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

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.