Analysis of board papers by GPonline shows that some CCGs were unable to spend as much as two thirds of their additional roles reimbursement scheme (ARRS) allocations in 2020/21.
Barriers to recruitment, such as a lack of time during the pandemic and a shortage of suitable staff to recruit means that networks - established in 2019 - have hired fewer recruits than they would have expected at this stage. The shortfall could in turn trigger a further loss of income if understaffing threatens PCNs' capacity to meet PCN service requirements.
GPonline warned in February that networks in England were on track to lose up to a fifth of their recruitment funding - but figures from CCG board papers show that in many areas the shortfall for 2020/21 is far greater.
PCN recruitment scheme
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 additional roles reimbursement scheme (ARRS). On average, each PCN was expected to hire approximately 12 additional full-time equivalent (FTE) staff in 2020/21, with this total rising to 21 by 2024 - but funding for the scheme must be spent in-year.
NHS England has said 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.
However, papers published by Sussex NHS Commissioners in March show that the area's three CCGs - Brighton and Hove, East Sussex and West Sussex - were expected to record a combined underspend of 65% (£8m) in 2020/21 - claiming only £4.5m out of a total £12.7m budget - as recruitment fell short.
The projected underspend and delays in recruitment were due to ‘constraints on recruitment due to estate and digital capacity’ and a ‘scarcity of supply affecting many roles’. It also noted that the COVID-19 vaccination programme had ‘increased workload and stress’ - impacting the ‘appetite to recruit’.
The document also revealed that there were set to be 307 fewer FTE ARRS roles in post at 31 March 2021 than planned across the three CCGs.
A similar situation was reported in Kernow, Cornwall, where documents published by the CCG in June this year revealed a total ARRS underspend of £1.4m for 2020/21 - equating to around 30% of its overall recruitment budget for the scheme of £4.4m.
Officials said recruitment to additional roles was ‘significantly’ affected by primary care’s need to ‘prioritise work to support the pandemic’ from March 2020. It also said there was ‘significant variation’ between PCNs in the area, with two only accessing around 20% of available funding.
Underspending was also reported in a number of other CCGs across the country, with Warwickshire North CCG board papers published earlier this year revealing PCNs were expected to use 56% of their allocation. Similarly, Heywood, Middleton and Rochdale CCG, in Greater Manchester, reported in September this year an underspend of 48% for 2020/21 - meaning they would miss out on roughly £1.4m.
Although official statistics show that PCNs' patient-facing workforce rose by 40% in the last quarter of 2020/21, GPs have continued to demand more flexibility over eligible roles in the future to ensure they can take advantage of the available funding.
Clinical directors have also recently called for a 'triple lock' on ARRS budgets to ensure that the overall ARRS spending budget increases along with rises to minimum NHS pay rates, national insurance and inflation. Without this, PCNs could be forced to hire fewer staff.
A report published by the NHS Confederation's PCN Network in August found that staff hired through the multi-million pound scheme had brought ‘little reduction in GP workload in the first instance’, with ‘most patients’ referred to ARRS staff by a GP.