PCNs and ARRS – collaborative working is the key

Catherine Lawler, social media manager at the PMA, discusses the challenges for employees who are part of the additional roles reimbursement scheme working in primary care networks and the benefits of collaboration 

We’re all accustomed to the huge volume of acronyms in the NHS, but it didn’t stop many of us raising a wry smile as emails with ARRS in the subject regularly made their way into our inboxes. The additional roles reimbursement scheme (ARRS) was first introduced in 2019 as a way of improving access to general practice; its main aim was to support the recruitment of 26,000 additional staff into general practice.

And yes, this is a big ask. 

Funding to employ care co-ordinators, social prescribers and other such roles is available through the ARRS, but it is down to each primary care network (PCNs)to decide which roles they choose to employ.

While PCNs have quickly recruited to these roles, some have not been integrated into primary care teams effectively. However, despite issues with some specific roles, other roles are having a positive impact on patient care, reducing clinical workload and aiding integration. 

One such success story is Emad Mahmoud, a clinical pharmacist at Merepark Medical Centre in Alsager. He told me that the ARRS is a unique way to introduce professions that you would not usually associate with being present at a GP surgery into primary care.

As a PCN pharmacist, Emad’s role allowed him to cover four different GP surgeries – providing specialist pharmacist services. 

Working within four different practices enabled Emad to identify processes which make the implementation of ARRS employees successful. He felt a lot more utilised, valued and effective within surgeries which were forward-thinking and had specific plans and processes they wanted him to work on. 

However, he also experienced what it was like working within a surgery that was not prepared or organised about utilising their ARRS allocation – here, he felt dissatisfied, like a ‘spare part’.

Emad’s tips to surgeries to make the implementation of ARRS successful are:

• Prior to the scheme starting, have a clear plan on the areas requiring assistance.
• Have an initial meeting with the ARRS member of staff to discuss the areas surgeries want help with, and to allow the member of staff to discuss their expectations and ideas of how they can participate.
• Ensure ARRS members are fully aware of all processes in each surgery and the points of contact for the surgeries should they encounter any issues.
• Educate all existing team members on the roles and responsibilities of the ARRS member so that other team members can effectively utilise their skills.
• Organise regular meetings to ‘check-in’ with the ARRS member and provide opportunities for both parties to provide feedback and resolve any issues encountered.

PCNs need to be proactive and work closely with training hubs and GP Federations. Collaborative working is clearly a key to success – something that Ruth Rankine, director of primary care for NHS Confed, is determined to build on. She told me that it feels as if the future of PCNs is now much more settled than it was. The vaccination programme did a lot for collaborative working in primary care and people are now beginning to see the real potential of primary care networks. 

A key challenge – recruiting and retaining 

There is, undoubtedly, a very tired workforce with high levels of sickness right across the NHS. The report Primary care networks: three years on talks about the high turnover of staff, both clinical and non-clinical. NHS Confed has been calling for a long-term workforce plan – and that call for that is coming from every sector. 

Ruth believes pay is important – but that this, on its own, won’t solve the problem. Being part of a team, and getting the right training, supervision and development, are all imperative. There may be a slightly rocky journey ahead but, credit where it’s due, considering the challenges the last three years have presented, PCNs have performed well, particularly in relation to the vaccination programme.

Other successes include improved access – centralised booking systems across practices – and individual practices have a much better working ethos – but PCNs do require certainty, and this includes guarantees for their existence and increased flexibility within ARRS. Nevertheless, PCNs are on track to meet the 26k target for March 2024 – over a year early – though they are being encouraged to continue recruiting and make full use of their ARRS entitlement.

NHS England has just published an overview of changes to the GP contract for 2023-24, in which it states the ARRS will be reviewed to ensure it remains fit-for-purpose and aligned to future ambitions for general practice.