There is increasing animosity developing across general practice towards the additional roles, but it is largely misplaced.  Here is why.

The misconception is that the additional roles have been introduced to replace GPs.  This has been exacerbated by recent stories where GP practices have reduced their numbers of salaried GPs and replaced them with additional roles.  Equally locum GPs are reporting that they are finding it harder than ever to secure work, and the increased numbers of GPs in training are starting to be concerned that they will have no jobs to take up once they qualify.

In all of these cases practices are using the additional roles (funded via the PCN additional role reimbursement scheme) to cover the work that these GPs would historically have undertaken.  So it is not surprising that the conclusion that is being jumped to is that these additional roles are here to replace GPs, and it is from this belief that animosity within general practice towards them has developed.

But what this misses is the change in context.  In 2019 the biggest challenge practices were facing was workload.  There were not enough GPs to undertake all of the work required.  This in turn meant GPs were overwhelmed and as a result were reducing the number of sessions that they worked, exacerbating the problem even further.  More capacity was urgently required.

There were calls for more GPs.  First 5,000 then 6,000 additional GPs were deemed necessary to meet the workload requirements.  Despite an increase in the number of GPs in training no dent has been made in the number of GPs needed because GPs are retiring and leaving faster than the new ones arrive.  There are now 2,000 less GPs than there were in 2015.

With no increase in the number of GPs, and an ever increasing workload, general practice desperately needed more capacity.  This is the point at which the additional role reimbursement scheme (ARRS) came along.  What these roles did was provide an injection of much needed additional capacity into general practice.

Practices have needed to adapt and find ways of working that make the most of the skills of each of the new roles.  This kind of change is not easy, but gradually practices are working out how to make the most of this new resource.

But what has happened at the same time has been a squeeze on general practice finances.  Two years of imposed contracts and real terms cuts have led to a huge fall in practice profits, and if the purported contract offer of 1.9% for next year is anything to go by then the financial challenges  for practices are only going to get worse.

70% of practice expenditure goes on staff, so inevitably practices are having to look at ways of reducing this spending.  The additional roles are fully reimbursed via the ARRS, and so it is no surprise that practices are having to be creative about making the most of these roles to be able to stay afloat financially.

The additional roles provide a welcome source of additional capacity for general practice, particularly given the insufficient numbers of GPs available.  But the it is the financial situation that has driven practices into a choice between either these roles or GPs.  So our ire shouldn’t be directed towards the additional roles.  Instead it should be directed at NHS England and the government, whose failure to provide enough funding for general practice to employ the (insufficient) number of GPs that currently exists is the real problem.

It is really important that with all the pressures in general practice the service does not turn on itself.   It is not the paramedics or physiotherapists fault that practices have not been resourced properly, that the core contract is insufficient to cover the cost of GPs, or that the ARRS funds cannot be used to employ GPs.  We need the additional roles, not as a replacement for GPs but as well as GPs, and the service needs to work together to secure the funding it requires.