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NHSE keeps back 40% of ARRS cash unless PCNs prove ‘need’


CCG PMS funding cut


NHS England is withholding 40% of PCNs’ additional roles reimbursement scheme (ARRS) funding this year and will only allow CCGs to access it ‘based on need’, it has emerged.

In a letter to CCGs and regional primary care leaders, NHS England said £257m of the £430m ARRS funding had been handed to CCGs for PCNs to use in 2020/21.

However, it noted the remaining £173m ‘has been held centrally by NHS England and NHS Improvement’.

It said CCGs would be able to claim the extra funding if they provide evidence that PCNs have used up their allocation of ARRS funding so far and can show the ‘month-by-month’ breakdown of costs for further staff they intend to hire.

But GPs have stressed it has been difficult to recruit staff and have called for the money to instead be released for practices to deal with current pressures.

NHS England said in the letter, dated 9 October, that the new arrangements for accessing the ARRS funding were first outlined in a separate letter sent in March. This latest letter reveals each CCG’s individual allocation of funding.

The letter said: ‘Once the PCNs in a CCG area have claimed the total of the CCG’s allocated share of the £257 million – and ongoing claims will cause the CCG to exceed this amount, a CCG can access additional funding based on need from the additional funding held centrally for that purpose.’

CCGs will need to provide evidence about PCN plans for recruiting roles if they want to access their 40% leftover cash from the central fund, said the letter.

It added: ‘This evidence should include a breakdown of what each PCN has claimed to date and is planning to claim for the remainder of the year each month through providing the month-by-month aggregated number by PCN of the full-time equivalents (FTEs) engaged by the PCN for each role type recruited (either through employing an individual or via a subcontracting arrangement for the service) and the associated costs by role and month.’

But GP Dr Geetha Chandrasekaran, clinical director of North Halifax PCN, said the money is ring-fenced for primary care so should be handed over directly to PCNs if they can’t recruit.

She said: ‘The money is earmarked for primary care so as GPs we would like it just to come to primary care, without having to jump through many hoops.’

She said GPs should also be allowed to use the money they’ve been unable to use to fund other primary care activities, instead of it being held back solely for recruitment.

‘A lot of practices are struggling for phonelines, admin support and everything else that goes with a patient care package – it’s not just clinicians, there’s a lot of background work.

‘I would be totally in favour of the funding being given to PCNs according to their allocation – by all means ask how we’ve spent it on patient care, but if that accountability is there it should be given to PCNs directly.’

Dr Simon Hodes, a GP partner in Watford and joint PCN lead for his practice, said he is worried NHS England’s system for allocating the money will make it difficult for GPs to get hold of.

He said: ‘The current PCN ARRS rules were conceived pre-Covid, and the scheme is clearly not suitable this financial year. If it was working, the funds would all be utilised.

‘NHS England are essentially holding money back that was earmarked for primary care, which could be used to help support practices and improve access, for example providing extra locum sessions which also relieve pressure for the practice.’

NHS England recently told GPs in a bulletin that ‘a PCN may use its additional roles reimbursement sum to reimburse extra hours worked by PCN staff, at plain time rates only, as long as the increase in whole-time equivalent hours worked is clearly recorded on the PCN’s claim form and national workforce reporting system’.

But Dr Hodes said he ‘doubt[s] this will be widely used’.

He added: ‘Advertising and recruiting at present is very challenging, and practices have no physical space for new staff due to social distancing.

‘It is highly likely that much of the ARRS funding nationally will go unclaimed this financial year unless there are more flexible changes made very soon, which could easily and quickly be used to improve access and patient care.’

NHS England has unveiled a £150m fund for GPs’ pandemic costs up until March as they deliver the Covid vaccination programme – but it requires practices to return to ‘at least prior levels’ of their core services.

Earlier this year, Pulse revealed PCNs used less than half of the funding they were entitled to last year to recruit staff under the additional roles scheme, leaving CCGs sitting on millions of pounds of surplus cash.

This was after NHS England said for 2019/20 it ‘strongly encourage[d]’ CCGs to share the unused funding among other PCNs for hiring more staff.

NHS England has since gone on to warn PCNs that any funding they do not spend on recruiting additional roles in 2020/21 may be ‘lost to general practice’.

A Pulse survey of 179 PCN clinical directors over the summer found almost two-thirds (64%) said their network had so far failed to fill its full ARRS allocation for 2020/21.

READERS' COMMENTS [13]

Kevlar Cardie 1 December, 2020 10:49 am

The Additional Roles Reimbursement Scheme should not, under any circumstance be confused with the take Every Low-paid Bugger Off Work plan.

Vinci Ho 1 December, 2020 11:07 am

Nobody is surprised here .
NHSE is always NHSE(Ministry of Plenty) , never bloody changed.

Michael Mullineux 1 December, 2020 11:31 am

It is in your NHSE- PCN smoke and mirrors contracts – ARRS funding was always for additional staff roles most of which looked debatable value in an effort to reduce GP workload , never for PCN’s to use as they saw fit. 98% of you signed up to this contract in the midst of the Covid pandemic despite LMC warnings to the contrary. Hardly a surprise really is it?

Turn out The lights 1 December, 2020 11:35 am

PCNs are dead in the water role on the next revolution/retirement/exodus.

Patrufini Duffy 1 December, 2020 2:22 pm

You created additional roles. They made a proud salary. You have no evidence of any increased health outcomes or reduced NHS demand. You just moved the patient buck, and the NHS cleverly filled your GP spaces with complex NHS 111 Cas slots, care homes, hot clinics and AE redirects. You took their bait. Do your core contract, or that too will be breached. Remember, your PCN obligation ties to your GMS/PMS – read your contract, or visit Hempsons solicitors.

Manu Agrawal 1 December, 2020 2:34 pm

The PCN programme, which was disguised as funding into General practice, was never funding into General practice. NHSE were and are very well aware that no PCN will ever utilise its full ARRS, thereby creating smoke and mirrors, and unfortunately our leaders in GPC fail to recognise that. THE FUNDING NEEDS TO GO INTO CORE.
LMCs voted for ballot to come out on PCNs to all GPS, this will be our last chance to save General Practice. VOTE IT OUT

David jenkins 1 December, 2020 3:29 pm

the large print giveth – and the small print taketh away !

why do intelligent, normally sensible and level headed GPs continually fall for this sort of scam ?

it is more smoke and mirrors from NHSE. DO NOT FALL FOR IT !

do what you can with the available staff in the time available. leave for another day any non medical, non contract rubbish admin tasks.

if you have fallen for it, and employed extra staff, don’t forget that when funding dries up (which it will), you will either have to take less pay (again), or possibly pay redundancy etc out of your own pot.

DO NOT FALL FOR IT !

REMEMBER “THERE IS NO SUCH THING AS A FREE LUNCH – SOMEONE HAS TO PICK UP THE TAB”

imagine how much extra work we could all get through if we didn’t waste our precious time reading through all these sorts of bogus incentives, and putting “bids” in for extra stuff to do !

when covid has all settled down a bit, come to locumland – where you can control your own workload and not deal with NHSE and their silly friends !

Dr N 1 December, 2020 4:15 pm

I’m one of the 2% that saw though this rubbish. PCNs were set up with the sole function of reducing secondary care costs, not to reduce GP workload except when it suited NHSE. You all ran around like idiots setting up red zones within your PCNs and are now running around doing pointless patient reviews but when the actual subsequent crunch came of rising non covid demand low and behold there is no money to support you. Good luck with your box ticking.

Patrufini Duffy 1 December, 2020 4:18 pm

Does the public realise many ARRS physiotherapists work for private companies? A future good Pulse article.
Next it will be yoga instructors, counsellors and magicians. Makes sense.

John Glasspool 1 December, 2020 5:53 pm

I like the idea of employing magicians. How about homeopaths too? It would keep Bigears happy.

Mr Marvellous 1 December, 2020 7:19 pm

PCNs will have to kick and scream and the best thing that can happen is that they’ll get their ARSS handed back to them.

James Morton 1 December, 2020 11:36 pm

If there are to be no CCGs in 18months time (I’m confident no money will be wasted or paid out in that transition!) do those who are against PCNs know of a better alternative that practices will be able to access in order to have a voice?
“Bunker down in your NHSEstates building” doesn’t really help the Partners in our forties…..

Michael Mullineux 2 December, 2020 10:49 am

JM 11:36: not convinced that being part of a PCN gives you a voice. It certainly ties you to an elaborate contract delivering additional evidentially unsubstantiated services whilst perversely reducing frontline GPS who are obliged to manage their PCNs. This while creating new roles for extra staff that we weren’t to sure we needed. I am a partner in my 50’s and continue to enjoy the freedom that my independent contractor status affords me to innovate and deliver services to my patients that are adequately funded whilst controlling costs. No bunker here, only gratitude that unlike millions of our fellow citizens I do not face imminent financial ruin.