By far the largest amount of funding in the PCN DES is for the Additional Role Reimbursement Scheme (ARRS).  But is general practice making the most of the opportunity that such an investment represents?

To put the funding into context, a PCN with a weighted list size of 50,000 will receive £356,600 under the ARRS.  This size of PCN will have funding for more than 7 roles this year.  This will rise to £618,600 next year, £850,900 the year after, and reach £1.17M in 2023/24 (network contract DES guidance p20). The £7.13 per weighted patient PCNs receive for the ARRS for this year compares to a combined total of £5.61 for all of the other funding in this year’s specification put together (excluding the care home premium, which is not going to significantly alter the figures).

The funding is not, however, given as a lump sum.  It is paid a month in arrears based on the actual expenditure made by the PCN.  A PCN must, “complete and return to the commissioner a workforce plan, using the agreed national workforce planning template, providing details of its recruitment plans for 2020/21 by 31 August 2020 and indicative intentions through to 2023/24 by 31 October 2020” (6.5.1 Network contract DES Specification, p36).

We are currently at the end of May.  Assuming a PCN has not yet employed any additional staff (although I know some have, many have not), our 50K weighted population PCN now has funding for 9.3 additional roles.  If the PCN waits until the end of August (the deadline for submitting its plan), it will have funding for 11.6 additional roles.  The longer we go into the year, the harder it is going to be to spend the money.  Once we are over a third of the way in next year’s funding is unlikely to cover the incurred recurrent expenditure even if we do manage to spend it all.

Any money allocated to a PCN that can’t be spent will be offered to “other PCNs within the commissioner’s boundary”.  So a smart PCN will not only be well into planning how to use its ARRS funds, it will also be looking at its neighbouring PCNs and working out whether they going to be able to use all their funding and preparing accordingly.

This year, impacted already by covid as it has been, does present general practice with something of an opportunity when it comes to ARRS.  In effect there is 12 months funding available for 6 months of work, because the requirements of the specifications only start on October 1^st.  The argument has been that the roles should be supporting core general practice, not simply carrying out additional work mandated by the PCN DES.  Well it may or may not be by design, but that opportunity is certainly there now for this year for PCNs.

The question, then, is how should PCNs respond?  With such a wide array of roles (10 in total) available, what roles should PCNs be prioritising?

Let’s take the work to meet the requirements of the specifications as a given, and focus on what to do with the roles beyond that.  The specifications are not going to require all of the ARRS funding, and certainly will not this year.  Once the specification requirements are met, it seems there are two ways to think about how to use the new roles.

The first is to focus on the roles that will free up the most GP time.  The biggest challenge in general practice for a long time now has been GP workload, and so it would be logical to use this funding on the roles that most directly reduce GP workload.  This would lead to a focus on first contact physiotherapists, physician associates, pharmacists and (next year) paramedics, as roles that can directly have this impact.

The second is to focus on the roles that can change the shape of demand into GP practices.  Instead of reacting to the incessant rise in demand on practices, this may be an opportunity to do something about it.  A team made up of some combination of social prescribers, health and wellbeing coaches, occupational therapists, dietitians, podiatrists and care coordinators may be able to start with the currently shielded and housebound patients, and prepare a PCN for the anticipatory care and personalised care specifications that are on their way in future years.  By proactively meeting the needs of those patients who are the biggest drivers of demand on PCN practices, the constantly rising demand may be slowed.

These two approaches are not mutually exclusive.  It may be that some combination to the two is what is needed locally.  And of course there may be others.  What is important for PCNs is to be clear on what they are trying to achieve with the new roles, before they start deciding which specific roles they want to employ.

It is rare that general practice finds itself with an opportunity like this, backed up with such significant resources.  I very much hope we make the most of it.