Recommendation 5

HM Government Deferred

Partially accept. The Department partially accepts this recommendation. We will continue to consider greater flexibility in the Additional Roles Reimbursement Scheme (ARRS). That is why in the changes to the GP contract published on 6 March 2023, we have increased the flexibility of the ARRS by adding Advanced Clinical Practitioner Nurses and apprentice Physician Associates to the reimbursable roles, increasing the cap on Advanced Practitioners, and removing the caps on Mental Health Practitioners. These roles sit alongside Care Coordinators, Clinical Pharmacists, Pharmacy Technicians, First Contact Physiotherapists, General Practice Assistants, Health and Wellbeing Coaches, Occupational Therapists, Paramedics, Podiatrists, Dietitians, Nursing Associates and Social Prescribing Link Workers. ARRS staff are a critical part of general practice and funding will continue to be available to continue their employment after 2023/24. However, we will not commit to allowing recruitment of all clinical and non-clinical roles according to local need as the scheme is used to encourage growth of an under-represented element of the workforce and a review of the scheme is being worked through to determine how it might operate from April 2024. We do not want to pre-empt the outcomes of that review in our response. Practices and Primary Care Networks (PCNs) are free to employ any non-clinical or clinical staff directly without using the ARRS. We recognise the need for practices and the PCNs they form to make decisions about the make-up of their workforce as independent contractors and that they are best placed to understand what workforce will provide the best service to their patients. NHS England keeps the additional roles scheme under review to ensure that it remains fit for purpose. Since 2019, we have more than tripled the number of roles available for reimbursement and continue to introduce greater flexibility where possible. As of 31 March 2023, over 29,000 additional primary care professionals have been recruited compared with a baseline of March 2019. Over the lifetime of the scheme to date NHS England has also responded to stakeholder feedback to increase the flexibility of the scheme by adding new roles, providing high-cost area support where appropriate, and widening reimbursement to include training time and apprenticeships for certain roles. • In October 2022 as part of the ‘Plan for Patients’, two non-clinical roles (General Practice Assistants and Digital and Transformation Leads) were made available through the scheme. Digital and Transformation Leads are well placed to support the embedding of other ARRS roles within PCNs as well as improving digital access. • As of October 2022, PCNs were able to be reimbursed through the scheme for the time Nursing Associates spend training to become a registered nurse, building a pipeline into GP nursing and providing career opportunities for more junior roles through the ARRS. • High-Cost Area Supplements were added to the scheme, this increased the maximum reimbursable amounts for PCNs located in areas with higher associated costs such as London. Where required, specific hiring controls are placed on roles such as paramedics being employed in rotational models. Employment models such as these ensure that the skills of specific roles can be employed across settings without leading to workforce shortages in any particular setting, whilst simultaneously providing career opportunities to professionals.