The rules around ARRS funding should be changed to allow for paid GP supervision time, a think tank has argued.
In a new report on the supervision of additional roles in general practice, the Nuffield Trust found that there is ‘huge variability’ in the level and quality of support offered to clinical staff such as advanced practitioners, physician associates and pharmacists.
It also found that there is ‘little information available’ about how supervision should differ ‘depending on the career stage’ of the staff member.
The Nuffield Trust noted that current ARRS rules mean that the salary is funded but supervisor time is not, and that ARRS funding cannot currently be spent on supervision. It called for changes to ‘allow payment of senior clinicians to supervise ARRS clinicians’.
The report said: ‘The wide variation in ARRS implementation, roles and the need for individualisation makes costing supervision challenging, and there has been no published cost analysis to date.
‘However, it is important to recognise that if safe supervision is to be provided, it must be adequately funded. ARRS roles are funded by the scheme, yet supervisor time is not.’
It argued that without full funding for supervision, the ‘opportunity cost’ is lost appointments for patients – or, in the absence of effective governance arrangements, supervision ‘may not be provided adequately, or at all’.
It added: ‘The rules on the use of ARRS funding should be changed to allow payment of senior clinicians to supervise ARRS clinicians. An analysis of supervision costs would be helpful to guide the allocation of a proportion of ARRS funding to PCNs to deliver supervision.’
It also suggested that the ongoing debate around the physician associate role – which comes under the ARRS – has ‘emphasised the need for rigorous supervision arrangements’.
The researchers acknowledged that patchy supervision arrangements across the country may be caused by capacity issues among GPs and other senior clinicians.
Their report said: ‘NHS England guidance calls for ring-fenced time for supervision, which needs to be “hard wired” into the clinical rotas and job plans of supervising clinicians.
‘If supervising GPs who are already overloaded are asked to oversee ARRS clinicians, they may not be able to allocate sufficient time for safe supervision.’
But the Nuffield Trust said there need to be formal supervision standards and lines of accountability in order to reduce variation in how ARRS roles are supervised.
Its other recommendations included:
- Making PCNs formally accountable to ICBs for delivering minimum induction requirements;
- Supervision time being enshrined in job descriptions for ARRS-funded roles;
- Giving all supervising staff specific training;
- Allowing clinicians to opt out of supervision of ARRS-funded roles, if clinical capacity allows;
- Making ICBs formally accountable for assuring that minimum supervision is taking place in each PCN;
- Implementing a ‘fluid’ supervision model which covers different career stages, such as ‘entry point’, ‘transition’, and ‘steady state’.
Report co-author Rebecca Best, a public health registrar on placement at Nuffield Trust, said: ‘It’s good news that the ARRS has contributed to the recent boost in staff working in general practice at a time when primary care is under immense pressure.
‘But it’s vital that the success of this scheme in recruiting staff is bolstered with robust training and supervision standards. These are hugely variable at present.
‘There are risks with rapidly changing the makeup of the GP workforce – our recommendations are designed to mitigate some of these risks and keep patients safe.’
Another recent report found that the Government’s ‘rapid expansion’ of additional staff in GP practices has not improved patient satisfaction.
Last year, the BMA put out advice on supervising ARRS staff which said that sessional GPs should not be obliged to take on supervision responsibilities.
The supervision of ARRS staff employed by a GP Partnership is the responsibility of that Practice’s GPs, as they are the employers and clinically responsible. PAs in particular cannot work unsupervised, and employer is fully responsible for all training. No additional payment is necessary.
The supervision of ARRS staff employed by a CCG or PCN is the responsibility of the employing authority, and clinically and career-wise falls within that organisation’s senior Clinician to supervise. No additional payment is necessary.
If a CCG/PCN wishes to pay a GP practice or salaried GP to provide supervision, then that is a separate and individual issue, but perhaps the Union should develop a standard set of conditions and payments for this.
The ARRS workforce is a new clinical workforce that the Government is training on the cheap. GPs take tremendous medicolegal risks and give free training to a workforce that is replacing GP’s. It takes time and effort. Of course it should be paid for.
Ultimately it depends if GPs want to be tightly defined pseudo governmental employees or if they want to keep their independence. As an employer over the years of nurses, pharmacist, nurse practitioners, physician associates (from pre ARRS funding), mental health practitioners there has always been a need for supervision and this should always be part of how you allocate GP time in your practice.
There are plenty of other ways to use ARRS money if PAs don’t work for you.
And for those whose ARRS staff are centrally allocated, not practice based and employed – toughen up to your PCN.
How about funding the costs of employing and housing an individual too let alone the clinical supervision. A prescribed salary reimbursement alone is simply abusive 😩