This site is intended for health professionals only

NHS England will not add GPs to ARRS because they are ‘not additional’

NHS England will not add GPs to ARRS because they are ‘not additional’

NHS England is not looking at adding GPs to the additional roles reimbursement scheme (ARRS) because it is not designed to ‘compensate for a shortage of core capacity’ in practices.

Earlier this week, ‘enhanced’ nurses were confirmed as the only addition to ARRS in the new GP contract coming in from April.

This is in spite of BMA’s GP Committee for England’s demands to include GPs, going as far as calling it a ‘red line’ in the contract negotiations.

During a contract webinar yesterday, NHS England’s national director of primary care Dr Amanda Doyle defended the decision not to include GPs in the scheme, saying they are ‘not additional’.

She said: ‘We still are not proposing to add general practitioners to the additional roles and I know that was something that lots of people were asking for.

‘A general practitioner is not an additional role in primary care, it’s a core role, and I don’t want us using the additional roles scheme to compensate for a shortage of core capacity within practices.’

But GPC chair Dr Katie Bramall-Stainer told Pulse that the BMA had attempted to allay these concerns as part of contract negotiations.

She said the GPC ‘listened and heard NHSE and DHSC’s concerns around additionality’ and drafted a set of papers detailing ‘comprehensive job plans’ for GPs within ARRS.

She said: ‘These were for GP roles in defined and discrete areas which would complement either commissioning gaps or GMS and PCN DES requirements, and which would absolutely need to be additional.

‘We will be publishing these examples shortly for everyone to see, and then they can make up their own mind around whether concerns were well founded, or merely ideological intransigence.’

Dr Bramall-Stainer previously called the inclusion of GPs in ARRS an obvious solution’ to practices’ financial and workforce issues, while a petition with the same goal gathered thousands of signatures.

In recent months, there have been increasing reports around GP locums struggling to find work, with some putting this down to an increase in ARRS roles.

In January, a practice in Surrey said it was making three GPs redundant due to ‘new ways of working’, including the use of ARRS staff, and virtual rather than physical consultations.

Also during yesterday’s contract webinar, Dr Doyle admitted that contractual changes aimed at ‘increasing flexibility’ will only make a small difference to practices, compared to increased funding.



Please note, only GPs are permitted to add comments to articles

Dr No 1 March, 2024 5:17 pm

OF COURSE GPs are excluded from ARRS. To include GPs would be counter to the now very obvious plan to depopulate Primary Care of expensive and experienced doctors. After typing this I’m deleting my Pulse registration before I type something I regret but which certain parties richly deserve… Bye everyone and best of luck.

Jonathan Pywell 1 March, 2024 5:45 pm

‘A general practitioner is not an additional role in primary care, it’s a core role, and I don’t want us using the additional roles scheme to compensate for a shortage of core capacity within practices.’

The implication being that NHSE want to prioritise additional roles over core roles. Can you imagine trying to present that type of logic at the board room of a private company? “We have a significant shortage of key people in our business but we are proposing to the board that they fund lots of new roles that may or may not help the business. And we are recommending to the board that you don’t spend any surplus money on key business roles, where we have the most shortages.” I think you would be laughed out of the room and your own contract terminated pretty quickly to save the business money for such a stupid recommendation.

How about NHSE changing the name of the scheme to “Roles Reimbursement Scheme”? Allow any clinical role to be reimbursed and let practices decide which type of clinicians would help their patients/practices the best. We would then see, which roles are wanted/needed by practices, rather than this artificial market where you can’t choose “core capacity” roles.

Turn out The Lights 1 March, 2024 6:19 pm

We as GPs seem to be expendable.So be it where will all these arseroles get their safety net from when we are not here.

neo 99 1 March, 2024 6:27 pm

The 5 year deal in 2019 was always going to be a disaster with the failure of the GPC to read the long term implications between the lines. The architects of that deal have long since departed into the shadows. This has always been a long game to defund core general practice, replace and deprofessionalise a highly trained GP workforce for a cheaper poor quality access focused alternative. GPs in the UK have no value as the general consensus is that anyone can do our job and this is what has driven this current direction. However no one can hold and manage risk needed to safely and cost effectively manage undifferentiated illness better than a highly trained experienced GP. I have secondary care colleagues frequently state they can never do what we do. There is total ignorance of this fact and it is going to spell disaster both in terms of cost and poor quality care. Partnerships are dead and will over the next few years be taken over by PCN equivalents. Pay and conditions for the existing and future GP workforce is and will continue taking a dive and it no makes no sense to train as a GP both in terms of effort, time or future pay other than to get a CCT and get the hell out if the UK. Long term, the use of “additional” roles is and will continue to result in over investigation, repeat attendances, increased hospital admissions and referrals resulting in higher NHS cost. Something NHSE seems too dumb to see or do not care. It is also sad to see that we and especially the GPC have been weak and complicit, maybe even naive in our failure by training an inferior workforce which is ready to replace us. It really is game over. Previously I have talked about a plan B outside the NHS which had never been forthcoming from the GPC however I doubt even that now would make a difference.

Sam Kam 1 March, 2024 7:43 pm

It is very simple- not to engage with the plan and not keep any additional roles in surgeries . Also mot to train them as sign of not co-operating rather than crying over 2 per cent offer. This scheme works only if GP’ s collaboration and supervision. There are few partners who are applying this.

So the bird flew away 1 March, 2024 9:58 pm

DHSC/NHSE know that everything they’ve done and said over the last few years about improving primary care services has been untrue.
Orwell – “Intellectually, it is possible to carry on this process for an indefinite time: the only check on it is that sooner or later a false belief bumps up against solid reality, usually on a battlefield”.
Their false belief will soon come across the solid reality of declining GP services on the battlefield of GP industrial action.
Put it this way, if all GPs shut up shop for 5 days, the NHS would crash to a standstill, and DHSC will be begging to negotiate properly. Or the Govt will get kicked out early.

John Graham Munro 2 March, 2024 7:29 am

The only way to sort this is by industrial action———–but don’t hold your breath

Rob M 2 March, 2024 9:38 am

Industrial action a waste of time – only way BMA/GPC can have any clout at the neg table is the threat of mass resignations backed by a real Plan B to walk away. Otherwise all just huff and puff that the DoH will ignore. Not sure the strength of will to en masse send in resignations and look set up outside of the NHS or leave the country is there anymore – looks as if our bluff’s been called and writing’s on the wall. Dont believe Mick Lynch would have allowed this to happen to his members without more of a fight if the BMA had been his watch

Zack Magkrachi 2 March, 2024 5:03 pm

Well, two tier NHS here we come! In the near future those who have will see a GP and those who don’t will see ARRS (pun intended).

Nick Bulmer 3 March, 2024 2:56 pm

Government don’t want GPs in the NHS anymore, but I don’t understand what they want us to do now. Are they expecting us to set up private practices? Or do they value us so little, that they don’t care what we do, as long as we’re not working in the NHS? I do know they don’t understand General Practice and they’ll miss us when we’re gone.

John Graham Munro 3 March, 2024 9:15 pm

I shall shortly relinquish my comments in Pulse. But,—- not before telling you all exactly who I am and why my contributions have not always been to every ones taste

So the bird flew away 4 March, 2024 2:07 pm

I’m putting bets on Banksy, the Joker or Lord Lucan 😉

Liam Topham 4 March, 2024 5:02 pm

It’s like The Masked Singer !