GPonline reported last week that seven-figure sums available through the additional roles reimbursement scheme (ARRS) in 2020/21 went unclaimed, with CCG board papers suggesting that some areas would struggle to spend even a third of their allocation.
NHS England has previously suggested that surplus funds could be claimed by other PCNs within the same CCG area where recruitment was going well. But it remains unclear what happens to the tens of millions of pounds unclaimed nationally - with NHS England failing to provide clarity.
The BMA has called on healthcare leaders to ensure that funding available through the ARRS is not lost to general practice completely - and to increase the flexibility of the scheme to help networks draw down on this money in the future.
Primary care recruitment
It comes as clinical directors called for a ‘triple lock’ on ARRS budgets to ensure that overall PCN recruitment funding increases alongside rises to minimum NHS pay rates, inflation and national insurance.
Board papers seen by GPonline show that groups of PCNs and CCGs were predicted to underspend by between 20-50% of their recruitment budgets for 2020/21 - resulting in huge piles of cash that was intended to help tackle the GP workload crisis sitting unclaimed. BMA executive team member Dr Krishna Kasaraneni described this as ‘very concerning’.
He said: ‘We know a lot of PCNs and practices have found it difficult to recruit for a variety of reasons, but not through lack of trying. Some PCNs can’t access the people they need because they simply aren’t there and some can’t because the funding doesn’t go far enough.
‘We need the funding to be as flexible as possible so that it can be spent in the most effective means. If it can’t be spent because PCNs are unable to recruit, then we need the funding to be retained within general practice for PCNs to spend on delivering services to patients.’
Funding flexibility
Dr Kasaraneni, who has previously called for increased flexibility around the recruitment scheme, explained that rolling over the unspent funding into recruitment budgets for 2021/22 could be ‘problematic’ - causing even greater underspends in future years.
He added: ‘[The money] should be retained within PCNs or general practice, with practices deciding on the best use of it to provide the most effective support and services to cater to the needs of their populations.
‘While GPs and healthcare staff are working tirelessly that cannot go far enough in a system that is under-resourced. It is very important that underlying issues such as chronic understaffing of GPs, practice staff and nurses is addressed so that patients can get the access and care they need.’
A total of £430m was available to PCNs in 2020/21 - around £344,000 per network - to recruit staff from a list of 10 roles through the recruitment scheme. Each PCN was expected to hire approximately 12 additional full-time equivalent (FTE) staff in 2020/21 on average, with this total rising to 21 by 2024 - but funding for the scheme must be spent in-year.
Workforce planning
NHS England has said that the recruitment funding would give a 'major boost' to multidisciplinary teams in general practice, with ARRS staff helping to take pressure off GPs and allowing them to focus on patients with more complex needs.
Responding to large recruitment underspends for 2020/21, NHS Confedaeration's PCN Network director Ruth Rankine said: ‘We have been in discussion with NHS England on this issue and have sought reassurance that the money is ring-fenced for PCNs.
‘Many PCNs have found innovative approaches to filling roles where they have struggled with recruitment through, for example, use of clinicians employed by a third party and working remotely. [But] we do know it still remains a challenge for many PCNs and we have been encouraging ICSs and CCGs to support PCNs with workforce planning and recruitment.’
NHS England was approached for comment.
