ARRS can continue to unlock a brighter future

Prof Aruna Garcea says ARRS has much to offer primary care but needs funding and flexibility to make it happen.

Rooted in communities, primary care is often called the gateway to the NHS, with GP surgeries being the first port of call for many patients. Any delays in seeing GPs and their teams can cause real frustration for patients but also for staff trying to provide the best care they possibly can.  

The additional roles reimbursement scheme (ARRS) was introduced in response to the government’s 2019 manifesto commitment to improve access and address workforce pressures to primary care. Patients can be seen by a wide variety of healthcare professionals, ensuring they receive the right care at the right time and easing pressure on GPs. The scheme has provided a real opportunity to do things differently, such as multi-disciplinary, integrated neighbourhood working with colleagues across health and care, and it should be supported to continue to drive progress in these areas. 

Despite the pressures that primary care leaders and their teams are under, they have continued to successfully hit every target the scheme set in 2019: recruiting more than 31,000 new patient-facing staff and providing an additional 50 million appointments. These are huge achievements. 

But significant challenges remain. Demand continues to rise, primary care estates are in desperate need of repair or development, and digital infrastructure is not always at the level it should be. 

Our ARRS report, released this month, found that flexibility to allow local leaders to select and recruit to roles is crucial. They know what their local population need and how best to tailor services to best meet them.  It is reassuring to know this will remain a key aspect of the primary care network (PCN) contract for 2024-25, as we have called for greater flexibility in the use of ARRS funding to allow for local determination of the required skill mix. But we need to see this commitment extended beyond 2025.  

We also hope any changes to the mental health practitioner role will address the challenges our members have experienced in getting these important roles into primary care and working effectively. Furthermore, the scheme needs to allow for sufficient funding for supervision and training to ensure it remains financially sustainable for PCNs. 

The NHS as a whole is facing a workforce crisis. It is important to recognise that primary care is often recruiting from the same limited pool of staff, and an unintended consequence of boosting ARRS staff is increased competition between care providers. Therefore, a long-term approach to workforce involving greater cross-system integration is needed to make sure recruiting to one part of the system does not cause shortages elsewhere.   

We must also ensure that when hiring more staff, we address the structural enablers that support the workforce – estates, digital infrastructure, retention and professional development. New digital infrastructure and better estates are key drivers of making services more efficient while providing decent environments and the best tools to do the job can help providers retain staff.  

Our report shows that progress cannot stop now. Primary care still faces challenges from high levels of demand, unfit estates and the race to get the right digital infrastructure in place. 

Primary care has come so far in such a short time despite all the pressure it has faced – including the pandemic, increasingly constrained finances, and the fallout of more than a year of industrial action. 

As the NHS Confederation’s Primary Care Network continues to highlight, the sector can punch well above its weight in delivering for patients if it is given the resources, support and headroom to do so. 

Professor Aruna Garcea is clinical director for Leicester City and Universities PCN and chair of the NHS Confederation’s PCN advisory group. Read more of her articles here.