The recent release of the Primary Care Network (PCN) Directed Enhanced Services (DES) confirmed the addition of consultant nurses in primary care and general practice nurses to the Additional Roles Reimbursement Scheme (ARRS).
Nursing in Practice breaks down which nursing roles are now under ARRS, what PCNs will be able to claim up to per ARRS nursing role, and what responsibilities the different roles involve.
The ARRS scheme was launched in 2019 to reimburse the salaries of some staff who work in GP practices.
The primary care nursing roles included in the ARRS now include:
- Consultant nurse primary care
- Advanced nurse practitioner
- Enhanced practice nurse
- Experienced general practice nurse
- New to general practice nurse
- Nursing associate and student nursing associate.
Consultant nurse primary care
From 2025/26, PCNs will be able to reimburse up to £102,683 per consultant nurse in primary care, which can go towards salary and some on-costs.
The PCN DES sets out that consultant nurses in primary care will be working at a level equivalent to band 8c on agenda for change (AfC).
To be employed by a PCN under ARRS, consultant nurses in primary care will hold a master’s degree and be working towards a PhD, educational doctorate, or equivalent research qualification.
They will have ‘extensive experience’ in advanced clinical leadership, service development, workforce planning and system-wide innovation.
How is the consultant nurse in primary care role defined?
- Provides strategic leadership and innovation in PCN-led service development
- Leads on workforce planning and the professional development of nurses across the PCN
- Drives improvements in population health outcomes, reducing health inequalities and improving access for underrepresented communities
- Leads research, evaluation, and implementation of best practice to transform service delivery
- Operates independently at an expert level, leading complex care management and service improvement initiatives
- Works across traditional boundaries to integrate care with secondary, community, and social care partners.
Consultant nurses in primary care will now be the highest reimbursable ARRS salary, with an annual equivalent maximum reimbursable amount per role of £113,256 in inner London and £110,103 in outer London.
Advanced nurse practitioner
The advanced nurse practitioner (ANP) role was added to the ARRS in 2023.
Advanced practice nurses will be working at a level equivalent to band 8a on AfC, with a national annual equivalent maximum reimbursable amount of £73,334.
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PCNs can reimburse up to £83,907per role in inner London, or £80,754 in outer London.
Advanced practitioners are required to have a master’s degree level in the relevant area and be working at a master’s level that encompasses the four pillars of clinical practice:
- Leadership
- Management
- Education
- Research.
How is the new to advanced nurse practitioner defined?
- ANPs must have graduated from a Centre for Advancing Practice accredited MSc advanced practice programme or completed the Centre’s ePortfolio (Supported) Route
- Or have enrolled as a trainee on a Centre for Advancing Practice accredited MSc advanced practice programme linked with subsequent guaranteed progression onto a reimbursable Advanced Practitioner Nurse role on completion of training
- Or enrolled on and progressed past the initial Learning Needs Analysis (LNA) stage of the Centre for Advancing Practice ePortfolio (supported) Route, linked with subsequent guaranteed progression onto a reimbursable Advanced Practitioner Nurse role on completion of the ePortfolio process.
Enhanced practice nurse
Enhanced level practice nurses were first added to ARRS list for 2024/25, with the role capped at one enhanced nurse per PCN – and two roles reimbursable where the patient list size was 100,000 or over.
The PCN DES sets out that enhanced practice nurses in primary care will be working at a level equivalent to band 7 on AfC.
PCNs will now be entitled to reimburse up to £64,907 per enhanced nurse in primary care nationally. Enhanced nurses working in inner London will have the annual equivalent maximum reimbursable salary of £75,480 per role, or £72,327 in outer London.
As set out by the Primary Care and General Practice Nursing Career and Core Capabilities Framework, the enhanced practice nurse role is a level between registered nurse and advanced and consultant levels.
To be employed by a PCN under ARRS, an enhanced practice nurse will hold a degree in nursing or from a registered nurse degree apprenticeship.
They must hold a postgraduate qualification (at Level 7 or above) that is relevant to their area of enhanced practice, such as in wound care, respiratory care, or another area of enhanced practice.
They must also be working across the PCN, in services that enhance the core general practice offer.
Other enhanced nurse responsibilities required by the PCN DES include:
- Consulting with patients, their family, and the MDT to undertake assessments of patient need and devise and evaluate complex care plans
- Teaching and advising patients and their families on how to manage their condition or support the multi-disciplinary team to do so.
Wider responsibilities expected of the enhanced practice nurse include:
- Participating in and/or leading formal training events promoting best practice in area of expertise
- Providing professional and clinical leadership and mentorship, acting as a clinical role model on the delivery of evidence-based practice.
Experienced general practice nurse
Experienced and new general practice nurses (GPNs) have been included in the ARRS for the first time.
Experienced general practice nurses will be working at a level equivalent to band 6 on AfC, with a national annual equivalent maximum reimbursable amount of £53,319.
PCNs can claim up to £63,892 per role in inner London, or £60,739 in outer London.
Experienced GPNs employed under ARRS must have ‘more than one’ academic Level 6 diploma or postgraduate diploma in long-term conditions care and/or public health initiatives.
They will be required to have ‘demonstrable experience’ in leading long-term conditions management and quality improvement within a PCN.
They will be working at registered nurse level practice as described in the Primary Care and General Practice Nursing Career and Core Capabilities Framework.
How is the role of experienced nurses in primary care defined?
- Lead long-term condition management across the PCN, supporting quality improvement and assurance initiatives
- Support public health and screening programmes, including immunisations, vaccinations, and cervical screening
- Embed population health management approaches within general practice, targeting health inequalities and improving access
- Support, mentor, and supervise new-to-practice nurses and other healthcare professionals within the PCN
- Work collaboratively across the PCN to enhance integration with community, secondary, and social care services.
New to general practice nurse
New to general practice nurses will be working at a level equivalent to band 5 on AfC, with a national annual equivalent maximum reimbursable amount of £43,352.
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PCNs can reimburse up to £52,172 per role in inner London, or £49,967 in outer London.
The new to general practice nurse will have an academic Level 6 diploma in long-term conditions and be undertaking the Fundamentals of General Practice Nursing Programme.
They must also be working at registered nurse level practice as described in the Primary Care and General Practice Nursing Career and Core Capabilities Framework.
How is the new to general practice nurse defined?
- Provides fundamental nurse-led care to communities across the PCN
- Undertakes early detection, prevention, and management of cardiovascular disease and other long-term conditions
- Takes a lead role in managing one specific long-term condition (LTC) following structured mentorship and preceptorship
- Participates in quality improvement initiatives to enhance patient outcomes and reduce health inequalities
- Works within a MDT, supporting integrated care and personalised approaches to patient management.
Nursing associates
Nursing associates have been included in the ARRS since autumn 2020.
They work at a band 4 on AfC, with a national annual equivalent maximum reimbursable amount of £36,150.
Nursing associates (NA) working in inner London will have the annual equivalent maximum reimbursable salary of £43,529 per role, or £42,038 in outer London.
Where PCNs employ or engage a nursing associate under ARRS, they must ensure the NA meets the specific qualification and training requirements specified by NMC standards of proficiency by completing a two-year foundation degree approved by an NMC approved provider.
The PCN must also ensure the NA is registered with the NMC and revalidation is undertaken in line with NMC requirements.
Other nursing associate responsibilities defined by the PCN DES include:
- Improving safety and quality of care at every opportunity
- Contributing to the delivery of integrated care
- Working with the PCN MDT to ensure delivery of nursing associate duties complement existing workforce
- Performing and recording clinical observations such as blood pressure, temperature, respirations, and pulse.
Since October 2022, PCNs have been able to claim reimbursement for nursing associates training to become a registered nurse.
Student nursing associates
Student nursing associates (previously trainee nursing associates) will be working at a level equivalent to band 3 on AfC, with a national annual equivalent maximum reimbursable amount of £32,159.
Student nursing associates working in inner London will have the annual equivalent maximum reimbursable salary of £39,164 per role, or £38,047 in outer London.
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A PCN must ensure that the student nursing associate has access to appropriate clinical supervision and an ‘appropriate named individual’ in the PCN to provide general advice and support on a day to day basis.
In February, the RCN said the government was failing to address long-term pay disparities faced by general practice nurses by instead directing funding through the ARRS.
Following the release of the Cogora General Practice Workforce whitepaper report, Nursing in Practice has published analysis on the impact of practice nurse’s exclusion from ARRS on the profession as a whole.
A report from the Queen’s Nursing Institute (QNI) found that almost half of GPNs were expected to provide education and supervision for staff employed under ARRS, despite often being paid less and given free development opportunities.
