The additional roles reimbursement scheme (ARRS) - worth more than £3.5bn in total over four years from 2020/21 to 2023/24 - underpins a recruitment drive described by NHS England as 'foundational to all other goals' for general practice.
The scheme aims to deliver an extra 26,000 full-time equivalent (FTE) additional roles staff to practices by 2023/24 - and is intended to fund seven staff per PCN in 2020/21, rising to around 21 in the last year. Funding was first provided to practices in July 2019.
But GPonline analysis of NHS Digital workforce data from 82% of England's 1,255 PCNs suggests that only 12,059 full-time equivalent (FTE) staff - equivalent to 9.6 staff per network - had been brought in by the end of December 2021.
PCN recruitment scheme
Although data suggest that in headcount terms, the ARRS had brought in 13,342 people by the end of last year, the FTE total indicates that just 46% of the overall staff target have been hired at the halfway point in the five-year GP contract deal.
The missed recruitment target comes as GPonline analysis of offical data showed that GPs in England's most underdoctored CCGs are caring for nearly twice as many patients as their counterparts in other areas of the country.
A total of £746m in ARRS funding is available in 2021/22 - roughly £597,000 per PCN. Although NHS England has not specified a total number of staff that should be in post at this stage, the funding available suggests networks should be aiming for around 12 FTE staff on average in 2021/22.
But with three months left of the recruitment window at the time of reporting, official figures suggest that PCNs are two FTE staff members short of their full allocation - with most networks having recruited 10 FTE staff by December 2021.
Additional roles staff
Figures for the 82% of PCNs that provided data show that they have recruited 2,923 FTE pharmacists, 1,612 social prescribers and 1,108 care coordinators, which are the roles with the highest number of recruits. A total of 538 admin and non-clinical staff have been hired and around one in three networks have recruited a PCN manager.
NHS Digital has told GPonline that it is unable to provide a true figure of the number of ARRS staff that have been recruited, with no data available from a fifth of PCNs.
RCGP chair Professor Martin Marshall warned last month that progress towards the government's 26,000 recruitment target was 'slow and very concerning' - adding that efforts needed to be 'stepped up' to meet the ARRS target.
Responding to the latest figures on PCN recruitment, Professor Marshall said: 'It’s great to see that around 12,000 people recruited so far through the ARRS scheme, but these figures are further evidence that efforts need to be urgently stepped up to catch up and meet the target of 26,000 members of the wider general practice workforce by 2024.
General practice workforce
'We’re all working flat out delivering care to increasing numbers of patients, with increasingly complex health needs, and we need the whole practice team in order to do this. We need the government to make good on its promise of 6,000 GPs and 26,000 members of the wider practice team by 2024 – and to tackle parallel workforce pressures facing practice nursing teams, which aren’t included in this target - to ensure patients can continue to receive high-quality and personalised care from their GP practice.'
BMA England GP committee executive officer Dr Richard Van Mellaerts, said: 'The additional staff promised by the ARRS were hoped to spread the workload burden, ease demand and improve access for patients, connecting them with the right professional. However, none of these goals can be achieved if the roles cannot be filled.
'We know ARRS recruitment has been varied across England, be this due to a shortage of suitable candidates or factors that already contribute to areas being under-doctored – therefore exacerbating rather than addressing health inequalities.
'It’s clear that the overly prescriptive nature of the scheme, based on a one-size-fits all group of roles is not benefiting practices or patients locally. Staff types should be based on practice and patient needs, and the BMA continues to push for more flexibility within the scheme, both in terms of roles themselves and the associated workload requirements.
'Furthermore, if money ring-fenced for this scheme is not being used due to lack of recruitment, this should be utilised in as permissive a way as possible to support practices in providing care for patients during these most challenging of times.'
Prominent London GP Dr Farzana Hussain, who recently quit her role as co-clinical director, warned this week that the list of roles networks can recruit to is too restrictive - adding GPs were ‘being run ragged’ by a lack of support.
Senior fellow at health think tank the King's Fund Beccy Baird has also argued that general practice and PCNs need more support to integrate additional roles staff into multidisciplinary teams - and the roles may need to change to boost recruitment.