GPs demand 'triple lock' on ARRS budgets as unfunded pay rise threatens recruitment

PCNs will be unable to hire the staff they need to support general practice because their budgets have not risen to reflect increased NHS pay rates, GPs have warned.

PCN budget warning (Photo: Milton Cogheil/EyeEm/Getty Images)
PCN budget warning (Photo: Milton Cogheil/EyeEm/Getty Images)

NHS England has confirmed maximum reimbursement rates for each role under the additional roles reimbursement scheme (ARRS) will be uplifted to reflect the 3% uplift to NHS pay from April this year.

However, officials have confirmed the change will not affect the ‘overall value’ of PCN recruitment funding. GP leading networks have warned the failure to increase PCN recruitment budgets in line with the pay rise means they will be forced to hire fewer staff.

GPs have warned reduced staffing will undermine support for general practices from PCNs - and have called for a 'triple lock'-style agreement to ensure budgets are topped up. The triple lock - a mechanism introduced to protect the value of the state pension until its suspension earlier this month - protected pensions by keeping them in line with the highest of three key factors - inflation, average wage increases or a 2.5% baseline. 

PCN staff wages

Concerns over the failure to hike PCN budgets echoes a warning from PCNs in London that they were being forced to recruit fewer staff or to ask member practices to top up funding because a pay weighting scheme for the capital had not come with additional funding.

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, who are intended to play a key role in easing chronic workload pressure on primary care.

The decision by NHS England to increase wage bands without increasing overall PCN recruitment funding has left GPs fearing that underspends built up through efficient management of networks will now be ‘eaten up’ by increased pay rates for ARRS staff.

Dr Richard Van Mellaerts, a GP in Kingston, Greater London, told GPonline that funding attached to recruitment scheme had to be fluid. He said: ‘The total ARRS budget needs to keep pace with recommended pay increases, national insurance, and other such factors, or else the total value is degraded over time.

Recruitment funding

‘It already needs to be supplemented to attract suitably qualified people for the roles and with the increasing complexity of the IIF these roles are vital. There needs to be a triple lock-like arrangement where the value of the fund increases depending on surrounding factors.’

Director of primary care Ed Waller told GPs during a webinar last week that the changes would not affect how much each PCN was allocated as a budget to spend under the ARRS, but said it would allow them to offer higher wages, or give out pay rises.

Clinical director at Whitewater Loddon PCN in Hampshire Dr Tim Cooper said: ‘The ARRS is a force for good in general practice, but we need much more flexibility in its deployment. Ultimately, it’s about delivering the best possible care for patients but being bound by rigid workforce rules hinders us at times.’

Dr Cooper added that his network had struggled to hire mental health staff through the ARRS, arguing greater flexibility was needed. He said: ‘I would love a national discussion about the deployment of ARRS funding to support patients, regardless of whether they fit the typecast role as described in the DES'.

Polling of 220 clinical directors carried out by Londonwide LMCs in May found that almost three quarters believed measures to expand the wage limits of staff hired through the ARRS were a ‘barrier’ to recruitment.

Last month NHS England announced that PCN service requirements would be gradually phased in over the next 18 months - with just two beginning from October this year. Practices have also been given an additional £43m to support PCN management.

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