What we do and don’t know about practice nurses being added to ARRS

It was confirmed last month that GPNs will be added to the ARRS, following an agreement between the British Medical Association and the government as part of the 2025/26 GP contract.

The idea had first been mooted by health and social care secretary Wes Streeting in December.

Recently-qualified GPs will also be permanently added to the scheme – following a move to temporarily add them last summer.

Under the incoming GP contract – which has not yet been published in full – NHS England has said there will be increased ‘flexibility’ around the ARRS, to support primary care networks (PCNs) to ‘respond to their local workforce requirements’.

This means there will be ‘no restrictions on numbers or type of staff who are covered’ by the scheme, according to a letter from the national director for primary care, Dr Amanda Doyle.

Under the previous 2024/25 contract there were limitations that meant, for example, only one enhanced level practice nurse could be hired per PCN, or two where the PCN’s list size is 100,000 or bigger. It also excluded GPNs and GPs.

The new GP contract will stipulate, however, that PCNs can only use the scheme to hire practice nurses who have not held a post in that PCN or any member practices in the last 12 months.

The ARRS, first introduced in 2019, currently covers 17 roles including nursing associates, advanced nurse practitioners and pharmacists. It enables PCNs to claim reimbursement for the salaries and employment costs of those on the list.

Last year, the 2024/25 GP contract saw the addition of the ‘enhanced level practice nurse’ role to the scheme – with reimbursements available of up to £70,330.

While there has been some confusion around what the role is, the Network Contract Directed Enhanced Service (DES) specification stated that those in post would work to deliver ‘enhanced clinical care’, train and supervise colleagues, and act as a ‘clinical role model’ for evidence-based practice.

There have been long standing concerns about the exclusion of GPNs from the scheme, and in August 2024, NHS England announced this was being reviewed.

What will be the remuneration of an ARRS GPN role?

It has not yet been revealed what the salary or reimbursement costs will be for GPNs employed through the ARRS.

This is expected to be outlined in the PCN Directed Enhanced Service (DES) which will be updated when the 2025/26 contract is out in full (hopefully in the coming weeks).

The Royal College of Nursing (RCN) has said previously that ARRS employment contracts are ‘often aligned’ to NHS Agenda for Change pay and conditions. But it also warned there was ‘no consistency or additional funding to support nursing staff employed on ARRS to receive or maintain fair pay, terms and conditions’.

In a policy briefing last month, the RCN stressed that practice nurses are not ‘additional roles’ but ‘a core part’ of the GPN workforce and accused the government of failing to address the long-term pay disparities faced by GPNs by instead directing funding through the ARRS.

And it believes that including GPNs in the scheme could cause ‘unstable employment’ for practice nurses, with employment contracts ‘subject to available funding’, rather than permanent ones.

Writing on X after news of the 2025/26 GP contract, Louise Brady, national primary care nursing lead at NHS England, said the confirmed introduction of GPNs into the scheme was a ‘small step change’ in the ‘long overdue’ recognition of practice nurses and their expertise.

Though she suggested a ‘long journey continues’, adding that she wanted to see ‘fairness, parity and equity’ for all nursing staff.

In January, an exclusive white paper published by Nursing in Practice’s publisher Cogora revealed that GP practices across England were struggling to recruit much-needed nurses because they are unable to match salaries given elsewhere.

With a ‘single ARRS pot’ for all roles coming into force – including for GPs and practice nurses – there has been some talk around how PCNs will use the money and what this will mean for ARRS roles currently in post.

Earlier this month, the BMA’s GP Committee England chair Dr Katie Bramall-Stainer suggested that the ARRS money should be spent on the roles practices needed, and warned GPs to follow ‘sound employment law’ when making staffing decisions, as reported by our sister title Pulse.

She told GPs: ‘Spend it on the roles you need. If you decide in the future that you want to restructure your teams on the back of this, then please follow strong HR principles and sound employment law. The BMA can and will help, but just take stock first and don’t rush.’

YORLMC medical secretary Dr Brian McGregor also urged caution when taking advantage of the looser ARRS restrictions, advising GPs to ensure they follow employment law.

In an update to local practices last week, he said he was worried practice nurses could use the scheme to ‘set practices against one another, and game job offers going forward’.

Separately, Martyn Davey, a nurse associate (NA) at a GP practice, told Nursing in Practice that the inclusion of GPNs into ARRS is an ‘opportunity for better workforce planning’ between NAs and GPNs to work together and not ‘compete for space’.

‘While the ARRS funding has expanded opportunities for GPNs, it’s crucial that this does not come at the expense of NAs, who bring unique skills and value to the multidisciplinary team,’ he added.

Those among the nursing profession have largely warned that the introduction of GPNs to the ARRS risks ‘significant instability’ that could ‘deplete’ practices of nurses.

In January, Sandra Dyer, primary care nursing clinical advisor for Wessex Cancer Alliance, said the introduction of GPNs into ARRS could ‘help drive up’ pay and conditions in practices but could also bring other unexpected risks.

‘More likely, given the current financial position, this could deplete practices of their GPNs with nursing provided by the PCN,’ she said.

Dr Helen Anderson, a nurse researcher at the University of York, last month published a report which heard from GPNs linking the deprofessionalisation of nursing with the introduction of new roles into primary care nursing through the ARRS.

Some felt that practices were using ARRS roles ‘rather than employing registered nurses, as it was less costly’.

‘Some nurses will be concerned about moving to ARRS roles as the scheme may not be considered inherently stable long term and contracts may be temporary,’ Dr Anderson told Nursing in Practice.

‘Nurses in our study, even when on poor employment contracts, were often cautious of leaving their employers because they are fearful of moving somewhere which proved to be even worse.’

Last year, a report by the Queen’s Nursing Institute (QNI) International Community Nursing Observatory (ICNO) revealed that almost half of GPNs were being expected to provide education and supervision for staff employed under ARRS despite often being paid less and given fewer development opportunities.

In the report, over a third of GPNs (37%) reported that the introduction of ARRS roles had increased their workload. A further two-thirds (67%) said their workload had not decreased since the introduction of the scheme.

The report’s authors also found a ‘recurring issue’ among GPN respondents was ‘inequitable pay and conditions’.

‘GPNs were expected to support and supervise ARRS colleagues, for lower pay,’ the report said.

‘They also had less access to developmental opportunities and paid time for learning compared to ARRS colleagues.’

The RCN has also previously warned that the ARRS has sparked ‘a lot of role substitution’ of GPNs since its introduction.

In a recent analysis piece, Nursing in Practice discussed how the shift towards multidisciplinary working since the ARRS was introduced had seen practice nurses taking on more responsibilities and lone working.

In August, an exclusive snapshot survey found that almost two-thirds of primary care and community nurses believe GPNs should be included in ARRS.