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Some partners ‘substituting’ GPs with PAs to save money, leaders claim

Some partners ‘substituting’ GPs with PAs to save money, leaders claim

Exclusive There are concerns that some GP partners are making ‘wrong’ and potentially unfair use of the additional roles reimbursement scheme (ARRS), Pulse has been told.

A number of influential GPs told Pulse that some partners are ‘substituting’ GPs with less qualified staff, using the ARRS ‘to save money’.

They said that some practices have not been ‘totally honest and fair’ about their use of the scheme, which currently does not include GPs but only ‘additional’ professions, and that the scheme has created a ‘conflict of interest’ for some GP partners.

It follows calls from both the BMA and the RCGP for the next Government to remove restrictions that do not allow practices to use ARRS money to employ GPs.

Kent GP Dr Zishan Syed told Pulse that the scheme provides a ‘perverse incentive’ to employ other staff instead of GPs and that some partners ‘have given up’ on employing salaried doctors and locums.

He also said that some GP partners have ‘obvious conflicts of interests to save money through the PCN DES’.

He said: ‘They have decided to substitute doctors with as many professionals from the ARRS scheme as possible without a care for patients’ desire to see a doctor. This is a scandal. 

‘Too many debates about replacement of doctors by allied health professionals are inappropriately silenced by some GP partners with obvious conflicts of interest to save money through the PCN DES.

‘Patients need to challenge the Government regarding the PCN DES as it is providing perverse incentives to use taxpayers’ money to fund every professional except a doctor to see a patient. This is unacceptable.’

He added that the profession should demand cessation of the PCN DES and ‘an active drive and commitment’ for the next Government to ensure doctors ‘are employed as first preference in GP surgeries and funded appropriately’.

Doctors’ Association UK GP lead Dr Lizzie Toberty, a GP in Newcastle, has highlighted similar concerns.

In a webinar attended by Pulse last week, she said that ‘it would be wrong’ to say that every practice has been ‘totally honest and fair’ about how the ARRS scheme is being used.

She said: ‘There was a panic that there wasn’t enough staff in general practice and I think that’s where the ARRS must have come from, but they were rolled out very quickly, and not based on evidence.

‘It would be wrong of us to say every practice is totally honest and fair, about how they’ve done that.’

She added: ‘But the majority are, and one way of trying to manage that funding would be to insist on ratios of patient to GP population, and saying: if you have this population, and we give you this much money, really you must have this number of GPs.’

But DAUK vice chair Dr Ellen Welch pointed out that GP partners have ‘their hands tied’ because of restrictions imposed by the Government.

She said: ‘I think it’s worth pointing out that that this money is ring-fenced by the Government, GP partners can’t use it on GPs or practice nurses. And this is what we need to be able to do.’

DAUK has also called for the next Government to reallocate ARRS and Pharmacy First money to restore GP core funding.

North Staffordshire LMC chair Dr Chandra Kanneganti agreed that this is an issue but said that ‘general practice is a business at the end of the day.’

He told Pulse: ‘I know of practices using ARRS to replace staff and patients are still getting services.

‘That is wrong though – for their business it might be good, but it’s wrong. Because we need to support our salaried GP colleagues and making sure that they have jobs.

‘I think that is a business decision that they have taken and as long as they can provide safe service who are we to say “yes” or “no” – but personally I feel that is not the right thing to do.’ 

Lancashire GP Dr Ann Robinson told Pulse that this was a ‘concern’ in a ‘minority’ of surgeries.

She said: ‘I know it goes on in certain places locally, and it concerns me as patients do not always get the care they need and deserve.’

Dr Samira Anane, deputy chair of GPC England at the BMA, said: ‘General practice is desperately short of GPs, with thousands of GPs wanting to work, and yet many practices can’t afford to hire them due to the lack of core practice funding.

‘The only workforce funding they can access through the Additional Roles Reimbursement Scheme forbids the use of GPs and practice nurses.

‘This is simply unacceptable at a time when our patients are telling us that they want and need to see GPs. We would like practices to be resourced to engage the staff they need for their patients and communities.’

The inclusion of GPs in ARRS had been a ‘red line’ for GPCE in 2024/25 contract negotiations but NHS England declined the request on the basis that GPs are core, rather than additional, workforce in practices.

Additional reporting by Eliza Parr



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

Centreground Centreground 27 June, 2024 1:03 pm

Let us be clear about PCNs and PCN CDs as once again there will be many exceptions but dishonesty and fraud within PCNs is widespread. I have raised this openly and suffered the most severe consequences as a result.
These PCNs and PCN CDs need to be investigated and there should be no attempt to disguise what has happened to these colossal sums of NHS taxpayer funds which have been abused by some PCN CDs and PCNs.
There has also been significant ‘game playing’ where PCN roles have been created which did not actually exist.
Some PCNs are simply large businesses focussed primarily on the profit motive and not patient benefit and lucrative for the small groups that run them
Yet again unsavoury but completely true and yet again these same GPs who sit as PCN CDs or those GPs or NHS managers on NHS /ICB boards who have not take action where they should need to be held to account and additionally the last 5 years or so of PCN payments accounted for.

So the bird flew away 27 June, 2024 1:08 pm

It’s a well known fact that in our city one of the large practices has 5 PAs! It’s also well-known that the majority of patients are BAME of whom many are non-English speakers who may not even know they’re consulting a PA. If patients’ diagnoses are missed or mismanaged or they present late to hospital, this will not be saving the NHS any money (nor distress to the patient).
The senior partner is the PCN CD. There’s always some “rotten apples” in the barrel.

John Graham Munro 27 June, 2024 1:49 pm

G.Ps on the make————–? surely not

SUBHASH BHATT 27 June, 2024 3:47 pm

Funding should be specified to employ gps only. Why fund less popular staff?

Nicholas Sharvill 27 June, 2024 4:12 pm

Brave of Pulse to come out on this. Perhaps numbers of f2f consultations by a GP (annually) (and qualified practice nurses) VS partners real income ( not the same as published ) might be made public. The big accountantcy firms have most of this data.

Michael Green 27 June, 2024 10:50 pm

I heard the Pope is Catholic

john mccormack 27 June, 2024 10:52 pm

Unfortunately General Practice has as many unscrupulous and greedy partners as in every other profession. PCNs and in Northern Ireland Federations have an incentive to facilitate the race to the bottom in General Practice. If individual practices raise any serious of quality they tend to be vilified and treated in a vindictive manner. General Practice funding needs to return to the pre 2004 contract days when appointing a GP as a partner brought with it considerable extra funding thus encouraging a lower patient to dr ratio. PCNs and Federations need to abolished as they tend to be run by work shy Dr’s who prefer sitting in meetings and furnishing their own needs rather than the real work of seeing patients

David Taylor 28 June, 2024 4:28 pm

If it’s a choice of keeping the lights on and using available funding to employ what we can and avoid going bust then of course like any sensible business we will make use of the ARRS schemes and employ fewer GPs. That isn’t a decision that has made any GP I know wealthier, it has though kept the practices afloat given the huge rises in costs both utilities and staffing given inflationary pay rises. We all have mortgages to pay for at the end of the day and if we are funded to provide service less than optimal that is what we have to do. Employing more GP’s is simply not financially viable at the moment, and if we exited the DES we would equally be looking at a financial cliff. I’m not quite sure what we are supposed to do – easy to pontificate from the sidelines. General Practice is a business first and foremost and if it isn’t financially viable it most certainly can’t offer any patient care.

Waseem Jerjes 30 June, 2024 4:17 pm

It is really sad that some GP partners are using the Additional Roles Reimbursement Scheme to cut costs by employing less qualified staff. Partners need to support the profession and their colleagues, ensuring patients receive the care they deserve. This issue highlights the urgent need to address the financial pressures facing General Practice.

Jude the Obscure 1 July, 2024 4:11 pm

“I was just following orders”..”at the end of the day its a business and so long as I make money thats all that matters”..”If it wasn’t me somebody else would be doing it”…says the Dr to reassure your life is safe in their hands. I’m not convinced and neither should you. Even if they’ve managed to convince themselves