As the end of the 5 year contract draws closer, and with it the (potential) end of the PCN DES, it is time to ensure your PCN has a plan in place for the ARRS staff.

First of all, what are the questions the plan needs to answer?  Well the key ones are how to maximise the associated recurrent funding, how to ensure the staff are not lost to other providers, and what to do about the ‘additional’ funding that the PCN has contributed.  We should probably also try to work through any future issues that we might be able to foresee.

While NHS England has committed on a number of different occasions to ensuring that the cost of the ARRS staff is met recurrently regardless of what happens to the PCN DES post-March 2024, it has not been clear on how this will happen nor how the amount that will be reimbursed will be calculated.  But if history is anything to go by it seems likely that an arbitrary date will be given with relatively little notice (which could potentially come as early as December this year) and expenditure at that point used as the level that will be continued into the future.

Despite the obvious flaws in such a methodology, using actual committed expenditure seems a much more likely choice for NHS England than committing to the final allocation totals for each PCN.  While this would be a fairer and more equitable choice, it would be more expensive (as there remains an underspend on ARRS budgets) and as such is unlikely.

The recent NHS Long Term Workforce Plan indicated that further investment in additional roles would be at a much slower rate than we have seen over the 5 years of the PCN DES, only introducing half as many of the roles again over the next 13 years.  It therefore seems wise for PCNs to ensure that they are maximising the use of their allocation wherever possible.  Some PCNs have said they are not yet ready for any more roles, but this may be a decision they come to regret in years to come when additional funding for the roles has all but dried up.

Whilst PCNs have been recruiting ARRS roles at a breakneck pace in recent years, other community providers who have not received such extra funding have been looking on enviously.  It seems inevitable to me that once ‘integrated neighbourhood teams’ with a much wider community engagement than PCNs shape up there will be calls for the ARRS staff to take on more of a community centred role and less of a practice based one.

While ARRS staff have an important role to play in improving the health and outcomes of local neighbourhoods, through the PCN DES they were also given an important role in ensuring the sustainability of local practices.  Practices and PCNs would be wise to ensure staff are sufficiently embedded into the practice work alongside the PCN-wide work to make their extraction from it impractical.

An obvious concern is where funding for roles has been topped up with funds outside of the ARRS.  It may be that while the ARRS funding is made recurrent, other funding sources (such as the £1.50 core funding) could potentially cease.  PCNs can work out contingency plans for this scenario, beyond hoping for replacement funding sources.  It may be that ARRS staff are deployed in the delivery of services that are income generating and unlikely to stop (such as enhanced access).  This funding could then be used for any excess beyond the ARRS.

Alternatively it may be that the roles can be redeployed out of existing PCN work and into more focussed practice activities.  Practices may be prepared to fund any additional cost of the roles as is, but this would be more likely if they had more direct control over their time and deployment.

Other factors to bear in mind are the push for NHS terms and conditions for these staff, the move to bring primary and community care workforce planning together, and the expectations those involved in Integrated Neighbourhood Teams (whatever these end up being) may have for ARRS staff outside of GP practices.

The key point from all of this is that working this through now, and coming up with a clear plan to mitigate the risks and maximise the longer term impact of these roles is likely to pay significant dividends beyond March next year.