NHSE tells PCNs to create more space in practices for ARRS staff

PCNs will need to free up workspace to ‘accommodate’ taking on more staff recruited through the Additional Roles Reimbursement Scheme (ARRS), NHS England has said.

In a primary care bulletin sent yesterday (29 June), NHS England reiterated the ARRS initiative provides funding for 26,000 additional staff to create ‘bespoke multi-disciplinary teams’, adding therefore ‘PCNs will need to accommodate more people on their estate footprint’.

This comes as NHS England revealed last week that PCNs have recruited 9,100 clinical staff under the ARRS so far, representing a third of the 26,000 target for 2024.

But GPs have said NHS England’s update fails to acknowledge that many practices will need funding to secure larger premises – and they questioned its suggestion to consider making more use of remote working.

The latest NHS England bulletin links to a page with case studies and tools to ‘help PCNs address this [workspace] challenge’ and achieve other aims, including using technology in managing the workforce.

NHS England said PCNs should ‘reconfigure current estate to reflect patient need’, which includes realigning clinical and admin space, and offered PCNs patient flow and workforce and workspace redesign tools to ‘assist in reframing the environment’.

It also provided case studies ‘demonstrating where PCNs have been rethinking the traditional use of space within and outside’ of their networks. 

NHS England also said PCNs should ‘utilise technology’, including remote consultations and remote working to free up GP time and allow for more efficient working.

One of the case studies, involving a practice in Portsmouth, said staff members throughout the surgery are now working remotely from home and in the community, adding this has allowed it to ‘free up space in practice and provide more convenient and flexible appointment options’.

PCNs should ‘build collaborative partnerships with secondary, community and voluntary partners’ to ‘deliver safe, effective and equitable services to the patient in the community’, while PCNs should ‘streamline care’ across the network to reduce overall patient demand, it added.

However, GPs have said the advice does not address the long-running problem of a lack of ‘insufficient effective estates’ in general practice.

Leicestershire GP Dr Grant Ingrams told Pulse: ‘If you look at [NHS England’s] advice, there is not a single mention recognising that as practices provide more and different services and the number of appointments increase, we are actually going to have to fund additional premises.’

Dr Ingrams said ‘a lot of us didn’t have space beforehand’, adding that his own practice has converted a storage cupboard, which has no natural light, into a remote consultation room, as it desperately needed more space. 

He added: ‘[The advice] suggests that we consider doing more remote consulting, but it’s the same NHS England that was castigating us for not seeing everyone face to face at the drop of a hat not long ago, which is inconsistent.’ 

Kingston PCN clinical director and GP partner Dr Richard van Mellaerts told Pulse that the primary care estate in England is ‘not suitable for providing a 21st century general practice and there’s not enough space to incorporate a load of extra ARRS staff’. 

He said: ‘Suggesting that we utilise other flexible and unconventional work spaces does not address the fundamental problem of insufficient effective estates in general practice.’

He added: ‘Not everybody is going to be working remotely forever. And as we move to 19 July, it’s likely lots of practices are going to be seeing more patients face to face as opposed to fewer.’

Last year the BMA urged the Government to invest ‘at least’ £1bn capital funding in GP premises, due to longstanding problems with estates, but also the need to house extra staff recruited through the ARRS scheme.

NHS England last month issued guidance to practices that said GPs’ patients should be offered face-to-face appointments if that is their preference, sparking an outcry among GPs and causing the BMA to halt meetings with NHS England until the matter had been resolved.