

Then we are faced with the ARRS maximum renumeration offering around 25% less than the average salaried GP wage.

The contracts are six-month fixed term and often split across a number of practices as the share per PCN means each practice is only eligible for a couple of sessions each.

What about those GPs with more than two years post certificate of completion of training (CCT) experience who don’t have a job? Many people in this position feel upset that experienced GPs are being forgotten.

And here is the crux of our conundrum. Do we try to make this work so that we can provide roles, although not ideal, for struggling newly qualified colleagues or do we dismiss the offer as inadequate and not engage?

 As a clinical director (CD) I find this a very difficult decision to balance. I never like to turn down funding that could benefit our patients or colleagues. Equally if we proceed, are we complicit in saying that a second-rate, lesser paid, role is allowable? 

The other option is topping up the pay from some other funding source and missing out elsewhere. As this comes at a time when ARRS budgets generally very squeezed and often having to be topped up from capacity budgets all of this is adding to PCN financial pressures.

I’ve been in post since the start in 2019 and I have found this year the most challenging as a CD. Decisions such as which roles not to replace after people move on and how to reduce service across practices are always tougher than service expansion.

I have put these options to my PCN and no doubt we will come up with some sort of compromise. I think most PCNs will have this debate internally over the next few weeks and months and I imagine we will reach differing conclusions. It will be interesting to see how many GPs are hired in this way.

I hope whatever the outcome we can find a way to resolve this mismatch between what’s on offer and what is fair for the profession and that the support for GPs in general is long- term rather than an emergency measure.

Dr Laura Mount is clinical director of Central and West Warrington PCN, Cheshire, and a member of the Pulse PCN Editorial Board.