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General practice ‘risks losing nurses feeling devalued by ARRS’

General practice ‘risks losing nurses feeling devalued by ARRS’

The role of general practice nurses (GPNs) is being ‘devalued’ by the additional roles reimbursement scheme (ARRS), a leading nursing charity has warned.

The Queen’s Nursing Institute (QNI) said GPNs – as well as GPs – are working longer hours to introduce new team members, calling on NHS England to dedicate resources to training.

It also noted with ‘disappointment’ that ARRS now caters to 17 multi-disciplinary team roles in primary care with the ‘continued exclusion) of GPNs from the scheme.

It called on NHS England to ensure GPNs feel valued or they will vote with their feet and go work outside general practice.

‘Many GPNs are being required to support new starters, despite nurses themselves being excluded from being recruited into the scheme,’ the charity warned.

‘It is well documented that many GPNs, alongside GPs, are spending a substantial part of their clinical time developing and delivering induction programmes, supervision, and training schemes for new starters, but are receiving no additional benefit or recognition for this, and there are minimal resources to deliver these induction programmes.

‘Indeed, the impact is one of longer working hours to enable GPNs to continue providing their clinical care alongside these additional responsibilities.’

To remedy the situation, NHS England should allocate ‘resources to support the comprehensive induction and supervision of new members of the general practice team recruited through the ARRS’, QNI said.

QNI went on to warn that ‘Advanced Nurse Practitioners, who are now included in the scheme, are often routinely named as the lead nurse over GPNs, even when they have not previously worked in general practice’.

There is also ‘an emerging risk of deskilling expert GPNs in favour of the new roles introduced through the ARRS’ the charity said, with clinical practices becoming ‘divided into tasks’ and patients losing the continuity of care that GPNs provide.

‘A unique part of a GPN role is the ability to deliver holistic, personalised care for the whole population; many other roles are providing care that is chiefly task orientated, risking duplication, omissions, or unnecessary interventions,’ it said.

‘By recruiting such a high proportion of new staff through the ARRS, the role of a GPN is being devalued. ARRS roles are perceived as the “life savers” of primary care – and there is no doubt that they have value – but GPNs have been central to the delivery of excellent care in general practice for decades.’

Unless there is a ‘clear acknowledgement of the value of GPNs’ and ‘a plan to support GPNs to stay, grow, and develop’, general practice risk losing GPNs to other areas of the health service, QNI concluded.

NHS England’s long-term workforce plan, published in June, said it would look to increase capacity and free up available appointments in general practice by bringing in 15,000 non-GP direct patient care (DPC) staff and more than 5,000 primary care nurses.

A version of this story was first published by Pulse’s sister title Nursing in Practice


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Please note, only GPs are permitted to add comments to articles

Michael Mullineux 22 August, 2023 11:27 am

Absolutely agree. And it is happening with many disgruntled Nursing Colleagues in our locality. Further the rates of pay for some of the ARRS roles even with starters with negligeable experience and enormous training needs beggar belief and massively outstrip those of our Nursing Colleagues.

Centreground Centreground 23 August, 2023 12:14 pm

The NHSE misuse of funding in relation to PCN ARR payments simply amounts to gross negligence in respect of their management and use of NHS taxpayer funds .

David Church 26 August, 2023 10:00 am

This applies to real Doctors too, they could become undervalued and displaced by the emphasis on Noctors getting great salaries for doing the same job, but more slowly and with less responsibility and no supervision and training responsibility.
It seems to me iniquitous that an experienced Practice Nurse is not simply considered an ‘advanced Nurse practitioner’, because they are not an ‘ordinary nurse practitioner’ (any newly qualified nurse who is working in nursing), they have had advianced training (not always formally recognised) and higher levels of experience.
I feel the proper name is ‘Practice Nurse’ when working in General Practice, and ‘advanced nurse practitioner’ MIGHT be equivalent but is not necessarily so, and is certainly not appropriate when used in relative terms to a Practice Nurse, and certainly not necessarily a higher grade – although it appears to be considered so by many who do not have the experience or actual higher level of skills – although some do.
The system needs an overhaul. I openly told the person who brought in the term ‘ANP’ this and why I felt so about 15-20 years ago. ANP (or even just ‘Nurse Practitioner’ when used to try to imply equivalence with a ‘General (Medical) Practitioner’ is an extrremely unhelpful term, used more not to inform, but to attempt to adopt airs of superiority which are not always helpful. The antagonism between Nurses and Doctors, often developed by trainers in the 2 education systems, needs to be eliminated and replaced with mutual respect for the 2 essential different jobs we do: one Nursing and one Doctoring. recognise a little overlap and shared skills perhaps, do not deny that the other profession may have shared skills – and I actually have some nursing training and qualifications as well.

R Fara 24 October, 2023 8:57 pm

Some of the ARRS staff roles are very valuable. In fact our GP trainees, and student nurses shadow our clinical pharmacists and physiotherapists as part of their training.
Regarding your comments on pay: The ARRS’s pay by NHS England that seen in the Network Contract DES are “the actual salary plus employer on-costs” and not what the ARRS are actually paid.