The addition of GPs to a (separate) ARRS

Recently the new government announced that it is creating a new £82m ARRS funding pot for PCNs to employ GPs. What are the implications of this announcement and what will it mean for PCNs and the profession?

The first thing to clarify is that GPs have not been added to the existing ARRS, as was called for by the recent petition that attracted more than 11,000 signatures. The existing ARRS pot stands at £1.4bn, and what that petition was calling for was to enable PCNs to be able to access this funding to employ GPs.  Instead, this is a separate pot of £82m, that seemingly will be subject to ARRS rules (details still to be confirmed), that PCNs can use to employ GPs.

Because of the funding cuts over the last three years, practices in need of additional or even replacement GPs have been unable to afford to employ them, and instead have become increasingly reliant on the new roles funded by ARRS. What practices wanted was to be able use the existing ARRS funding to employ GPs, and many would have been happy to swap out some of their existing roles to enable this.

The government and NHS England understood this but wanted to protect the existing additional roles.  As a result, and much to the chagrin of the profession, they have instead come up with this scheme to have a separate pot limited to £82m for GPs only. This funding is not enough to provide an additional GP for every practice. Indeed, it is not enough for an additional GP for every PCN, and the separate nature of the scheme means PCNs will not have the option to substitute in existing ARRS funding to make up the shortfall. 

Wes Streeting has said that the £82m will fund 1,000 new GPs (although the maths he is using to calculate this remains hazy), but even so, given there are about 1,250 PCNs, it is not clear how giving all PCNs except the largest ones insufficient funding for a whole GP will then translate into effective recruitment.

Employment of these GPs will also be made subject to ARRS restrictions, although we do not yet know exactly what these will be. Historically, however, this has meant that PCNs have to prove ‘additionality’ (i.e. that this funding is not being used by practices to employ a like for like replacement).

Three years of funding cuts following the 2022 contract imposition have meant some practices have been unable to recruit like for like replacements for GPs. The ARRS precedent set for pharmacists was that practices had to record a baseline figure on the number they employed to ‘prove’ that any ARRS pharmacists were indeed additional and not pre-existing practice employed pharmacists being moved across. If the same idea is applied to ARRS GPs it will be fascinating to see when NHS England intends to take the baseline for GP numbers from. Given the numbers of GPs have fallen recently, if that baseline figure is taken right now these additional GPs will be replacing ones recently lost – so not in fact additional at all.

Of course, the alternative approach to additionality NHS England could take is a relatively tight specification on how PCNs can use these new GPs, and potentially prevent them from supporting individual practices by insisting on cross-PCN working. Many are expecting this. Essentially blocking these new GPs from undertaking core general practice work, at a time when the profession is under such pressure that it has voted to take collective action, does not feel sensible and is hardly likely to be popular with the profession.

All that said, the addition of GPs to ARRS teams could prove to be hugely beneficial for the effectiveness of these teams. Where these teams have been lacking in leadership, supervision and support, suddenly this could be provided by the incoming GPs, who could not only increase the scope of what these teams can do but also make them more able to function as self-sufficient units, without constant calls for extra GP time from across the member practices. For many PCNs it could be a game changer, enabling the additional roles to transform from being a drain on practice time to a team that adds tangible value.

The exact criteria for employing the additional GPs is to be set out in a revised PCN DES specification. The funding is due to be available from October, so presumably we can expect this new specification some time in September. The devil will be in the detail, but the whole presentation of this funding for new GPs within a new, separate ARRS pot is good news for the existing ARRS teams but likely to limit the direct impact these GPs will be able to have on practices.

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.