The Cogora GP Workforce Report: The Headlines, ARRS Impact and Recommendations for the Future

Introduction

At THC Primary Care, we provide resources for primary care Network leaders and the focus of this blog is the recently published Cogora General Practice Workforce White Paper, which provides crucial insights into primary care staffing, funding, and the future.

Over 700 practices and 2,000 healthcare professionals in England, along with conducting interviews with 150 HCPs and analysing 250 data points across GP practices, have informed this report.

While the report acknowledges ARRS staff's contribution to primary care, it also discusses their role and the perceived value they bring to primary care networks.

However, the paper is not just about PCNs and practices; it discusses the wider topic of boosting training capacity in general practice through analysis of clinical staff training needs and supervision requirements.

It explores regional and demographic disparities and shows how staffing levels and funding correlate with deprivation levels.

The impact of various NHS workforce plans and initiatives is thoroughly examined, including the ARRS, Fellowship programs, and international recruitment efforts.

Premises and infrastructure limitations are highlighted as a major barrier to workforce expansion, with many practices unable to accommodate additional staff despite having the funding and need for more clinicians.

Part 1 of this blog will provide the headlines from the report.

Part 2 will look at this report through the lens of ARRS staff workers.

At the time of writing this blog, I am serving as the interim PCN Manager in Maidenhead PCN, which employs 45 staff members.

Let's jump in!

Report Headlines

• GP headcount has increased while full-time equivalent numbers decreased

• Patient numbers per GP have risen significantly

• UK has 16% fewer GPs per patient than OECD average

• 2024 marked first year where only 50% of appointments were with GPs

• Patient demand continues rising year-on-year

• ARRS has fundamentally changed the workforce mix

PCN Success Stories

Networks have demonstrated effectiveness in:

• Cross-practice staff coordination

• Enhanced access service delivery

• Community wellbeing initiatives

• Group consultations and population health management

• Career development opportunities

• Preventative care programs

• Innovative ARRS staff deployment

• Creating speciality development pathways for newly qualified GPs

  
  

Challenges to Address

• Limited uptake of ARRS GP positions (300 of 1,000 filled by December 2024)

• Staff integration issues

• Disconnect between PCN staff and practice requirements

• Questions over cost-effectiveness of roles

• Physical space constraints

• Funding uncertainty

The Fundamental Funding Crisis

The white paper reveals a critical underlying issue that cannot be overlooked: general practice is facing a severe and systemic funding crisis. While the workforce challenges are complex, money - or the lack thereof - sits at the heart of the problem.

The report highlights that successive governments have provided minimal funding increases - around 2% annually - during a period of significant inflation and rising healthcare costs. This has created significant financial pressures, particularly for practices in more deprived areas.

The funding formula is in question, which means practices in less affluent areas receive less funding despite often having patients with more complex and demanding health needs. This creates a vicious cycle in which practices with the greatest challenges have the fewest resources to address them.

The report starkly illustrates a paradoxical situation in which there is simultaneously a shortage of GP jobs and GPs, with patient demand increasing.

The current funding model is pushing practices into making difficult choices: reducing GP hours, replacing GP roles with cheaper alternatives, or in some cases, struggling to keep their doors open.

The ARRS Staff Perspective

The report highlights that ARRS staff are sometimes seen as less embedded in practices because they are PCN-employed. For many, Im sure this is particularly frustrating because this is not of their own doing, and many are going above and beyond to integrate into practice teams and build relationships with both staff and patients.

It's also disheartening to read about questions over their "cost-effectiveness" and suggestions that they're "not the most appropriate" for patient care. The report mentions that some GPs feel they can "increase workload" by requiring supervision and support. Howvers, we can all point to an example where, over time, with the right support and training (if the person is right for the role), supervision is reduced, but it does take time. If it takes too much time, this is where management and HR support is required.

The Identity Crisis

There's an underlying tension in how the ARRS roles are portrayed - on one hand, they are seen as a solution to workforce pressures, but on the other, sometimes characterised as a cheaper alternative to GPs rather than professionals with valuable skill sets.

The Integration Challenge

The report points out that some of us are "unaware of practice-specific requirements like QOF.

The question I would be asking is why?

Roles should be directed both by PCN and practice leadership.

Looking Forward

Despite the challenges, (Im not naive and experience these first hand), there are many positives. The report acknowledges:

• Their role in innovative service delivery

• The value they bring to community initiatives

• Their contribution to preventative care

• The potential for career development within PCNs

The overall report's recommendations include

• Increase core funding for general practice

• Reform funding formula to better support deprived areas

• Remove restrictions from ARRS to give practices more flexibility

• Expand premises and encourage training

• Promote general practice as a flexible career

• Avoid short-term fixes in favor of comprehensive solutions

For ARRS staff, this means our future is intrinsically linked to broader systemic changes. Our roles, our integration, and our potential to transform primary care depend on solving this fundamental funding challenge.

In addition, we need:

1. Better recognition of professional expertise and unique contributions

2. Improved integration support when working across multiple practices

The report raises important points about workforce planning and integration, and it will be interesting to see how this develops.

About the Author

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, where we have now published over 300 episodes.

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, have an MBA in Leadership and Management in Healthcare, have been published in the London Journal of Primary Care, and 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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