Under the additional roles reimbursement scheme (ARRS), PCNs have been supported to recruit two staff in 2019/20 - with 70% reimbursement for the cost of a clinical pharmacist and 100% for a social prescribing link worker.
Funding can be claimed as soon as staff are in post - but analysis by GPonline suggests at least an eight-figure sum available for additional roles in the current financial year will not be claimed by PCNs.
A BMA survey of 213 clinical directors completed in October and November 2019 shows that 26% of PCNs had not received reimbursement for either of the additional roles staff. This is halfway through the nine-month period in which networks - which went live in July 2019 - will be operational during the 2019/20 financial year.
Total funding available to PCNs in 2019/20 for additional roles is worth around £70m - but the BMA poll suggests that with one in four networks failing to claim any of this in the first half of the year, at least £9m has been lost - while many more PCNs have not recruited to one or other of the roles.
Close to two thirds (64%) of clinical directors responding to the BMA survey indicated that their network was not receiving reimbursement for the social prescriber role, while 59% said they had not made use of funding to appoint a clinical pharmacist.
With just 98% of PCNs having less than 100k patients, the vast majority of practices are entitled to claim back a total of £53,942.25 for additional role salaries during 19/20. This means the total reimburseable money pot for additional roles in the first year by all PCNs is around £70m, which equates to £7.8m per month.
PCN leaders said that difficulty recruiting additional staff was due to a ‘limited availability of sufficiently trained or qualified candidates’. They also highlighted insufficient funding for activities linked to the management, development and training of these additional roles.
A recent Twitter disucssion about PCNs and the primary care workforce revealed that clinical directors were still struggling to recruit, two months after the BMA conducted its survey, with one GP saying networks were all ‘fishing from the same rather reduced pool’.
BMA GP committee chair Dr Richard Vautrey said: ‘It’s clear that many PCNs are finding the process of recruitment challenging. These survey results add to the findings of the NHS England and NHS Improvement service specification consultation, so it’s imperative that the necessary support is provided to PCNs to enable them to fulfil their potential and help to relieve pressure on overstretched practices.’
The Leeds GP recently admitted that recruitment to additional roles would be the acid test for PCNs in 2020, explaining they would be crucial to networks' efforts to carry out service specifications.
‘We know that it's challenging, we know that recruiting in some parts of the country is going to be easier than in others. But we hope that CCGs can work with their networks to provide recruitment support and maybe, where it is really difficult to recruit, support from other healthcare providers,’ he said.
Primary care networks
The PCN draft service specifications were published before Christmas and have threatened to kill off PCNs after less than a year in existence with GPs seeing the contract as giving them extra work for little support.
An NHSE consultation of the specifications closed on Wednesday and the feedback will be considered before the final specifications are released.
With NHS England set to redistribute surplus funds to networks making ‘swift progress’ with recruitment, funding for addititional roles that goes unclaimed may be permanently lost to the networks it was originally intended for.
GP leaders warned last year that inflexibility around the reimbursement scheme could block vital funding if networks were unable to hire to more roles, and GPonline analysis suggests some PCNs may have already missed out on vital funding.