Editor Jaimie Kaffash reflects on the health secretary’s plans to include GPs in the ARRS
I do not expect to say these words too often: I have sympathy for Wes Streeting.
Not in general, but specifically with regards to his plan to put GPs in the additional roles reimbursement scheme. Now, quick declaration of interest – I was one of the first people (to my knowledge) to call for this.
But I didn’t remain the only one. The RCGP called for it. A petition supported by the Doctors Association UK and signed by 11,000 people called for it. And GPC England called for it.
So I am slightly surprised that Mr Streeting’s decision to include GPs in the ARRS has been met with such opposition – including from GPCE.
Now, I get why it could be seen as a political move – it was announced on the same day as GPCE announced collective action. It wasn’t done to offer an olive branch, it was done to undermine collective action.
Furthermore, adding newly-qualified GPs to the ARRS doesn’t get to the systemic issues around GP recruitment. It is not even a great sticking plaster. As the GPCE has pointed out, funding should be given to practices – not PCNs – for the recruitment of GPs, and it doesn’t help older and experienced GPs to find employment. It will also force GPs to move across the country.
This is all correct. However, we need to see this for what it is (other than a cynical political move): it is an emergency measure. We have the prospect of thousands of newly qualified GPs being out of work this month. This is the dreaded scenario that we needed to avoid.
Yes, it would be great if the Government committed now to a long-term scheme that ensured that there were no unemployed GPs, and practices were as close to fully staffed as they can be. But, with a month between the election and these thousands of GPs receiving their full qualifications, it would have been a disaster to implement a long-term scheme – or even a temporary new solution – in this amount of time.
For all its faults, the ARRS is established. The mechanisms are in place to get funding to PCNs. Any unforeseen problems with using these mechanisms to funnel this money will be minimal compared with a completely new scheme, permanent or temporary.
Of course, we need a replacement for the ARRS – it is the cause of many of the recruitment problems we are seeing now. But this replacement needs to be thought through in great detail, and with negotiation between the Government and the GPCE.
My preference would be a radical one: to have all staff costs paid centrally. It used to happen in the past, and it would ensure practices get the staff they need while negating government (in some circumstances, justified) concerns around partners putting money in their own wallet.
But a solution like this should never be implemented in four weeks. I’ve summed it up in a paragraph, but there are so many potential pitfalls. Rushing something like this risks reproducing the problems with the ARRS.
This is not the perfect solution. But, just like my sympathy for Mr Streeting, we need to see it as a short-term measure.
Jaimie Kaffash is editor of Pulse. Follow him on X @jkaffash or email him at editor@pulsetoday.co.uk
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The issue of PCNs and ARRs is a political issue and I believe PCNs should be disbanded asap.
The issue re partners pay is also one that needs addressing and as a partner I firmly believe partner pay should be capped to give an annual cap on returns(or whatever term is used) which would be broadly in line with consultants.
Partners should not be able to earn above this threshold, but we are all aware of the complexities of partnership drawings and this requires some work.
Many practices who never achieve these levels would benefit and many who exceed these levels would lose but therein lies the fundamental issue the government has wished to address.
The above would solve the government issue that partners in some cases earn excessively which is definitely the case in my view.
The complexities lie in practice accounts wherein drawings are not the same as the actual take home pay for partners, but this aspect requires a technical accounting input.
Although controlling partner take home pay is also long overdue, a cap on NHS locum pay is also ideally required.
During the period of PCNs we in our practice have seen an anomalous benefit as we been able to recruit locums where previously we could not and have maintained or increased our locum use and not replaced via ARRs.
Previously our practice was seen as a less desirable locum venue due to area, building etc. etc. so in recent times, locums have been easier to recruit whilst we continued to maintain the same reasonably high locum rates (never reduced) as previously.
I have had locums in the past request £135 to £145 per hour and this is unaffordable other in absolute dire emergencies. Here lies the other unpalatable problem akin to that of excessive partner pay.
I for one as a partner would welcome a cap of partner and locum pay as this in one fell swoop would at least start to address health inequalities resulting from inner city practices then playing on a more level playing field in recruiting locums or partners.
Practice earnings taking partners above the earning threshold would need to be utilised for NHS work /projects or returned and used for other NHS work. This will prove very unpopular amongst some.
Whether there are new grades of GP within practices in line with experience or qualifications or other measure is another matter.
If we are all professionals, then a reasonable set return should be enough to encourage the highest standards and aiming for high achievement should be enough of an incentive alone and without the distractions.
However, PCNs and PCN CDs must be made a thing of the past as a matter of urgency as billions continue to be used inefficiently at cost to all.