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Additional Roles Reimbursement Scheme (ARRS) – What is it?
Under the Primary Care Network DES, networks will be able to recruit new roles to expand their care team with NHSE&I with a forecast of 26,000 additional staff working in general practice by 2024. This means that on average, each PCN will have approximately 7 Full Time Equivalent (FTE) staff in 2020/21 rising to 20 FTE by 2023/24 through the ARRS, with the funding covering the salary and on costs, although PCNs can use the allocated funding to cover the costs of recruiting, apart from management fees, from a third party.
The aim of the scheme is to build and utilise the additional roles to solve the workforce shortage in general practice. Whereas the funding will be for new roles being introduced within PCNs, each network will have the flexibility to determine which roles form a core list they require based on their patient population requirements.
Although some roles were to be 70% reimbursable when the ARRS was first released, it has since been agreed that all roles are 100% reimbursable, affording the extra flexibility for networks.
A) ARRS 2019
During 2019, each PCN had to agree a workforce baseline which indicated the number of staff they employed within the then five ARRS roles of:
Clinical Pharmacists – work as part of the multidisciplinary team in a patient-facing role to clinically assess and treat patients using their expert knowledge of medicines for specific disease areas. The Clinical Pharmacist can be a prescriber or undertake training to become one. The maximum reimbursable amount for this role per annum is £55,670 and there is no limit on the number eligible for reimbursement.
Social Prescribing Link Workers – connect people to community groups and agencies for practical and emotional support and complement other approaches such as care navigation and active signposting. The maximum reimbursable amount for this role per annum is £35,389 and there is no limit on the number eligible for reimbursement.
Physician Associates – are healthcare professionals with a general medical education who work alongside and under the supervision of GPs providing clinical care as part of a wider multidisciplinary team. The maximum reimbursable amount for this role per annum is £53,724 and there is no limit on the number eligible for reimbursement.
First Contact Physiotherapists – can assess, diagnose, treat and manage musculoskeletal (MSK) problems and discharge a person without a medical referral. Those working in these roles within a network can be accessed through direct referral by staff in GP Practices. The maximum reimbursable amount for this role per annum is £55,670 and one WTE per PCN is eligible for reimbursement unless the patient population is over 100,000 where two will be eligible.
Community Paramedics (funding not available until 2021) – this role is currently being developed. Some networks have already trialled this role where the request for a home visit was triaged by the GP and then home visits, apart from those which were complex or end of life care, were undertaken by the paramedic. Some of the outputs were that more patients were managed at home and there was earlier intervention by the multidisciplinary team.
During 2019/20, the maximum amounts for each role in addition to the baseline workforce were restricted to nine months of the annual reimbursement amounts, given that posts can only be filled from 1 July 2019.
B) ARRS 2020 and Beyond
During this current year (2020-21), each network has been allocated a maximum reimbursement sum based on its weighted population. Following feedback from networks who wanted greater flexibility in the roles they could recruit, there have been 6 more roles added to the ARRS. During 2020-21, PCNs can recruit and employ the following roles as part of the scheme:
Care Co-ordinator – works closely with GPs and other primary care professionals within the network to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers. The maximum reimbursable amount for this role per annum is £29,135 and there is no limit on the number eligible for reimbursement.
Pharmacy Technician – will complement the work of the Clinical Pharmacist by using their pharmaceutical knowledge to undertake activities such as audits, discharge management and prescription issuing. This role will be under the supervision of the Clinical Pharmacist and will be part of a wider PCN pharmacy team. The maximum reimbursable amount for this role per annum is £35,389 and one WTE per PCN is eligible for reimbursement unless the patient population is over 100,000 where two will be eligible.
Dietitian – diagnoses and treats diet and nutritional problems. Dietitians will support PCNs with patients of all ages with their food intake to address diabetes, food allergies, coeliac disease and metabolic diseases. The maximum reimbursable amount for this role per annum is £53,724 and there is no limit on the number eligible for reimbursement.
Health and Wellbeing Coach – will use health coaching skills to support people with self-identifying existing issues and encourages proactive prevention of new and existing illnesses. They may provide access to self-management education, peer support and social prescribing. The maximum reimbursable amount for this role per annum is £35,389 and there is no limit on the number eligible for reimbursement.
Nursing Associate (from 1 October 2020) – is a new support role that bridges the gap between healthcare assistants and registered nurses. The role will be part of the PCN nursing team under the supervision of a nurse. The maximum reimbursable amount for this role per annum is to be confirmed.
Occupational Therapist – supports people of all ages with problems arising from physical, mental, social or development difficulties. OTs can help GPs across the network with frail patients, those with complex needs, those who live with chronic physical or mental health conditions and who need help with managing anxiety or depression. The maximum reimbursable amount for this role per annum is £53,724 and there is no limit on the number eligible for reimbursement.
Podiatrist – can help diagnose and treat foot and lower limb conditions. Podiatrists provide assessment, evaluation and foot care for a wide range of patients. The maximum reimbursable amount for this role per annum is £53,724 and there is no limit on the number eligible for reimbursement.
A Mental Health Practitioner role will be added to the ARRS from April 2021. However, further guidance is to be developed.
C) What should our PCN be doing?
Each PCN will have completed their ARRS workforce planning template for their recruitment plans for 2020/21 by 31 August 2020.
By 31 October 2020, each PCN will need to complete their indicative intentions through to 2023/24 by developing a workforce strategy.
Once the plans have been submitted, the commissioner will confirm the plan with each PCN’s Clinical Director and, once each plan is agreed, will share with NHS England and NHS Improvement Regional Teams by 30 September 2020 for 2020/21 plans, and by 30 November 2020 for indicative future plans.
