PCN Workforce - ARRS

The update to the GP Contract Agreement 2020/21-2023/4 brings enhancements to the Additional Roles Reimbursement Scheme (ARRS). Additional workforce will be introduced and funded through the Network. Extra Government investment is funding a further 6000 staff through the scheme at 100% reimbursement, bringing the total to 26,000 rather than previously stated 20,000 staff.

From 2019, each network was be able to employ one clinical pharmacist and one social prescriber.

From April 2020, in addition to the previously agreed roles of :-

PCNs can now also choose to recruit from the following additional roles

Pharmacy Technician
Care Coordinator
Health Coach
Dietitian
Podiatrist
Occupational Therapist
Nursing Associates (From 1st Oct 2020)
Trainee Nurse Associate (From 1st Oct 2020)
Mental Health Practitioner (from April 2021)

There is also a full list of these new roles in primary care with role specific information on e-learning for health.

There is a further opportunity to work as an Advanced Practitioner in the following roles:-

Clinical Pharmacist
Physiotherapist
Occupational Therapist
Dietician
Podiatrist
Paramedic

There are additional requirements to the base role for anyone working at the advanced practitioner level and they can be seen here. Please also visit our dedicated webpage for Advanced Clinical Practice including roles.

Paramedics in Primary Care

Health Education England has developed a new pathway to help paramedics advance their careers. The ‘roadmap to practice’ outlines the skills and attributes needed to help paramedics become first contact practitioners (FCPs) or advanced practitioners (APs).

The new roadmap provides a clear educational pathway for paramedics who wish to work in primary care, as well as setting out the supervision and governance needed and giving training guidance for supervisors.

NHS England and Health Education England have co-published this guidance document which describes the scope of practice of paramedics working in general practice. It includes information on education/development needs, supervision requirements and the differences between enhanced, first contact and advanced levels of practice.

Useful Resources

The FutureNHS Platform now has a dedicated space for the ARRS including the claims process and portal link.
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.
There was a further update from NHSE in August 2020 about expanding the primary care workforce to provide additional flexibility to PCNs now.
NHSE have published a Workforce Planning Template 2020/21 which you may find useful.
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 tables below set out the maximum annual reimbursement rates for 2022/23. (Includes HCAS - High Cost Area Supplements)

Whilst these tables show the maximum reimbursements, it is recommended that you look at chapter 10.5 Workforce (pg71 onwards) within the document for more detailed guidance.

In November 2019 NHSE agreed to extend the Additional Roles Reimbursement Scheme (ARRS) funding for social prescribers, following calls from the GPC, LMCs and PCNs. Many organisations supplying a Social Prescriber Link Worker Service (SPLW) are passing on additional costs over and above the equivalent of the actual salary (plus on costs), for example in administration fees. The ARRS scheme has been updated, so that where a PCN engages a SPLW service through a supplier, a PCN will be able to claim an additional flat rate sum of £2,400 per SPLW (on an annual WTE basis and will be pro-rata to both WTE and duration of the roles providing the service as appropriate) as a contribution toward those additional costs. This must be affordable within the existing maximum annual reimbursable amount for social prescribing link workers. This will apply to any existing supply arrangements for SLPWs and any new supply arrangements for SPLWs agreed from this point forward.

Details of the Network Contract DES - Additional Roles Reimbursement Scheme Guidance can be found on the NHSE website.

Training opportunity with funding

Health Education England (HEE) South School of Pharmacy are delighted to announce funding to support the training of pre-registration trainee pharmacy technicians (PTPTs) in general practice from February 2021.

HEE want to work with employers to support the training of up to 30 pharmacy technician apprentices across the South region (South West, Thames Valley and Wessex) with GP ideally as the host employer. This will enable a new pharmacy technician workforce with primary care experience.

The funding available is £32,000 per PTPT over the 2-year apprenticeship training period.

Funding can be used to support salary, educational supervision or other elements to support the trainee to successfully complete the apprenticeship, and the apprentice can be someone new to your team or an existing team member to upskill.

Click here to download their flyer for further information.

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. CCGs 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 network. This Clinical Director will be funded – an average of a day a week for a network of 40,000 patients (including on-costs) from new funding provided by NHS England.