Third of target ARRS roles hired but ‘not enough to ease GP workload’

PCNs in England have recruited more than 9,000 clinical staff under the Additional Roles Reimbursement Scheme (ARRS) so far, according to NHS England.

This represents around a third of the target 26,000 ARRS staff expected to be hired by 2024 – including roles such as physiotherapists and pharmacists – after the scheme was brought in as a core part of the Network Contract DES in 2019/20.

NHS England says its figures show PCNs are on track to meet the goal, but GP leaders have warned the extra staff are not enough on their own to reduce the pressure on GPs’ own workload – and in some cases add to it in the short-term.

The figures, published in NHS board papers last week (24 June), show PCNs in England had recruited 9,100 additional staff under ARRS by the end of March 2021.

The papers said: ‘To further bolster workforce numbers primary care networks are entitled to recruit staff from 14 roles under the Additional Roles Reimbursement Scheme, and by 31 March 2021 our triangulated data shows that PCNs had successfully secured over 9,100 additional staff in post – on track to deliver against the 26,000 manifesto goal.’

While GP leaders have welcomed the increase in PCN staff, they have warned it is not enough to cut GP workload.

GP Survival chair Dr John Hughes told Pulse that the additional ARRS staff employed so far ‘is not going to make up for the shortfall in GP numbers’, adding ‘it’s absolutely vital that NHS England and Health Education England start recruiting and training more GPs’.

While an overall increase in the number of ARRS staff is positive, Dr Hughes warned some PCNs seem to have an ‘insufficient number’ of ARRS staff, with some practices ‘only getting one [additional staff member] for a couple hours a week, which isn’t going to make a dent in the workload’.

He added that there is a ‘big issue’ with space being at a premium in general practice, meaning, ‘lots of practices don’t have enough space for their own GPs, never mind any extra staff’.

BMA GP Committee executive workforce lead Dr Krishna Kasaraneni also told Pulse: ‘The 9,100 staff recruited via the Additional Roles Reimbursement Scheme (ARRS) will make a difference to primary care.

‘However, general practice is currently under enormous pressure with demands of Covid, the vaccination programme and a growing backlog of care to contend with. While ARRS staff are very beneficial, much more needs to be done to boost the GP workforce itself who are struggling under the weight of current workloads.’

Doncaster LMC chief executive Dr Dean Eggitt told Pulse he was ‘extraordinarily grateful for the ARRS funding’ and the contribution from those in the posts, ‘but right now, we need doctors. Where are the 5,000 that we were promised?’.

He added that the newly recruited staff will require ‘supervision, support and development’, which actually ‘takes time away from GPs seeing patients’, but added it is likely that the level of support they need will reduce over time, along with the additional burden on GPs. 

Meanwhile in some regions, it is still proving difficult to recruit. Liverpool LMC medical director Dr Rob Barnett told Pulse that the problem is PCNs are having to recruit staff from a ‘small pool’.

He said: ‘The idea that everyone is going to have physician associates sounds great, except my own network has advertised twice so far with very little success. The first contact physio again sounds wonderful, but what’s available is a drop in the ocean. And all we are doing is taking physiotherapists away from elsewhere in the service. We are not seeing a real expansion in the workforce. We are just moving some deckchairs around.’ 

In December, it emerged that NHS England withheld 40% of ARRS funding from PCNs in 2020, stating, at the time, it would only allow CCGs to access it ‘based on need’.

Also, last month, a think-tank warned that ARRS could worsen health inequalities because recruitment is likely to be ‘skewed’ to wealthier areas.