What you need to know about the Additional Roles Reimbursement Scheme

Brand new to your role in primary care and looking to better understand the Additional Roles Reimbursement Scheme? Here’s what you need to know

CREDIT: This is an edited version of an article that originally appeared on The Primary Care Network Specialists

The Additional Roles Reimbursement Scheme (ARRS) is an automatic funding stream available to Primary Care Networks (PCNs), to support recruitment which currently enables the employment of service provision.

Which roles are not part of the ARRS?

• Clinical Director
• PCN Manager

Core General Practice staff:

• Practice Managers
• GPs
• Receptionists
• Health Care Assistants
• Prescribing Clerks
• Personal secretaries
• Practice nurses

How is the Additional Roles Reimbursement Scheme calculated?

Each PCN’s Additional Roles Reimbursement Scheme sum is based upon the PCN’s weighted population share. This is in recognition of workload and relative costs of service delivery and is calculated against the total available national funding.

To ensure consistency and fairness in allocations, the basis for weighting is the same as for global sum (i.e. the Carr-Hill Formula).

What do the PCN roles do?

The DES contains guidance on the minimal requirements for each role in Annex B.

You can also see a summary of each PCN role provided by NHS England here.

If you don’t already, make sure you subscribe to the FutureNHS platform. They offer a useful section titled; ‘Roles to support your PCN‘. You will also find further information on all of the roles, and the contribution they can make to the work of the PCN. There isn’t full insight on all roles, but they do cover most.

What doesn’t the reimbursement cover?

• Supervision
• Training
• Management fees
• Premises
• Equipment

If you procure a role from an external provider, you may incur VAT, which may push you past the maximum reimbursement for a role. This investment will need to be sourced using another PCN income stream, or directly from the PCN practices.

Additional Roles Reimbursement Scheme Employment Models

The most common employment models used to support the recruitment of additional roles fall into four main categories.

Directly employed by the Primary Care Network

If the PCN has been established as a legal entity, the network can directly employ roles.

Recruitment, training, supervision, IT requirement and all HR activities sit 100% with the network.

Directly employed via a lead practice

A practice agrees to hold the employment responsibilities for the network.

Recruitment, training, supervision, IT requirements and all HR activities sit 100% with the network.

Employed via a GP federation or Community provider

The GP federation or community provider agrees to and is paid to hold the employment responsibilities for the network.

Recruitment, training, supervision, and IT requirements are negotiated between the parties and is often a shared responsibility.

HR activities are the responsibility of the federation or community provider.

In this model, there is typically a management charge that the Additional Role Reimbursement Scheme cannot claim.

Commissioned service via a specialist provider

In this arrangement, the PCN is a commissioning service and not just the recruiter to a role.

The service provider is skilled and experienced in providing the service and works to the service requirements of the network.

• Their workforce can usually hit the ground running, working on-site or remotely.
• This model enables the PCN to increase or decrease the service based on utilisation.
• HR activities and IT equipment are the responsibility of the specialist provider.
• Neither model is better or worse. They all work.

The employment model and management will depend on the network’s culture, structure, and ease of recruiting.

How are roles allocated?

Typically, roles may be assigned either to practice first or patient first.

The practice-first approach

By this, we mean equity of provision is based on the patient list size, and this is seen as a priority over the utilisation and demand of the service.

The patient-first approach

The patient-first approach organises the workload based on demand, which is facilitated by a regular review of the appointment utilisation and considers the practice’s existing workforce.

In this model, provision is based on the demand for the service and not just the patient list size.

What about space and the lack of premises?

As a result of the Covid-19 pandemic, technology has enabled many roles to be delivered remotely and due to a lack of space for many networks, this arrangement is still in place.

Both models work depending on the role and culture of the network.

Communication is key to making remote working a success, as sometime people out of sight may feel out of mind. Here’s some simple (and practical) tips for supporting your team to feel involved, and included:

• Schedule regular check-in’s and 1-2-1’s
• Newsletters, WhatsApp and Microsoft Teams channels are great ways to keep team members informed
• Include the PCN team in Protected Learning Time events and PCN meetings

Who manages the roles?

Line management of the roles depends on your employment model. Responsibility will typically fall to:

• The PCN Clinical Director
• The PCN Manager
• The lead practice
• The ARRS provider

Alternatively, practices may share their roles and consequently, line management of these.

What about supervision?

There is no direct funding for the time required to provide supervision, but some PCNs have made use of core funding, IIF funding, and leadership and management funding to fill this gap.

Some networks also point to the PCN engagement fund, which gets paid directly to practices to support the cost of supervision.

If you want to get the most from your PCN team, and help your practices remain compliant with CQC requirements, supervision is a must.

Benefits of the PCN Additional Roles Reimbursement Scheme

• The Additional Roles Reimbursement Scheme:
• Enables PCNs to recruit additional roles, to help increase access to patients.
• Provides a range of roles that networks can recruit to.
• Helps foster collaboration amongst PCNs by encouraging joint working between practices.
• Provides professional development opportunities for general practice staff looking to increase their Primary Care experience.
• Can help practices and PCNs generate income by utilising these roles to support QOF, enhanced access, the Impact and Investment Fund and other locally-based enhanced services.

Issues relating to the scheme

Whilst many networks have embraced the PCN’s extended workforce; they have trained them to increase appointments, generate income (related to the QOF and the Impact and Investment Fund (IIF) indicators) – and provide a greater range of healthcare professionals to support their patient’s health and wellbeing. That said, it hasn’t been a positive experience for everyone.

If your network is struggling to see the benefit in a role, don’t recruit to the same role until you have addressed the following.

• What is currently working well?
• What data do we have to review and inform the service being delivered?
• Where do we need to increase/decrease the provision?
• What do we need to start, stop and continue doing?
• What feedback has been provided about the service to date?

This being said, even when the role is adding value through increased appointments and patient feedback, sometimes the network just doesn’t see value in the role.

In this instance, it is advised to help the person to seek employment in another network who does value the expertise the role brings, or the network would decommission the service.

This isn’t a quick or easy decision. We usually reach this point after months of discontent.

Focus on what will drive your network forward, versus, what will keep the network stuck in the present.