We have all been struggling to get our heads around the Additional Role Reimbursement Scheme (ARRS) for PCNs, and in particular how to make most of the opportunity it creates.

Significant changes were made to the ARRS in the 2020/21 GP contract (in particular the increase in reimbursement from 70% to 100%, and widening the number of available roles to 10).  However, the impact of these changes were somewhat lost initially, as a result of uncertainty as to whether PCNs were going to sign up to the revised DES and, of course, the emergence of coronavirus.

But now PCNs are moving forward as quickly as they can with their recruitment plans.

The problem is, despite an apparent enthusiasm nationally for each PCN to use all of its ARRS fund to be used, the rules seem to conspire against this happening.  PCNs can only be reimbursed up to a maximum monthly reimbursable amount, which means funds can only be used once the new staff are actually in post.

In order to spend all of the money PCNs would have needed their new staff to be in post on the 1^st April.  But given at that point most practices had not even signed up to the DES, not to mention the distractions posed by the small matter of a pandemic, it is not surprising that for many PCNs staff are only being recruited now.

It seems likely (and entirely reasonable, given the PCN DES specifications only start on the 1^st October) that the majority of the new PCN roles will probably not be in post until October.  And if the PCN staff do not start until October this means somewhere in the region of half the available ARRS money will not be spent.

How then can PCNs ensure they make the most of the available ARRS fund for this year?

The best way is for PCNs to start their recruitment to their 2021/22 roles now.  PCNs can use the underspend against this year’s roles to pay for additional months of next year’s roles.

The “average” PCN has £344k available for additional roles this year.  This goes up by nearly 75% to £597k next year.  Even a PCN that is on track to spend as much as 70% of its funds this year could still afford to have all of its roles for next year start in the middle of November this year, and remain within budget this year and next.

This means, taking into account the need for notice periods and the delays these cause to recruitment, PCNs who want to maximise the use of their allocation would be wise to start their recruitment for next year now.

One caveat of course is that paramedics and mental health practitioners cannot be employed until April 2021.  These roles will be popular, so even for these it is worth considering starting the recruitment process at the end of October/early November so that they are recruited and ready to go on April 1^st 2021.

Even for those PCNs who did manage to get ahead of the curve and are not looking at much of an in year underspend, it is still worth being ready for early recruitment to next year’s roles.  It is highly likely your neighbouring PCNs will have an underspend (because the majority will), and the rules are that any underspend in an area should be offered in the first instance to the neighbouring PCNs, rather than being lost to general practice.

PCN recruitment may have got off to a slow start this year, but I suspect this wont be the same in the years to come as savvy PCNs get started well before the next year begins!