We are about to embark on year 3 of the Additional Role Reimbursement Scheme (ARRS), through which the PCN DES funds additional roles for individual PCNs.  How can we take the learning from the first two years and build it in to our planning for next year?

The first year of the ARRS was relatively quiet, as PCNs were only allowed to employ a pharmacist and a social prescribing link worker.  Last year the scheme took off, in part because the list of different roles was expanded to 10, and in part because 100% (as opposed to 70%) of the salary costs were reimbursed through the scheme.

The investment into roles through the scheme continues to increase significantly into year 3, with the total investment reaching £746M nationally.  Many PCNs will be in a place where they can afford 10 or even more staff with the funding available. This number will continue to rise for the next two years.  What this means is PCNs have to move from considering the ARRS staff on an individual basis to thinking about all of the roles collectively as a team.

I have written previously about the challenge of introducing the new roles.  This challenge just gets greater as the number of roles increases.  We are now at a tipping point where the overall approach needs to change.

Any business that employs 10 or 20 staff would put a business plan in place.  Having a plan is what is now required for PCNs.  The plan needs to contain (as a minimum) the following 4 elements:

1. Team Objectives

PCNs need to clarify exactly what the objectives for the ARRS team are.  How will the PCN know at the end of the year whether the new team has been a success?  How will the team itself know?  How will the practices know?  Agreeing objectives for the team will help everyone, and help move the PCN away from a mentality that it is recruiting these roles simply because the funding is available.

2. Team Structure

The retention challenge for these roles is something I have already written about, despite the recruitment only really taking place in earnest over the last 9 months.  It is clear the individuals in these roles need to feel part of a team.  At the same time, practices cannot simply absorb the extra work of looking after these roles, and asking them to do it means in many cases it simply does not happen.

My sense is most PCNs will need to create an overall ARRS team.  Very large PCNs can probably create more than one team, such as a pharmacist team and a social prescribing team, but the majority of PCNs will need one team so that the individual Health and Wellbeing Coach (for example) does not end up being isolated.

The team will need a leader.  It needs to be someone’s job to be responsible for the overall ARRS team.  This does not mean line managing every member of the team, but it does mean responsibility for ensuring the team is functioning effectively, delivering on its objectives, has effective communication across it, and that any issues that arise are dealt with.  This could be the Clinical Director or PCN manager, but someone needs to take on this role.

The team needs to have a structure.  Moving beyond 5 or 6 members of the team means that there needs to be levels within it, e.g. one of the pharmacists managing the other pharmacists, a senior link worker managing the other link workers etc.  Planning the structure, thinking about individual advancement, making the team more self-sufficient are key aspects of this part of the process.  No structure means as more staff are recruited, the burden simply becomes greater on a relatively small number of individuals.

3. Team Support

The key retention question for the PCN is how will this team be supported?  The provision of support is critical to getting the most out of them.  There are plenty of examples up and down the country of either ARRS staff such as Physician Associates carrying out low level work because no clinical support is being provided, or of staff such as social prescribing link workers working to other agendas because what support there is is provided outside of the PCN.

Increasingly there are opportunities (e.g. for pharmacists here or physician associates here) to ensure ARRS staff receive the training they need.  We are beginning to understand better how work needs to be organised to ensure ARRS staff can be effective (e.g. for FCPs here).  The PCN plan needs to be explicit about exactly how the ARRS staff will be supported.

4. Team Finances

As the team expands the financial model of matching the monthly cost of the ARRS staff against the reclaimable allowance is no longer sufficient.  This is an important element of the financial plan, but cannot be it in its entirety.

The ARRS team are a (funded) investment in the wider work of the PCN.  There are wider costs beyond those which can be reclaimed, e.g. clinical supervision, line management, estates costs, training costs.  PCNs also need to be mindful of potential VAT costs as they are likely to exceed the £85,000 VAT threshold, and of the need for a fund to cover potential employment liabilities.  Equally, income can come from other sources such as CCG/HEE/ICS funding pots, PCN core and development funds (etc), as well as benefits in kind provided to practices (e.g. support for vaccination services, a home visiting service, support with the delivery of enhanced services etc).  There are also future opportunities on the horizon, such as support with the delivery of extended access.

The funding model is not perfect, but for the ARRS team to be effective a financial plan for the team as a whole needs to be put in place.  This is more important this year than it was last year, and its importance will continue to increase year on year as the total amount of ARRS funding received (and associated costs) grows.

The plan does not need to be long or complicated.  But spending some time and energy now in putting a plan together will put the PCN in a much stronger position for making the most of the opportunity of these new roles in the year ahead.