Burnout warning over plan to ask PCN staff to work more hours in pandemic

Plans to ask primary care network (PCN) staff to work longer hours during the pandemic could put them at risk of burnout - and won't solve capacity problems in primary care, GPs have warned.

Photo: Adam Smigielski/Getty Images
Photo: Adam Smigielski/Getty Images

NHS England officials confirmed last week that PCNs could use unspent funding from the additional roles reimbursement scheme (ARRS) to pay existing staff for taking on extra hours.

However, PCN clinical directors have warned the extra flexibility does not go far enough - calling for flexibility to bring in a wider range of staff to ease workload pressures, potentially including locum GPs, rather than burden existing staff already fatigued from working through the COVID-19 pandemic.

GPs have called repeatedly for more flexibility around the £430m in funding available through the ARRS in 2020/21. GPonline has reported that practices risk losing out on millions of pounds because PCNs have simply not had time during the pandemic to make full use of funding to recruit staff such as pharmacists, physios and occupational therapists available through the scheme this year.

GP workforce

The NHS England update last week said: 'A PCN may use its additional roles reimbursement sum to reimburse extra hours worked by PCN staff, at plain time rates only, as long as the increase in whole-time equivalent (WTE) hours worked is clearly recorded on the PCN’s claim form and National Workforce Reporting System.'

The update came as BMA chair Dr Chaand Nagpaul warned this week that general practice workload is out of control - telling MPs that working during the pandemic had driven up numbers of clinicians experiencing fatigue.

GPonline has previously reported that practices risk losing out on millions of pounds of funding if they fail to recruit additional staff. GPs leading PCNs say they have not had the headspace to recruit and train staff during the pandemic, while some roles have been difficult to hire.

Although GPs were encouraged by the flexibility shown by NHS England to allow practices to make use of funds, they said that more could be done to boost capacity and take some burden off staff.

Primary care capacity

Watford GP Dr Simon Hodes agreed that ‘any movement towards more flexibility was good’, but insisted actions that helped to bring in new staff would be more beneficial.

He said: ‘Using existing staff may not be the answer [to creating extra capacity] because people are often at their limits in what they are doing. People have been working hard and they are stressed. And actually the “a” in ARRS does stand for additional, so you really do want to increase the members on the team.

‘And I think what a lot of people are calling out for now is to use recruitment funding to cope with winter pressure or pay for GP locum time… even if it frees up partners or permanent doctors to have some headspace to do management stuff would be a good thing. Any flexibility is good, but full flexibility would be better.’

Clinical director of Central and Thistlemoor PCN in Peterborough Dr Neil Modha said: ‘It’s helpful. I think what general practice needs is as much flexibility around the ARRS as possible, and so allowing existing staff to do more hours is really helpful. For people like pharmacists, that will make a tangible difference.

Additional roles

‘But for me it’s about having even more flexibility. So when I look at next year’s list and I see paramedics, mental health workers and people that can make a meaningful, clinical difference [but cannot be hired through the scheme this year] it’s frustrating.’

Dr Modha warned that burnout was a ‘real worry’, adding he was mindful of having to protect staff during the second wave of the pandemic - and ahead of a potential COVID-19 vaccine roll-out.

‘Bringing in a new workforce rather than asking people that are already often working near full time to do more hours would make a big difference,’ he said.

Analysis from LMCs recently showed that the pandemic has added 50 hours a week to overall GP workload per average practice, while four in five GPs believe the rise in workload is ‘unsafe for patient care’. Statistics also show that general practice teams continue to deliver more than 2m in-person appointments per week.

GP leaders will argue at a BMA conference next week that NHS England should increase flexibility to allow recruitment funding to be used to employ locums and practice nurses. At present PCNs can use ARRS funding to recruit from a list of 11 roles in 2020/21, with NHS chiefs adding chief nursing officers and nurse associates in August after calls for increased flexibility.

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