BMA GP Committee to argue for inclusion of GPs in ARRS

The BMA’s GP committee for England is arguing for the inclusion of GPs in the Additional Roles Reimbursement Scheme (ARRS), its chair has revealed.

Dr Katie Bramall-Stainer told Pulse that the committee is currently arguing for the inclusion and that it could be ‘an obvious solution’ to practices’ financial and workforce issues.

Under the ARRS, primary care networks in England are given funding to hire pharmacists, physiotherapists, physician assistants and advanced nurse practitioners among other professionals, but the scheme currently excludes GPs.

Earlier this month, a petition to allow ARRS funding to be used to employ GPs and practice nurses gathered thousands of signatures.

Dr Bramall-Stainer said: ‘At the moment, there is no means to allow GPs in subsidised roles such as the additional roles reimbursement scheme.

‘To me, that would be an obvious solution because if what the Department of Health and NHS England suggest is that the financial envelope is incredibly tight and the country is in a dreadful parlous financial state of debt that no money is available, surely then we need high trust, low bureaucracy, flexibility, and creative solutions.’

However, she said she thinks ‘it is a sad day that the GPC has to argue for GPs in additional roles’.

‘I think that shows you what we’ve had to inherit, but we are where we are and we have to try and make the best with what we have,’ she added.

‘An improvement on the status quo is all I’m interested in, it has to be a demonstrable improvement for practices.’

But she said that there was resistance to grant the inclusion from NHS England and the Government, who said that ‘GPs aren’t additional’.

Dr Bramall-Stainer added: ‘The challenge that is given back [from the Government and NHSE] is: how does that prove additionality? The comeback to that is that GPs aren’t additional.  

‘Then let’s describe a number of GP roles which will absolutely be additional and which would bring [NHSE] what they want from a neighbourhood integrated team angle and what we would need, for the work that we’re already doing in practices, but that actually falls outside the contract.  

‘It could be a focus on child health and safeguarding, because of course, we’re not going to not do safeguarding, even though it’s not in our contract.’  

Dr Bramall-Stainer also said that the scheme could include a named GP at a neighbourhood level, which ‘will complement’ the named GP at a practice level and a named GP at a system level.

‘Or you could have additional roles GPs that lead frailty provision across a community,’ she added. ‘You could also have additional GPs in the enhanced access setting that could then provide greater resilience for those appointments, allowing substantive GPs to continue long term condition management.’

In an update to BMA members, GPC England deputy chair Samira Anane said: ‘It is GPC England’s view that it would be appropriate to include GPs (and practice nurses) as reimbursable roles within the ARRS programme.

‘Had the considerable financial support associated with the ARRS programme over the past five years been directly available to GPs for use within their practices, without the constraints on recruitment associated with the PCN DES specification, this would have created a far more flexible, responsive and sustainable solution to the workforce crisis facing general practice.

‘We also believe this would have resulted in better value for money from ARRS funding in terms of patient care.’

In an exclusive interview with Pulse last week, Dr Katie Bramall-Stainer said that general practice has suddenly gone from a recruitment to an employment crisis, driven by the Government’s squeeze of practice finances.

In recent months, there have been increasing reports around GP locums struggling to find work, with some putting this down to an increase in ARRS roles.

And last week, a practice in Surrey said it is making three GPs redundant due to ‘new ways of working’, including the use of ARRS staff, and virtual rather than physical consultations.

Yesterday, Pulse exclusively revealed that the practice has been running at a financial loss, with the partners unable to take drawings for themselves for a year.