The PCN DES has been reissued to include the addition of GPs to the Additional Role Reimbursement Scheme.  This contains the details of the new £82M funding that the government previously announced for GPs to be added to the scheme.  What do the details mean for the difference this funding will be able to make?

The good news is that there are relatively few strings attached to the funding.  There were concerns that there would be a relatively tight specification on exactly what these new GPs could be employed to do, but PCNs have been given a relatively free hand in choosing how to make the most of these GPs once they are employed.

It is also good news that PCNs are not being asked to produce a baseline on how many GPs they had, to prove that any employed via this scheme are additional (as, you will no doubt recall, was the case with pharmacists).  The funding cannot be used to continue to fund someone already in post pre-October 2024, but that is more or less the limit of the additionality test.

The bad news is that any GP employed with this funding has to be within their first two years since qualification (at the point at which they start with the PCN).  If they are more than two years post-qualification then this funding cannot be used to employ them.  These GPs cannot be employed as locums, and must be employed or engaged on terms or conditions that are no less favourable than the model terms and conditions for salaried GPs (B.19.4).

This terms and conditions requirement means that there is no chance of PCNs being able to reduce the on-costs of the additional GPs, and raises the important question of what it means in terms of how much funding each PCN will receive.  PCNs will receive £1.303 per weighted population, which means that a PCN with a population of 50,000 will receive an indicative amount of £65k for the six remaining months of 24/25 (that can only be spent on these newly qualified GPs).

The (annual equivalent) maximum reimbursable amount per GP is £92,462 (£95,233 with London weighting).  This falls more or less at the mid-point of the NHS Employers current salaried GP range of £73,113-£110,300, but of course this doesn’t take into account on-costs.  If we assume 9 sessions per week and 28% on-costs it means the maximum reimbursable amount is just over £8,000 per session.

Unfortunately, the available newly qualified GPs are not evenly distributed across the country.  This level of funding is unlikely to be enough on its own to persuade them to move to areas that may already by under-doctored.  Equally where there is competition amongst local PCNs in areas where there are GPs it seems highly possible that PCNs limiting themselves to the maximum reimbursable amount may find it difficult to secure a GP, and may need to dip into (already overstretched) PCN coffers to do so successfully.

When £82M arrives nationally at a single point in time and can only be used for one specific purpose (employing newly qualified GPs) then demand is always likely to exceed supply and so it should not be a surprise if it leads to prices going up.  Good for the newly qualified GPs, bad for the practices.

Overall, the issue with the scheme is that it seems designed to support and help the newly qualified GPs by securing them employment, but not GP practices with the challenges they are facing.  The call for the profession had been that if there is no new funding they need to be able to use some of the ARRS funds for GPs (the more experienced the better) rather than additional roles.  What this does is still maintain the protection on the existing ARRS money, limit the employment of GPs to those who are newly qualified, and most likely create an additional drain on PCN funds.  Of course new money is welcome, but it feels like the challenges practices are experiencing are still neither understood nor being taken seriously at a national level.