Flawed pay weighting scheme hits primary care recruitment in London

Primary care networks in London are being forced to recruit fewer staff or to ask member practices to top up funding because of a flawed pay weighting scheme, GP leaders have warned.

London recruitment concerns (Photo: Shomos Uddin/Getty Images)

Following changes to the GP contract for 2021/22, PCNs in London are able to offer salaries in line with inner and outer London weighting to staff employed via the additional roles reimbursement scheme (ARRS).

The move is aimed at boosting recruitment in the capital after clinical directors argued inflexible wage bands were causing networks to miss out on potential recruits, with other employers able to offer more money.

But Londonwide LMCs chief executive Dr Michelle Drage has warned that because there was no increase to London PCNs' budgets alongside the pay weighting flexibility, networks have been left to choose between recruiting fewer staff than their counterparts elsewhere in the country, or funding the top-ups out of member GP practices' pockets. 

PCN recruitment

Clinical directors have told GPonline that the current system is ‘unhelpful’ and has caused them to miss out on hiring a full range of ARRS staff - forcing them to prioritise roles they need most urgently.

A total of £746m is available to PCNs in 2021/22 - around £600k per network - to recruit staff from a list of 10 roles through the ARRS. The average PCN is expected to employ around 21 extra staff by 2023/24 - and this additional workforce is intended to play a key role in easing chronic workload pressure on primary care.

But polling of 220 clinical directors carried out by Londonwide LMCs in May found that almost three quarters believed London weighting measures were a ‘barrier’ to recruitment, while 40% said retaining ARRS staff was a ‘challenge’.

Although measures have been introduced to ensure London PCNs can offer higher wages to reflect the higher cost of living in the capital, clinical directors explained a lack of additional funding to compliment the changes had left them facing tough choices.

London practices

Dr Drage said: ‘Living and working in the capital is costlier than in most other parts of the UK, and paying staff below the agreed rate for their work is unacceptable.

'So London’s GP practices and PCNs are faced with the triple whammy of either paying the going rate for staff and consequently recruiting fewer, or diverting resources from other services to top up wages, or paying for staff out of their own personal incomes.

'Most are choosing the former option in order to not let down patients or staff who have worked heroically through the pandemic.’

She added: ‘With the assumption that the continued management of COVID-19 and long COVID in the community and the backlog of patients who have held off seeing their GP through the pandemic will rely on doctors, nurses and other allied health professionals being in post and ready to help, it is essential that we untie the hands of practices and their PCNs.

Staff training

‘To sustainably provide this care to patients and communities, PCNs need to be fully staffed and member practices financially stable.’

Dr Richard Van Mellaerts, a GP in Kingston, Greater London, told GPonline that his network qualifies for outer London weighting. He said: 'Unfortunately it comes out of our ARRS allocation, so we end up recruiting fewer people if we use it. This is unhelpful.'

Patient-facing staff working in PCNs rose by 40% in the last quarter of 2020/21, according to official figures, which suggest networks had 5.7 full-time equivalent (FTE) staff on average.

PCN clinical directors have also called for additional funding to ensure they can properly train and integrate ARRS staff - warning that practices are not funded to backfill time spent by GPs out of clinical sessions.

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