Wes Streeting pledged to review the ARRS scheme should he become health secretary, and now that he is it seems highly likely that the rules around this funding will be relaxed.  What might such a change mean?

The GPC is adamant that the ARRS scheme should be changed.  I have written previously about the absurdity of the NHS position that any use of the ARRS funding must prove additionality when core funding has been so drastically cut.  This has created the current situation where practices cannot afford the GPs they need (even when, for the first time in recent years, there are actually GPs available) because of the financial pressure on the core contract.  Meanwhile, the ARRS funding is protected and so can only be used for new/additional roles.

So it feels like this is an easy quick win for the incoming government.  Changing the rules won’t cost them anything (because the money is already there), and with no investment for general practice seemingly identified in Labour’s fiscal plan then some concessions will be needed if Wes Streeting really does want to prevent any potential industrial action by the profession.

However, making such a change does not come without its challenges.  Many of these have been eloquently identified by my PCN Plus colleague Tara Humphrey.  If core funding is replaced by PCN funding we might simply be masking the overall practice underfunding issue, creating a short term solution that although it may be welcome may serve to actually undermine the partnership model.  It could potentially make practices unsustainably dependent on PCNs (or are we there already?), which in turn could increase any existing tensions between practices and PCNs.

The other issue is the potential impact on the existing additional roles.  The ARRS funding is largely spent, as for the first time this year there is no growth in the ARRS pot.  So where will the money for the GPs and practice nurses (should they be added to the scheme) come from?  Will it be from any underspends that remain, plus any in year turnover (but how many GPs will that fund?), or would it actually result in some of the existing staff in post losing their jobs so that they can be replaced by GPs and practice nurses?

We could very easily end up in the situation where practices and PCNs are forced into some difficult decisions about which of the existing ARRS staff they want to keep and which are the ones they want to lose in order to fund GPs and nurses.  Some PCNs are likely to be more radical in the changes that they would be willing to make than others, and uncertainty and anxiety would undoubtedly spread across all of the ARRS roles.

But there could a significant upside for the existing ARRS staff if GPs were added to the scheme.  Whereas now in some places ARRS staff shift from practice to practice trying to add value where they can, they could be galvanised into a high-functioning team with the addition of dedicated GP leadership.  Instead of patchy, inconsistent supervision the addition of GPs could lead to the quality and quantity of support that these roles need to be able to come into their own.

The devil will be in the detail of any revisions to the guidance.  The extent to which “additionality” rules are still applied, any restrictions on practice-specific versus PCN-wide work, along with any financial limitations are all likely to shape how any changes to the scheme play out in future.  What is clear, however, is that any changes will need to be delicately handled in order to maximise the potential benefits without creating greater problems elsewhere.