The model that primary care networks (PCNs) use to recruit additional roles staff has ‘worsened’ health inequalities, a BMA representative has said.
Addressing the House of Commons health and social care committee today, BMA GP Committee deputy chair for England Dr Kieran Sharrock suggested that the current PCN funding model makes it harder for practices in more deprived areas to recruit staff.
The additional roles reimbursement scheme (ARRS) funds PCNs to hire non-GP staff, including paramedics, physiotherapists and healthcare assistants, and is one of the biggest incentives for practices to sign up to the Network DES.
But Dr Sharrock said that practices in more deprived areas struggle to attract staff and so do not benefit from ARRS funding compared with practices in affluent areas who typically face fewer recruitment challenges.
He said: ‘One of our concerns is that the current new funding model for general practice, which is primary care networks, has actually worsened health inequalities.’
He added: ‘In an affluent area where it’s easy to recruit already, they receive the funding for extra staff, so the people of that population get better care.
‘In a less affluent area, which is less attractive, they can’t recruit, so they don’t get funding.’
Dr Sharrock told MPs that the ARRS is ‘very prescriptive’ and stated that providing greater flexibility around hiring would allow PCNs to hire staff in line with the needs of their population as well as local availability.
For example, a PCN that might benefit from or be able to recruit ‘four or five’ social prescribers should not be limited to just one per 100,000 patients, he suggested.
He added: ‘Allow them to recruit an extra doctor if they can or an extra nurse, but at the moment, the additional roles reimbursement scheme is very prescriptive and isn’t flexible and is making health inequalities worse.’
It comes as new BMA guidance on ‘safe working’ last week encouraged GPs to ‘consider’ opting out of the PCN DES.
And a King’s Fund report this month warned that PCNs have ‘inadequate funding’ and support to implement the additional roles scheme, with many networks lacking ‘a clear, shared overall purpose’.
It said that there is ‘a risk that the scheme will fail to have the intended impact’ on reducing pressures in general practice.
More to follow
READERS' COMMENTS [8]
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Well the whole DES is pants though the concept of PCNS is not a bad one .
Remember how it was even worse and had to be completely reformed in the first year to keep most practices on board!
How did the GPC ever negotiate this? ( without a democratic mandate ) and of course our current GPC chair was part of this negotiation .
Sign up and you are committed to deliver the DES for a year , if you cannot get the staff you keep the workload but don’t get the funding .
But you can opt out …. You lose some of the money but you lose the extra workload to include Saturdays and evenings , which if you cannot get the staff might be the best move .
The ARRs scheme had a massive flaw.
There is a desparate need for more GPs and Nurses -but we weren’t allowed to do this through PCNS or ARRS. The ARRs staff are employed by, and need supervision by a diminishing number of GP partners- rather than being autonomous clinicians to bolster the team.
Why not concentrate on actively recruiting GPs and even retaining the ones we have? It looks like more graduates are coming on stream. But for them to choose GP rather than another medical specialty we have to make it better for them. Pay, terms and conditions, the lot. And financially incentivise practice in less affluent areas to get the even spread of GPs the UK needs. If you leave this to market forces, you’ll end up with a city based amazon service only.
Perhaps there are some ideological blind spots concerning ARRS:
(1) Together with the concept of PCN , the original telos was to reduce the workload of GPs as far as negotiating a five year GP contract is concerned . Everyone seems to have forgotten this 😵💫😵!
Has this original goal been achieved? The answer is already written on the wall.👿
(2) The ARRS money is so tightly scrutinised in terms of how it can be spent, as such there was no contingency allowed for using underspent money every year . We certainly had this recurrent dispute between overspending and understanding PCNs in Liverpool every year towards the end of the financial year . The system is so paranoid about the taxpayer’s money being misused that PCNs with good reasons for underspending are lagging behind in further development.
(3) Undoubtedly, some additional roles are helpful e.g. prescriber-clinical pharmacists and -first contact physiotherapists(FCPs).But they still need supervision by adept clinical leaders inside PCNs( I would argue they are older and experienced GPs) who are probably already tied up with workload in their practices .
Furthermore, these supervisory roles are not discretely funded . There is no incentive for more experienced colleagues to involve themselves providing support for their clinical director , realistically. Clearly smaller PCNs are more likely to confront this phenomenon time to time .
Ideally , I would argue , each practice ,rather than at PCN level ,should have the choice of employing their own additional roles aiming at reducing their workload .
Of course , the system would never consider this as appropriate because of ‘control’ issues . Extending this argument to Covid vaccinations , PCN approach is facilitating the government to deliver services more than individual practices ( GMS practices) .
** After all , PCN/ARRS were negotiated on the basis of GMS contract . Now the Health Secretary is talking about vertical integration , phasing in quickly towards an end-game by 2030 . There is really no need to have PCN/ARRS logically . Everybody will be employed by acute trusts/hospitals anyway , ‘happy days’ 🤨🤔😳🙄😈
Here goes the inequality. You sign up, you get the access to staff. You don’t sign up, you don’t get zilch. Makes fair planning. From the employer that was equal and just enough to fire you without a vaccine, remember.
Most (not all) clinicians prefer ‘easier’ work and generally this is found away from inner cities. (I realise the generalisations I have assumed here!)
Inner city practices struggle to recruit GPs so it is of no surprise that when the ARRS staff are in short supply and have a pick of places to work then they choose the same way GPs do.
The only counter balance to this would be an inner city premium but this isn’t available within the system.
All this stuff is so predictable and is part of the lack of work force planning that has gone on.
When all this PCN/ARRS money is spent and GPs lives aren’t much better and access is still perceived as being poor then the chances of getting further investment in primary care will be zero.
Who would spend their own practice money on these schemes?
Rather assumes that the various extra staff employed are doing anything useful. Which seems unlikely from our experience, with the sole possible exception of the musculoskeletal physio. Most are simply an extra barrier to seeing someone who might know what they are doing.
Any evidence?
What they need to be funding is pharmacists to do all the EPS and coders to file the documents
PCNs have are are too presciptive and under funded,most of us involved dont want to be and are just kicking the can down the road as we approach retirement.Most off the arrs(e) role are not of much help at all.The whole thing has been a damp sqib onthe roat to the end of general practice.Cant wait for ICS I will be out of the game and I can watch the clusterf*** unfold as the service will cost 4 x as much for a poorer service ala the ooh shamble of 2004 onwards.They will miss GP land when its gone.But it will be too late.PCNs are akin to the Russian invasion of Ukraine, looked good on paper but in the real world!!!!!