Newly Qualified GPs added to Primary Care Network the Additional Roles Reimbursement Scheme

At THC, we provide resources for Primary Care leaders. In this blog, the focus is on the latest updates affecting primary care networks released in July and August.

We cover:

1️⃣ GP contract changes and the additional roles reimbursement scheme (ARRS) update

• In this section, we share our initial thoughts in the form of an infographic

• Share the pros and cons of this opportunity

• Remind networks to learn the lessons from the past!

2️⃣ The BMA's new vision for general practice

3️⃣ Trainee Nurse Associate name change

Let's jump in!

Newly Qualified GPs added to the Additional Roles Reimbursement Scheme

Ardens Manager

1. GP contract changes and newly qualified GPs added to the additional roles reimbursement scheme

On the 2nd of August, NHSE released the following information.

• Implementation of DDRB Recommendations: The government has agreed to fully fund the pay recommendations from the Review Body on Doctors and Dentists Remuneration (DDRB) for GPs. This includes a 6% pay uplift backdated to April 1, 2024, covering all practice staff and not just GPs.
  

• Inclusion of Recently Qualified GPs in ARRS: An additional £82 million has been allocated to include recently qualified GPs in the Additional Roles Reimbursement Scheme (ARRS) for 2024/25. This aims to address GP unemployment and provide employment opportunities for over 1,000 newly qualified GPs, who can start being employed from October 2024.

The letter can be found here: https://www.england.nhs.uk/long-read/gp-contract-changes-government-response-to-ddrb-and-arrs/

At the time of writing, there isn't any further information regarding the details of what implementation would look like, and we should wait before jumping to conclusions. However, I'm sure you will already be considering what this could look like in your PCN. Here are my initial thoughts for you to consider, build on or disregard.

Adding newly qualified GPs to ARRS

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The pros and cons of adding newly qualified GPs to the scheme

The additional roles reimbursement scheme (ARRS) has always been controversial and remains a hot topic.

The scheme, introduced in 2019, was intended to increase GP capacity by offering patients an alternative route to care from members of the wider general practice team, and it now includes more than 30 different job roles.

Year after year, there has been an ARRS underspend, so it makes sense for us to review how and what we spend this money on, but let's carefully think this through.

The pros of opening the scheme to GPs

1. Increased Utilisation of ARRS Funding: Opening the scheme to GPs could help PCNs struggling to recruit and fully utilise funding.
   

2. Enhanced Engagement: General practice may feel more heard and valued, addressing criticisms of the Network DES being imposed without sufficient frontline input.
   

3. Collaborative Approach: Keeping services at the PCN level could foster more buy-in from practices and reduce the 'us versus them' mentality between PCN ARRS teams and practice teams.
   

4. Patient Understanding: Patients might better understand the network structure if GPs and nurses communicate their roles within the network.
   

5. Insight into PCN Complexities: GPs and nurses would gain a deeper understanding of the complexities of navigating multiple practices.
   

6. Easier Staffing for Enhanced Access Hubs: Filling these hubs could become more straightforward with GPs included.
   

7. Short-term Financial Relief: Practices could experience reduced financial pressures in the short term.

The cons of opening the scheme to GPs

1. Long-term Recruitment Issues: This move does not address underlying issues such as recruitment, staff retention, increasing demand, and negative media coverage.
   

2. Broader Impact on Practices: It fails to address other challenges negatively impacting practices, like estates and the long-term disinvestment in general practice
   

3. Partnership Model Concerns: It could further question the future of the partnership model.
   

4. Impact on Current ARRS Roles: Some roles currently part of the scheme might be disadvantaged in favour of maintaining the status quo.
   

5. Exacerbating Workforce Issues: It could worsen the two-tier workforce issues if newly qualified GPs are not paid the same as general practice colleagues. ( Whilst there will always be variation, we need to ensure the gap is not too wide).
   

6. Limited supply and limited impact: It will be challenging to deploy a limited amount of sessions across a network and make a significant impact ( as all know too well).

Also, if payment thresholds for GPs were more attractive or worse than general practice salaries, it could either lead to increased movement between general practice and PCN structures or worsen recruitment efforts.

These reflections were originally shared on Pulse PCN here.

There are so many lessons to be learnt from the current ARRS scheme, and I really encourage the networks to think carefully about this latest opportunity.

PCN staff need support, supervision, admin time, training, variety, and all practices onboard with directions on travel.

Networks need to clearly stipulate the role and responsibilities of:

⚠️ All PCN staff members

⚠️ The practice

⚠️ The employing organisation

⚠️ The PCN Leadership and management team/ board

Primary Care Analytics

2. A new vision for general practice and collective action

On the 17th June, The BMA’s ballot for collective action opened for GPs in England. The ballot closed at midday on Monday 29th July.

To rally support and keep members informed, the GPC England Officer Team Webinar carried out a series of webinars titled IF NOT NOW...WHEN? Protect Your Practices, To Protect Your Patients and shared their Vision for General Practice. In the form of a manifesto titled Safety, Stability, Hope: A Vision to Rebuild General Practice in England

Along with the webinar, they also held an in-person event at BMA House in London which I attended.

The rationale for change collective action is clear. At an individual patient level, the average core contract payment equates to £107.57 per annum, around 30p per patient per day. Around the cost of an apple!

The disinvestment in general practice causes GPs to leave the profession or remain and be burned out, practices to close, and recruitment to fall.

During the event, it was great to hear that the whole practice team recognised, but ultimately, the decisions rest with the GP partners as the owners of the business.

Speakers also shared that ‘What we see before us is not an example of what people want when it comes to a career in general practice, so things need to change'.

The General Practice Survival Toolkit

The General Practice Survival Toolkit, I believe, is designed to make practice life a bit more manageable, and the tool kit consists of 10 actions for practices to choose from.

The actions practices choose will depend on your patients, your local contracts your LMC’s feedback and the consensus reached in the practice partnership.

Practices can choose all, nothing or anywhere in between.

Read here for the details.

Some people in the room felt the BMA GP Practice Survival Kit was not going to make enough of a difference, and in response to this, there was acknowledgement that collective action is not a one size fits all and practices will take incremental steps at their own pace.

Three of the recommendations directly affecting primary care networks can be found below.

➡️ Limit daily patient contacts per clinician to the UEMO recommended safe maximum of 25.

➡️ Defer signing off ”Better digital telephony”: do not agree yet to share your call volume data metrics with NHS England.

➡️ Defer signing off “Simpler online requests”: do not agree yet to keep your online triage tools on throughout core practice opening hours, even when you have reached your maximum safe capacity. 

It's important to understand the implications these actions will have on your PCN.

PCN June Update

For more information on what collection action could mean in your primary care network, please visit our June update.

3. Trainee Nursing Associates will now be known as Student Nurse Associates.

Trainee Nursing Associates (TNAs) will now be known as (SNAs) Student Nurse Associates. The role will remain the same, and there is no cause for concern and there are no issues.

The NMC Standards for pre-registration nursing associate programmes was actually

updated in April.

The term trainee nursing associate and student associate will be used interchangeably for a while.

Pure Physio

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About the Author

The Business of Healthcare Podcast

I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast.

I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 120 PCNs by providing interim management, training and consultancy.

I have managed teams across multiple sites and countries; I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care, and I am the author of over 250 blogs.  

I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.

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