£3bn PCN cash should be redirected into core practice funding, say GPs

More than £3bn from the additional roles reimbursement scheme (ARRS) should be added to core practice funding to ensure it is not lost to general practice and to cut bureaucracy, GPs have warned.

A selection of one pound coins
Call to redirect PCN cash (Photo: John Lamb/Getty Images)

More than £3bn is available through the recruitment scheme between 2021/22 and 2023/24 - but GPonline reported in September that vast amounts of funding from the ARRS went unclaimed in 2020/21 - and could be completely lost to the profession despite the current workforce crisis.

GPs have previously warned that restrictive measures around recruitment and a lack of available talent are the main drivers behind the unclaimed cash - a problem the BMA has described as ‘very concerning’.

Some GPs leading PCNs are warning that the funding should be moved into the core GP contract to avoid it being wasted - and to allow networks more flexibility to employ the staff they need.

ARRS funding

The suggestion comes as GPs prepare to debate a motion at next week's LMCs conference for England that warns the PCN model is a ‘Trojan horse’ that threatens the independent contractor model of general practice - and calls for PCN funding to be redirected into the core contract.

Kingston PCN clinical director and GP partner Dr Richard Van Mellaerts said his network had recruited well so far, but argued it would become more difficult to attract staff over the next few years unless rules around the ARRS funding changed.

He said: ‘The strictures placed by the PCN DES are becoming a straight-jacket for PCNs, largely in terms of the fact that we cannot recruit nurses and doctors - and actually, those are the types of clinicians that would make the most difference at the moment.

‘The advantage of putting recruitment funding straight into core is that you actually cut out a vast amount of bureaucracy, and a vast amount of hoops that PCNs have to jump through consistently to access the funding. It creates a whole industry of work that doesn't ever benefit patients.

Primary care recruitment

‘Recruitment is going to become more difficult because we've already recruited the majority of people who are enthused to be recruited into general practice roles. If we could move funding into core and allow practices more flexibility, it would cut down dramatically and immediately on bureaucracy and benefit practices immediately.'

Clinical director of Whitewater Loddon PCN (Hampshire) Dr Tim Cooper agreed that shifting ARRS funding into core would benefit networks. He said: ‘The shift would allow us to develop our PCN administrative function, governance and permit us to get the right roles for our PCN workforce.

‘I still see the ARRS funding as too prescriptive, it doesn’t allow local knowledge and lateral thinking, such as working with the voluntary sector, to help support the workforce. It also unintentionally creates another market, with networks looking to hire to the same roles.

‘I think the scheme has brought significant value into general practice, but it could do a lot more. Flexibility and autonomy are what have preserved general practice up until this point and it would be wise to allow PCNs to adapt into their space.’

Primary care transformation

Other clinical directors, however, have challenged the idea, arguing that collaboration could suffer and partners may be less keen to invest in joint ventures. Clinical director of Stort Valley and Villages in Essex Dr Sian Stanley, said: ‘If you’re looking at true transformation in primary care, I think you have to take it away from core.

'I understand why NHS England and Improvement have done it, but I don’t think they’ve done it particularly well. I think they have made it too bureaucratic and too prescriptive by saying you can only have certain roles. But I don’t know how many practices would be altruistic enough to invest in things that didn’t necessarily benefit them if it was put into core funding, but a PCN forces them to.’

BMA GP committee England executive team member Dr Krishna Kasaraneni told GPonline that, where funding cannot be spent, it should be 'retained within general practice so PCNs can use it flexibly in the way that suits their needs best'.

GPonline reported in September that CCGs were unable to spend as much as two thirds of their ARRS allocations in 2020/21, with one group of CCGs managing to spend only 40% of their annual budget.

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