Top Tips to Embed your Primary Care Networks ARRS roles and ways to incorporate newly qualified GPs

On Thursday, October 10th in the Best Practice PCN Transformation Theatre, Dr Ishani Patel, GP Partner at Wembley Park Medical Centre and Co-Founder of Lantum, and Dr Hussain Gandhi, GP Partner at Wellspring Surgery and Clinical Director at Nottingham City East PCN, came together to discuss the innovative use of the additional role reimbursement scheme and the different approaches we could consider when implementing newly qualified GPs, who are now part of a new ARRS scheme.

Here is a summary of this conversation, which covers:

🎯 The challenges with embedding staff employed via the additional roles reimbursement scheme

🎯16 insights on how to get more from your PCN resources

🎯 The GPs in ARRS funding criteria

🎯 6 questions to consider when approaching the GMP ARRS

Let's jump in!

The Challenges with the Embedding Additional Roles

Before we jump into the opportunities, it is important to highlight some of the challenges.

1️⃣ Resistance to change when identifying new ways of working or integrating new roles.

2️⃣ Integrating ARRS roles into existing practice teams and cultures.

3️⃣ Finding the right balance between work at the PCN level and practice-specific tasks.

4️⃣ Difficulties in recruiting and retaining ARRS role holders, particularly in certain areas, specific roles or practices.

5️⃣ Ensuring that ARRS roles are used to their full potential and deliver measurable benefits to practices and patients.

6️⃣ Limitations on how ARRS funding can be used, particularly with the inclusion of GPs in the scheme and the limited time available to implement this.

7️⃣ Uncertainty surrounding future funding and policy changes was noted as an ongoing challenge.

8️⃣ The need to effectively measure and demonstrate the value of ARRS roles to various stakeholders

Concerns were also raised about:

9️⃣ How the current ARRS model for GPs might limit opportunities for newly qualified GPs to experience different practice settings.

1️⃣ 0️⃣ Fragmentation between different healthcare sectors, such as community pharmacy and general practice with Dr Patel sharing her vision of creating a "clinical pharmacist academy" that would bring together community and general practice pharmacists. This approach aims to break down silos and improve learning opportunities across the pharmacy sector.

For those practices struggling with their additional roles, it will likely be a combination of:

⬇️ An unaligned vision

⬇️ Differing expectations

⬇️ Fractured relationships

⬇️ A lack of trust and transparency

Ways to make it work | Dr Ishani Patel

Here are some of Ishani’s practical approaches and insights on how she has managed to make the most of the resources provided by her PCN. It’s important to note that Ishani is not the CD. She is an extremely engaged GP in her PCN.

1️⃣ Diverse ARRS Workforce: Ishani highlighted the importance of utilising a wide range of ARRS roles, noting that their PCN has maximised nearly every available ARRS role, including mental health practitioners, dieticians, first contact

physiotherapists, care coordinators, physician associates, and social prescribers.

2️⃣ Balanced Role Distribution: Ishani mentioned that in her PCN, roles like care coordinators split their time 50-50 between PCN-level work and practice-specific tasks. This approach ensures a balance between network-wide initiatives and individual practice needs.

3️⃣ Equality in Team Treatment: Ishani emphasised treating all clinicians equally, regardless of their role. This approach has helped with the recruitment and retention of ARRS role-holders.

4️⃣ Comprehensive Support System: She stressed the importance of providing comprehensive support for ARRS roles,which include:

• Regular catch-up breaks

• Daily debriefs

• Promoting a non-blame, open culture of learning

• Addressing system issues rather than focusing on individual mistakes

5️⃣ Leveraging Technology: Ishani discussed the use of digital blood pressure monitoring software overseen by clinical pharmacists, showcasing how technology can enhance ARRS roles.

6️⃣ Portfolio Careers: Ishani emphasised the importance of encouraging portfolio careers for GPs, where they split their time between clinical work and other roles (e.g., leadership, special interests) to improve retention.

7️⃣ Integration with Existing Teams: Ishani stressed the importance of ensuring that ARRS-funded roles, including GPs, are well-integrated into practice teams and cultures.

Ways to make it work | Dr Hussain Gandhi (aka Gandhi)

1️⃣ Innovative Use of ARRS Roles: Gandhi shared an innovative example of using a health and wellbeing coach to lead a project focused on managing physical health checks for carers. This approach addressed a specific need while giving the ARRS role a sense of ownership and purpose.

2️⃣ Leveraging Technology: He mentioned using a care coordinator to help patients access digital consultation platforms, showcasing how ARRS roles can be utilised to bridge the digital divide and improve patient access to services.

3️⃣ Creative Social Prescribing: Gandhi shared an innovative social prescribing initiative involving board game sessions for patients suffering from social isolation. This creative approach demonstrated how ARRS roles can be used to address broader determinants of health in unique ways.

4️⃣ Long-Term Vision: Gandhi emphasised the importance of having a long-term vision when implementing ARRS roles. Gandhi mentioned that some initiatives, like the board game sessions, took years to come to fruition but have had a significant impact on patient well-being.

5️⃣ Integration of ARRS Roles: Gandhi, like Ishani stressed the importance of integrating ARRS roles into the broader practice team, rather than treating them as separate entities. He highlighted the need for clear communication and collaboration between all team members.

6️⃣ Flexibility in Role Development: He advocated for flexibility in developing ARRS roles, suggesting that practices should be open to adapting roles based on local needs and the individual strengths of role holders.

7️⃣ Balancing Short-Term and Long-Term Needs: Gandhi discussed the challenge of balancing immediate workforce needs with long-term sustainability when using ARRS funding, particularly in the context of including GPs in the scheme.

8️⃣ Value of Portfolio Careers: Gandhi supported the idea of portfolio careers for GPs, suggesting that ARRS funding could be used to support GPs in developing diverse skill sets and interests within primary care.

9️⃣ Community Engagement: He stressed the importance of using ARRS roles to better connect with and understand the local community, as exemplified by the board game initiative for socially isolated patients.

GMPs in ARRS

From 1 October 2024, general medical practitioners (GMPs) will be part of a a new, ring-fenced section of the Additional Roles Reimbursement Scheme (ARRS) in 2024/25 specifically for newly qualified GMPs.

GPs in ARRS | The Funding Criteria

➡️ The Additional Role Reimbursement Scheme does not apply to General Medical Practitioners (GMPs) who were previously substantively employed in general practice. This is to prevent practices from shifting existing GMPs funded through practice contracts into the scheme.

➡️ HOWEVER Commissioners have local discretion to decide if a GMP's prior employment was substantive, with exceptions like short-term cover not being considered substantive employment.

➡️ PCNs will only be eligible to claim reimbursement for additional posts to be occupied by staff on fixed-term contracts, if these are for a minimum period of six months or more, unless the purpose is to provide temporary cover (e.g. sickness or parental leave) for an individual employed through ARRS or they are a General Medical Practitioner employed or engaged in a permanent role for less than six months.

➡️ The Additional Roles Reimbursement Scheme does not apply to General Medical Practitioners who are beyond the second anniversary of their certificate of

completion of training, issued by the General Medical Council at the start of their

employment or engagement.

➡️ Once employed or engaged, General Medical Practitioners can continue to be reimbursed past the second anniversary of their certificate of completion of training.

➡️ PCNs will be funded at £1.303 per patient, but networks can choose to top up this amount if they wish.

 

Potential approaches / questions

1️⃣ Could you use the ARRS-funded GPs to support home visiting services or care home ward rounds

2️⃣ If you outsource your extended access, could they provide the GP?

3️⃣ Could you develop your own GP fellowship to introduce them to working across your PCN?

4️⃣ Could you create a winter pressures service?

5️⃣ Do you have a local staff bank you can draw on?

6️⃣ What newly qualified GPs are already known to your practices?

Don’t be shy about lobbying for flexibility with your integrated care boards (ICBs). Present your case, positively framed, which focuses on the benefits, like:

🎯 Improved patient care

🎯 Potential cost savings

🎯 Workforce retention

🎯 Service continuity

Etc….

We hope this helps, and you may also find the blog below helpful ⬇️

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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