CCGs should redistribute any unused funding for hiring extra staff under the new DES agreement to other primary care networks (PCNs), NHS England has said.
In its latest Additional Roles Reimbursement Scheme guidance, NHS England strongly suggested CCGs implement local schemes for the allocation of leftover entitlements destined to help cover the costs of additional PCN roles for 2019/20.
GP leaders fear the move might create further inequalities and encourage PCNs to compete against each other.
Under the new network DES arrangements, funding will be unlocked to employ 22,000 additional practice staff – including pharmacists, physiotherapists, paramedics, physician associates and social prescribing workers – by 2023/24.
NHS England has guaranteed to cover 70% of the costs for pharmacists, physiotherapists, paramedics and physician associates and 100% for social prescribers.
In guidance released last week, NHS England said that if a network failed to use its full entitlement the funding should go to other PCNs in the area to help them recruit further staff, as it cannot be carried over into the following year.
The guidance said: ‘NHS England expects the funding under the Additional Roles Reimbursement Scheme to be used in full, on the terms set out in the Network Contract DES and in this guidance, in each year of the scheme.
‘For 2019/20, in the unlikely event that a CCG forecasts an underspend on its Additional Roles Reimbursement Scheme funding (as a result of PCNs failing to draw down their full entitlement), NHS England strongly encourages CCGs to put in place local schemes to share that unused financial entitlement across the other PCNs in the area to enable them to carry out further recruitment – on the terms set out in the Network Contract DES and in this guidance – above their 2019/20 entitlement (with those further additional posts then attracting national funding via the Additional Roles Reimbursement Sum for 2020/21).’
NHS England added that it will discuss with the BMA about introducing ‘a national system of entitlements for PCNs to claim unused Additional Roles Reimbursement Scheme funding from other PCNs’ unused entitlements within a CCG area’ for 2020/21 and beyond.
It said: ‘This would enable those PCNs which have made swift progress in recruiting to the additional roles set out in the Network Contract DES to bring forward further recruitment plans from the subsequent year.’
Berkshire, Buckinghamshire and Oxfordshire LMCs chief executive Dr Matt Mayer warned this could create a competing feeling among networks.
He said: ‘The important thing NHS England should be asking is “why any PCNs have not drawn down their full entitlements?” There’s a differentiation between those PCNs that have chosen not to, because they don’t think there’s any benefit or that it’s financially viable, and those who have tried and were unable to do so because they can’t compete with other PCNs.
‘What we don’t want is to create an arms race where PCNs are competing against each other and the bigger, more powerful, established ones are getting all the staff and the smaller, growing ones are unable to because they are not as progressed. I would be concerned about that.’
Echoing his comments, Dr Farzana Hussain, a GP in London and PCN clinical director said: ‘While I can see the logic behind this guidance in terms of using the resources allocated most efficiently and keeping the resources local, my worry, particularly for 2019/20 is that unused resources will go to the networks who already have infrastructure in place – perhaps they were previously a super partnership anyway or a larger organisation who have practices in many areas of the country – so have easier access to recruiting to the new roles more quickly.
‘This will put the new PCNs at a disadvantage and increase health inequalities further.’
An NHS England spokesperson said: ‘We recognise the skills and experience clinical pharmacists can bring to general practice and that is why we have agreed with our GPC colleagues to fund 70% of the cost of recruiting pharmacists in bands 7 to 8a, up to a maximum of £37,810.
‘An extra £1.799bn is being invested in PCNs by 2023-24, of which £891m will be available to recruit 20,000 more healthcare professionals over the next five years to support GPs, including pharmacists.’
GP leaders have previously expressed concerns that some networks – particularly those in deprived areas – might struggle to cover the remaining 30% of funding for some of the additional roles.