PCN funding worth millions at risk as rising GP workload hits recruitment

GPs fear millions of pounds in primary care funding could be lost because rising workload in general practice has left primary care networks (PCNs) struggling to recruit.

PCN funding at risk (Photo: John Lamb/Getty Images)
PCN funding at risk (Photo: John Lamb/Getty Images)

The additional roles reimbursement scheme (ARRS) offers £430m in 2020/21 for PCNs to recruit staff including pharmacists, physios and occupational therapists.

But clinical directors leading PCNs say they are behind on recruitment plans because of COVID-19, a surge in workload in recent months and the prospect of an expanded flu campaign and catch-up work on other vaccinations. GPs in clinical director posts told GPonline they do not have the ‘time nor the headspace’ to recruit staff due to heavy workload.

Face-to-face GP consultations rose more than 70% by mid July compared with the early stages of lockdown. NHS England has urged GP practices to 'make rapid progress' on childhood immunisation and cervical screening backlogs and to start work on PCN service specifications - and practices are now preparing for the largest flu programme in history.

PCN recruitment

Some PCNs say they are struggling to recruit to certain roles because of a shortage of available staff - with practices forced to top up wages beyond the pay scales offered throuth the ARRS to try to attract applicants. Retaining staff already recruited through the ARRS has also been identified as a challenge.

Speaking at a NHS Confederation conference last week, NHS England deputy medical director Dr Raj Patel admitted that PCN recruitment had been ‘difficult to achieve’, but insisted it should remain a priority.

However, clinical directors have argued that COVID-19 disruption and a growing task list is preventing them from pressing ahead with recruitment.

Clinical director of Newham 1 PCN in London Dr Farzana Hussain said she was concerned that her network would lose funding to other, more mature PCNs in the area.

GP workload

‘Quite honestly, we just haven’t had the time nor the headspace to recruit to additional roles. We know what we want, we’ve filled in our workforce template and submitted it to our federation, but we haven’t even started the recruitment process,’ she said.

‘The only roles we are currently recruiting to are the first contact physio and a social prescribing link worker, but we have so many more. I think we’re a bit behind as a lot of others have started that,’ she added.

Dr Hussain said her network would recruit a first contact physio (FCP) through a community trust because this would assist with appraisals and training. She suggested her team could struggle to retain staff without support, having lost a link worker already.

‘We are a bit concerned about how we are going to embed these people - who is going to do the training because there is no extra money for all of this. The last thing we need is, a year from now, we had all these roles and they all walked away, because that’s worse than not having them at all,’ she said.

Pharmacist shortage

Clinical director of Abbey Health PCN in Hertfordshire Dr Mike Smith told GPonline that his network had been unable to hire a clinical pharmacist despite three attempts. He was worried about missing out on funding, saying his network would have to supplement pharmacist wages by 30-40% to recruit.

A recent report by NHS Confederation found that recruitment failures were exacerbating workload pressures on PCNs, especially in London. It called for further flexibility around which roles PCNs can hire to - despite NHS England widening the list earlier this year.

COVID-19 has also affected recruitment plans, he said: ‘The first contact physiotherapy role has now had to have a rethink because of the changing nature of how people are presenting in general practice during the pandemic.

‘The FCPs are having to relearn what they do in terms of virtual and video consultations, which has been difficult for us. So we’ve had to pause our arrangement with our arrangement with our FCPs and the provider we are seconding them from.’

Career progression

Clinical director of Central and Thistlemoor PCN in Peterborough Dr Neil Modha said his network had been able to recruit staff, including multiple pharmacists and link workers.

However, he agreed that retaining staff could be a difficult task with network leaders facing high workloads. ‘For me, the benefit of this DES is the long-term workforce and so anything that causes the workforce to move along or impacts on that is obviously quite difficult,' he said.

‘You have to think through how you make it a job that is meaningful for the individual and how they are supported in the practices. That’s probably one of the most important ingredients, [making them] feel they have some sort of career pathway.' he added.

Almost a third of link workers admitted they could quit over a lack of support that has deepened in the COVID-19 pandemic, according to a recent National Association of Link Workers survey.

Health bosses have previously encouraged networks to make use of ARRS monies to expand their teams or risk losing funding. 

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