GPs demand flexibility and support as £430m additional roles cash drives PCN recruitment

PCNs' patient-facing workforce rose by 40% in the last quarter of 2020/21 as £430m from the additional roles reimbursement scheme (ARRS) drove recruitment, official data suggest - but GPs have warned that more flexibility over eligible roles and funding to support training new staff is vital.

NHS England has yet to reveal what proportion of £430m available to PCNs through the ARRS in 2020/21 was claimed - but official data suggest staff employed by networks rose rapidly in the last quarter of the financial year.

Meanwhile, PCN clinical directors in several parts of England told GPonline they had managed to make use of most of their funding allocation for 2020/21 - including some in areas that had previously expressed concern that a lack of available staff and headspace could see millions in funding lost.

However, primary care leaders have repeated calls for NHS England to increase flexibility around the staff they can hire through the additional roles scheme - and warned that additional funding is essential to cover the cost of senior primary care staff taking time to train new recruits brought in by PCNs. GPs say practices have also had to 'top up' funding to recruit staff in some areas.

GP workforce

The BMA has also warned that recruiting staff through PCNs to support primary care will ‘not solve the current crisis in general practice alone’.

Despite this, GPs leading networks have said that staff recruited through the additional roles recruitment scheme (ARRS) have helped practices to run successful COVID-19 vaccination campaigns - and eased workload.

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 ARRS. Official data are not complete because only around two thirds of PCNs have reported on staff numbers - but the latest figures suggest that recruitment to patient-facing roles in PCNs has increased rapidly.

Figures for March 2021 suggest that PCNs had 5.7 full-time equivalent (FTE) staff in roles involving direct patient care on average - with the headcount figure significantly larger because most are employed on a less-than-full-time basis.

Primary care networks

This was up nearly 40% compared with the 4.1 FTE staff per PCN recorded in data for December 2020 - although NHS Digital cautions that the data may not be reliable because a significant proportion of PCNs have yet to report figures.

The BMA has confirmed that the majority of practices have now recruited at least one social prescriber, clinical pharmacist and a first contact physiotherapist.

Clinical director of Kingston PCN in London Dr Richard Van Mellaerts said his network had managed to use almost all of its recruitment funding for 2020/21, but admitted they had encountered some problems. He said: 'We’ve been fortunate to be able to recruit well, but I think that the one-size-fits-all mechanism is too inflexible and doesn’t necessarily speak to every practice and PCN’s needs.

‘There is no doubt that bringing in allied healthcare staff has given a massive boost to the PCN and to the practices…and they have been able to offer really good support for our patients and our colleagues in the practice, and specifically in the context of the vaccination programme.

GP funding

‘But we’ve done probably what most PCNs have done [and] we’ve topped up the wages a bit to attract people in, which is a necessary evil to get the best people into these posts… they also need a lot of support.'

Clinical director of Manor View Pathfinder PCN in Watford Dr Ketan Bhatt praised the role played by incoming staff, but highlighted a lack of investment around supervision and training. He said: ‘[The incoming staff] have been excellent…lots of them have got involved with the vaccination programme, one of the paramedics and a couple of the pharmacists, and they’ve felt very much part of the team.

‘But there should also be financial support around training and administration...which is not currently recognised. It’s very easy to say, “right, let’s go and get this member of staff and that will fix that problem”. But it’s the other work that needs to go along with it.’

He added that if staff were not properly trained and supervised they ‘won’t understand systems’ and ‘will probably leave’. BMA GP committee executive team member Dr Krishna Kasaraneni told GPonline that additional staff recruited through the ARRS had boosted general practice capacity, but acknowledged continuing hiccups.

Flexible roles

‘This year practices were able to recruit further roles which we hope will further support PCNs and allow GPs to focus on the patients who need them most, especially at a time when practices are facing unprecedented levels of workload. PCNs also want and need the flexibility to use the ARRS funding to recruit the roles that best meet the needs of their practices and local populations.

‘Ultimately, however, while we hope that expanding the practice team will alleviate some pressure on workload, it will not solve the current crisis in general practice alone – not least because these roles come with additional work that PCNs are expected to deliver as part of the DES.’

Senior clinical advisor at the NHS Confederation Dr Graham Jackson, said: ‘The recruitment of additional roles by PCNs this year has been very successful, despite the difficulties presented by the pandemic and some understandable variance among PCNs and between different professions.

‘This additional workforce has been essential, particularly during the vaccination programme, providing a boost in capacity, more flexibility and new ways of providing primary care services.

‘Among the challenges we have now are to ensure that PCNs are sufficiently supported to adapt how they deliver services in order to optimise the use of these additional roles in providing the best possible care to their populations, including support to adequately train and supervise their staff.

‘As PCNs mature, we will also expect to see greater flexibility in the roles they can recruit to enable them to better shape services based on the needs of the populations they serve.’

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