In evidence to the House of Commons health and social care committee's inquiry into the future of general practice this week, Beccy Baird, senior policy fellow at The King's Fund, also warned that deprived areas were struggling to recruit, leaving networks in some parts of the country competing with each other to hire new team members.
'One of the issues around the additional roles reimbursement scheme is that it's not weighted for deprivation,' Ms Baird told MPs. 'And so you might see more need in places, and not only are they not necessarily funded as much, but it's also harder to attract the roles in those places. And I think that's important to really pay attention to.'
She added: 'In some areas you see PCNs competing with each other for these roles. We've got a lot to do more generally to unpick financing, particularly so that it reflects deprivation – and it doesn't do it well at the moment.'
Earlier this year the committee also heard evidence that the GP funding formula was perpetuating health inequalities. In March, GP and senior policy fellow at the Health Foundation think tank Dr Becks Fisher told the inquiry that the GP funding formula was the 'root cause' of underfunding for general practice in deprived areas.
Ms Baird, who led the research for a DHSC-commissioned report published earlier this year that was highly critical of how the ARRS had been rolled out, also told MPs that lack of funding for supervising ARRS staff was also creating challenges for PCNs.
She said: '[Supervision] is very variable and it's not funded. The ARRS funds staffing costs that funds the National Insurance and the salaries of staff, but it doesn't pay for supervision. So it requires either a GP's time or, in some places, they're using professionals from other places.
'But the GPs need to have the headspace to do that supervision, to have the time to answer the queries.'
Support for PCNs
Ms Baird argued that investment in HR, change management and organisational development support was essential if the ARRS was to succeed.
'When people are stressed and don't have the headspace to really think about the change management, the redesign of processes, how is this actually going to work?' she said.
'That's when it falls down. And our findings in the report are very much if we don't invest in that kind of stuff – the leadership, change management, the HR the organisational development – the money is in danger of being wasted because they're not satisfying jobs. People get thrown into the deep end, it's fragmented, it doesn't work. people get frustrated.'
She added there were shortages of staff across all roles, so 'making what we've got work well seems absolutely critical'.