Primary care networks (PCNs) have warned they may resort to cutting practice staff employed through the Additional Roles Reimbursement Scheme if a funding uplift for the initiative is not given.
Clinical directors have told our sister title Pulse PCN that they would face shortfalls between £26k and £60k if they honoured the recently announced Agenda for Change pay rise for ARRS staff.
It comes as clarity on whether ARRS reimbursements will be uplifted to match the pay increases announced earlier this summer for roles within general practice.
The government announced a 2024/25 pay award of 5.5% for Agenda for Change staff on NHS terms and conditions, and 6% for doctors and other practice employed staff, backdated to 1 April 2024.
Last year, reimbursements under ARRS were uplifted to match the Agenda for Change pay increase, however there was no overall change to the total funding available for PCNs. This meant that while PCNs could pay staff more, they had less money to hire further additional roles.
The ARRS scheme was launched in 2019 and enables PCNs to reimburse the salaries of some staff including nursing associates, advanced nurse practitioners and pharmacists.
In April, NHS England revealed the overall increase in GP contract finance had included a ‘planning assumption’ that ARRS pay would increase by 2%.
The British Medical Association (BMA) suggested last month that ARRS staff would be entitled to a further 3.5%, to bring them in line with the Agenda for Change uplift, which would be an ‘unfunded cost pressure’ for PCNs.
Clinical directors have told Pulse PCN that without an uplift to the overall budget, they may have to cut the number of ARRS staff employed by the PCN and ‘revise’ plans.
Clinical director at SMASH PCN in Cheshire, Dr Neil Paul, said they could be facing an estimated shortfall of between £40,000 and £60,000 as a PCN if they were to grant the pay rise.
‘The reality is that if the money gets tighter, we will reduce the number of staff or have them working less hours and less overtime,’ he said.
‘As a PCN, we are currently projecting an overspend as there is no point underspending. Our overall budget is around £1m, so if the budget doesn’t uplift to cover pay rises, we’re looking at a £40-60k shortfall – we might need to lose one band eight.’
Dr Sarit Ghosh, clinical director at Enfield Unity PCN in North Central London, said his PCN was ‘waiting for clarification’ as they are also already over their spending cap and would ‘need to explore how we could facilitate the rise’.
Dr Laura Mount, clinical director at Central and West Warrington PCN, said her network were ‘yet to decide’ whether they will grant a pay rise for ARRS staff, as if they did and kept to their current plan, they would have overspent by £26,000 by the end of the year.
‘Unless an uplift comes, we will have to revise plans,’ she said. ‘It has been stressful because staff quite rightly want to know and we don’t have the clarity we need.’
Dr Dan Bunstone, clinical director at Warrington Innovation Network PCN, Cheshire, added: ‘The funding recommendations and subsequent money that follows from NHSE need to tally. Recommending is one thing, but not having a pot to draw the additional funding from makes things very complicated.’
He said the uplift would be around £70,000 in his PCN.
Ben Gowland, director at consultancy Ockham Healthcare, added that it would make sense for PCNs in the same area to agree a ‘common policy’ on whether they are granting the uplift or not.
He said: ‘If PCNs have spent their full allocation, they simply can’t match the full Agenda for Change rise, unless NHSE uplift the pot. However, if they have an underspend, they can choose to use this to fund the pay rise (or use the underspend any turnover of staff would generate).
‘It would make sense for PCNs in the same area to agree a common policy on this, if they can, to reduce the risk of losing staff if they can’t/decide not to fund the rise.’
He added that there was ‘more of a chance’ that NHS England would uplift the ARRS budget this year, ‘because the ARRS pot hasn’t risen this year in the same way that it has for the past five years’. But this did not necessarily mean they would do this, he said.
NHS England told Pulse PCN that the Department of Health and Social Care (DHSC) and NHS England would consult with the BMA’s GP Committee England (GPCE) ‘in the coming weeks’ on changes to the 2024/25 Network DES, including revised ARRS entitlements.
In recent weeks, concerns have also been raised that not enough funding has been given to GP practices to honour a 6% pay rise intended for practice nurses and colleagues.
A version of this article was first published by our sister title Pulse PCN.
