The update to the GP Contract Agreement 2020/21-2023/4 brings enhancements to the Additional Roles Reimbursement Scheme (ARRS).
• increasing the cap on Advanced Practitioners from two to three per PCN where the PCN’s list size numbers 99,999 or fewer, and from three to six where the PCN’s list size numbers 100,000 or over;
• reimbursing PCNs for the time that First Contact Practitioners spend out of practice undertaking education and training to become Advanced Practitioners;
• including Advanced Clinical Practitioner Nurses in the roles eligible for reimbursement as Advanced Practitioners; • introducing apprentice Physician Associates as a reimbursable role;
• removing all existing recruitment caps on Mental Health Practitioners and clarifying that they can support some first contact activity.
• amending the Clinical Pharmacist role description to clarify that Clinical Pharmacists can be supervised by Advanced Practice Pharmacists
NHSE has full details of the Network Contract DES
NHSE has also produced a useful quick reference summary for the ARRS roles
We have a detailed account of all the ARRS roles on a dedicated webpage.
The roles from April 2023 are:
- Clinical/Senior Pharmacist
- Pharmacy Technician
- Social Prescribing Link Worker
- Health and Wellbeing coach
- Care Coordinator
- First Contact Physiotherapist
- Nursing Associate
- Trainee Nursing associate
- Adult Mental Health Practitioner
- Children and young people’s mental health practitioner
- Physician Associate
- General Practice Assistant
- Digital and Transformation Lead
- Advanced Practitioner
There is also a full list of these new roles in primary care with detailed role specific information on e-learning for health.
- The FutureNHS Platform now has a dedicated space for the ARRS including the claims process and portal link.
- ARRS Claims Portal FAQs Aug 2023 (FutureNHS login required)
- NHSE Innovative Employment Models for PCNs. Whilst PCNs can employ ARRS directly, this is a guide to looking at different employment approaches.
- NHSE now has a dedicated page entitled “Expanding our Workforce” that details each of the new roles above.
- PCN & Practice Ready Reckoner 23/24 (inc ARRS funding)
- The LMC website has a skills and competency matrix that includes these roles that can be seen at :- https://www.wessexlmcs.com/skillsmatrix
- New to Partnership – Some of the ARRS roles may be eligible for the New to Partnership Scheme, if Partnership is something that both they and the practice are considering.
Funding for ARRS
The BMA have noted that the 5% uplift to ARRS staff on AfC contracts is not funded “additionally”.
The BMA go on to say that whilst the overall ARRS funding envelope/allocation has gone up in 2023/24, this has not been increased to such a degree that would reflect 5% for those staff on AfC contracts (which is not everyone).
They feel there is a risk that GPs, PMs, and PCN managers may erroneously believe that this is funded with ‘extra money’. However, as per previous years, it was set out in the NHSE guidance (2023/24 paragraph 13):
13. Following the publication of the previous version of this guidance in May, changes to the maximum reimbursable rates have now been set out in the PCN DES Specification for the Additional Roles Reimbursement Scheme (ARRS), as a result of the AfC pay award. As in previous years, the overall PCN entitlements and maximum ICB funding available for 2023/24 will remain the same for the year, as they are already set and underpin the five year contract in place.
The tables below set out the maximum annual reimbursement rates for 2023/24. (Includes HCAS – High Cost Area Supplements)
Whilst these tables show the maximum reimbursements, it is recommended that you look at chapter 10.5 Workforce (pg66 onwards) within the document for more detailed guidance.
Where a PCN engages a Social Prescribing Link Worker via a subcontractor/supplier, a PCN may claim a contribution towards additional costs charged by the sub-contracted provider for the provision of the social prescribing service of up to £200 / month (£2,400 per year) for each whole WTE that the sub-contracted provider has appropriately apportioned to PCN- related activity provided.
Details of the Network Contract DES – Additional Roles Reimbursement Scheme Guidance can be found on the NHSE website.
Worries around accrued employment liabilities have also been addressed in the update contract agreement 20/21 as follows:-
• For those PCNs who do not wish to employ extra staff directly, we encourage them to engage their community-based partners, who can employ staff on their behalf. ICBs can help broker these arrangements;
• Under this agreement, we can confirm that the level of reimbursement already drawn down to support new staff employed by a PCN will now be guaranteed during this GP contract period with their ongoing participation in the Network Contract DES, and these staff will be treated as part of the core general practice cost base beyond 2023/24 when we consider future GP contract funding, like the practice global sum; and
• Furthermore, should all the practices which comprise a PCN ever decide in future to hand back the DES, the commissioner must arrange timely alternative provision for the same services from another provider, e.g. another PCN or an NHS community provider. In this circumstance the law regarding transfer of staff would apply as normal. The commissioner will approach the appointment of the new provider on the basis that, unless there are exceptional circumstances not to do so, (1) relevant staff will transfer from the outgoing practice(s) to the replacement(s), (2) the TUPE Regulations will apply to that transfer and (3) transferring staff will be treated no less favourably than if the TUPE Regulations had applied.
The network will need to decide how the additional workforce is employed (ie by a single lead practice, by an organisation (eg a Federation or community trust) on behalf of the network, or different professionals being employed by different practices within the network). The workforce may be employed in these ways but must provide services for the Network rather than individual practices.
The workforce and network will be led by a Clinical Director, chosen from within the clinicians of each practice in the network. This Clinical Director will be funded for 23/24 at the rate of £0.729 per registered patient per annum.
There is also a Leadership and Management payment of £0.684 multiplied by the PCN Adjusted Population.