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We are now, six months from the end of the five year deal, and, potentially, six months from the end of the PCN DES. But the additional role reimbursement scheme (ARRS) staff will still be here in six months’ time regardless of what happens to the contract. With this in mind the question for many PCNs is: What actions should we being do with our ARRS staff now?
A big concern is the liability. If the funding stops, will PCNs – or, more accurately, their member practices – be left with the liability for these staff? Honestly, I don’t think that is something PCNs or practices need to worry about. It has been written down enough times that the funding will continue in one form or another that concerns that it will stop are unfounded.
My biggest concern is something else entirely. When the NHS Plan was published back in 2019 it made it very clear that PCNs were, ‘to deal with pressures in primary care and extend the range of convenient local services, creating genuinely integrated teams of GPs, community health and social care staff’(page 6). But the role of PCNs dealing with pressures in primary care is often overlooked by the system, despite the majority of the additional resources for general practice since 2019 coming into the PCN.
Now we have local systems planning what integrated neighbourhood teams (INTs) are going to be, with the primary difference from PCNs seemingly that they will have no explicit role in supporting core general practice. My concern is that systems will view ARRS staff as a resource that can simply be transferred into, and form the basis of, these new INTs, and if this happens practices that are increasingly dependent on these staff will struggle.
There are a few other concerns to consider. The uncertainty of the current situation may cause ARRS staff to move to more secure employment. This is likely to already be starting as the end of March deadline ticks closer. Added to this some of the softer funding streams outside the ARRS budget, such as the £1.50 or IIF, that have been used to fund supervision and development are not quite as secure, and so require some forward planning.
Given all of this, here are my four priority actions to be taking now:
1. Embed the ARRS teams in how the practices operate. Yes the ARRS teams work across the PCN but they also support the practices. It is not helpful to have clear lines drawn between PCN work and practice work because it potentially makes it easy for others to disentangle. There are lots of examples of this beyond simply pharmacists or first contact physiotherapists carrying out practice clinical work, such as care coordinators leading safeguarding across all PCN practices or pharmacy technicians running CQC clinical searches for practices. What needs to be made difficult is extricating ARRS staff from general practice, as they are now an essential part of how core general practice operates. The system needs to understand that ARRS staff are not a supernumerary resource that can be deployed however the system sees fit.
2. Bring ARRS staff in-house wherever possible. I understand the flexibilities and advantages that third party providers of ARRS staff provide. My concern is that anything provided through a third-party provider could be viewed by the system as a non-essential, non-core resource that could either be provided instead by a local provider, or deployed differently as local priorities dictate. Directly employed staff, on the other hand, are much more concretely embedded in the PCN and its practices, and as a result are harder to be redeployed by others.
3. Future-proof the funding streams. The question here is how the additional costs of the ARRS staff, such as supervision and training, are funded by the PCN. If it is through direct PCN funding lines (like the £1.50 management payment) then this funding is not as secure as the ARRS staff reimbursement which now has assurances attached. What some PCNs are doing is using funding from other more secure funding streams (such as the enhanced access funding) to ensure that ARRS supervision and training are covered. Putting a plan in place to future-proof this resource wherever possible will safeguard against whatever scenario eventually plays out without putting staff at risk.
4. Stabilise the workforce. The period of recruitment is (finally) coming to an end. Now the challenge is to retain the staff we have. It is inevitable that the end of the PCN DES will be causing anxiety for our ARRS staff. It is vital that we are clear on the ongoing value these staff bring, and that we tell them. We need to be proactive in allaying the concerns that ARRS staff have, and that rather than passing on any uncertainty we might be feeling about the end of the DES we provide reassurance about the future and underline the PCN’s and the practices’ commitment to them.
Ben Gowland is director and principal consultant at Ockham Healthcare, a think tank and consultancy. He was an NHS chief executive for eight years and has also been a director of Croydon Health Services NHS Trust. He established Nene Commissioning, first as a PBC organisation and then as one of the largest CCGs