Tara Humphrey
Apr 29 min
At THC Primary Care, we write blogs for Primary Care Network leaders.
You may be brand new to your role in Primary Care (and looking to better understand the Additional Roles Reimbursement Scheme). You may be an experienced PCN leader looking to review your employment model. Alternatively, you may be on the hunt for some resources to help you better understand the role, remit, and value of the members of your PCN team.
Whatever your aim, you have come to the right place, as we will address all of the above and hopefully, equip you with a resource which you can revisit and re-share with your team.
In this blog, we cover the following:
What is the Additional Roles Reimbursement Scheme (ARRS)?
Which roles are not part of the ARRS?
How is the Additional Roles Reimbursement Scheme Calculated?
Resources to better help you understand what each of the PCN roles do?
What is the reimbursement for each role?
What doesn’t the reimbursement cover?
The four most common ARRS employment models
The two most common ways to allocate roles across your PCN
The challenge of space and working remotely
Five Benefits of the PCN Additional Roles Reimbursement Scheme
Who manages the PCN team?
Supervision guidance
Issues relating to the scheme
To accompany this blog, you will need access to the following:
Along with many other resources, I will also signpost you to the FutureNHS platform, which you will need to sign up to.
There is a lot to cover, so remove all distractions and let's jump in!
Here is a super quick introduction to the ARRS.
The Additional Roles Reimbursement Scheme (ARRS) is an automatic funding stream available to Primary Care Networks (PCNs) to support the direct employment or a service which comprises of specific roles within the scheme.
These roles include.
Clinical Pharmacists
Care Co-ordinators
Physician Associates
Podiatrists
Nurse Training Associates
Nursing Associates
General Practice Assistant
Mental Health Practitioners (Adults and children)
Clinical Director
Core General Practice staff:
Practice Managers
GPs
Receptionists
Health Care Assistants
Prescribing Clerks
Personal secretaries
Practice nurses
Each PCN’s Additional Roles Reimbursement Scheme sum is based upon the PCN’s weighted population share.
This is in recognition of workload and relative costs of service delivery, and is calculated against the total available national funding.
To ensure consistency and fairness in allocations, the basis for weighting is the same as for global sum (i.e. the Carr-Hill Formula).
We have created a Primary Care Network Additional Roles Reimbursement Scheme Calculator to provide an indicative salary calculation to support networks in understanding their workforce costs via the Additional Roles Reimbursement Scheme (ARRS). You can view this calculator as you are part of our Members' Club Community.
The DES contains guidance on the minimal requirements for each role in Annex B.
You can also see a summary of each PCN role provided by NHS England here.
If you don't already, make sure you subscribe to the FutureNHS platform. They offer a useful section titled; 'Roles to support your PCN'. You will also find further information on all of the roles, and the contribution they can make to the work of the PCN. There isn't full insight on all roles, but they do cover the following:
At THC, we have also provided an introduction to the role and included an induction checklist. Access to this blog is here.
This covers nursing associates and trainee nursing associates.
➡️ General Practitioner Support
This covers physician Associates and General Practice Assistants.
➡️ Digital and Transformation Lead
At THC, we have also provided some resources to support this role which can be found below:
To learn more about the PCN personalised care roles, which include Social Prescribers, Health and Wellbeing Coaches and Care Coordinators, check out:
The Health London Partnership’s PCN Toolkit: Using Social Prescribing, Health Coaching and Care Co-ordination to tackle health inequalities
Personalised care development and competency frameworks via the NHS Futures Platform can be found here.
At THC Primary Care, we hosted a webinar titled; 'What does a PCN Health and Wellbeing Coach Do?'. You can catch the recording below.
To learn more about the Social Prescribing Link Worker role, we have a blog for you here. This blog features advice from The National Social Prescribing Network.
To learn more about the role of the First Contact Physio, check out; 'What does a PCN First Contact Physio Do?', below: or click to read our blog The role of the Primary Care Network First Contact Physiotherapist
The NHS Confederation has created guides for recruiting Paramedics.
At THC, we also have an interview with an experienced Paramedic Practitioner, which will give you further insight into the role. The interview can be accessed below:
For information on the PCN Pharmacist, please access the information provided by Health Education England.
For more about the PCN Pharmacy Technician, check out this blog.
All about the PCN Dietitian here.
To find out more about the wealth of skills on offer from an Occupational Therapist in Primary Care:
- Our blog is here.
- Our Business of Healthcare podcast episode is here (and also available in video format, here).
And finally, nurses.co.uk offer a wealth of information about the role of the PCN Advanced Nurse Practitioner here.
The PCN Ready Reckoner reflects the recent changes and updates to the PCN income, maximum reimbursable ARRS rates effective from 1 April 2023. Click here to access the NHSE Ready Reckoner.
Supervision
Training
Management fees
Premises
Equipment
If you procure a role from an external provider you may incur VAT, which may push you past the maximum reimbursement for a role. This investment will need to be sourced using another PCN income stream, or directly from the PCN practices.
The most common employment models used to support the recruitment of the additional roles fall into four main categories.
1️⃣ Directly employed by the Primary Care Network
If the PCN has been established as a legal entity, the network can directly employ roles.
Recruitment, training, supervision, IT requirement and all HR activities sit 100% with the network.
2️⃣ Directly employed via a lead practice
A practice agrees to hold the employment responsibilities for the network.
Recruitment, training, supervision, IT requirements and all HR activities sit 100% with the network.
3️⃣ Employed via a GP federation or Community provider
The GP federation or community provider agrees to and is paid to hold the employment responsibilities for the network.
Recruitment, training, supervision and IT requirements are negotiated between the parties and is often a shared responsibility.
HR activities are the responsibility of the federation or community provider.
In this model, there is typically a management charge which the Additional Role Reimbursement Scheme cannot claim.
4️⃣ Commissioned service via a specialist provider
In this arrangement, the PCN is a commissioning service and not just the recruiter to a role.
The service provider is skilled and experienced in providing the service and works to the service requirements of the network.
Their workforce can usually hit the ground running, working on-site or remotely.
This model enables the PCN to increase or decrease the service based on utilisation.
HR activities and IT equipment are the responsibility of the specialist provider.
Neither model is better or worse. They all work.
The employment model and management will depend on the network’s culture, structure, and ease of recruiting.
Typically, roles may be assigned either practice first or patient first.
The practice-first approach
By this, we mean equity of provision is based on the patient list size, and this is seen as a priority over the utilisation and demand of the service.
The patient-first approach
The patient-first approach organises the workload based on demand, which is facilitated by a regular review of the appointment utilisation and considers the practice's existing workforce.
In this model, provision is based on the demand for the service and not just the patient list size.
As a result of the Covid-19 pandemic, technology has enabled many roles to be delivered remotely and due to a lack of space for many networks, this arrangement is still in place.
Both models work depending on the role and culture of the network.
Communication is key to making remote working a success, as sometime people out of sight may feel out of mind. Here's some simple (and practical) tips for supporting your team to feel involved, and included:
Schedule regular check-in’s and 1-2-1’s
Newsletters, WhatsApp and Microsoft Teams channels are great ways to keep team members informed
Include the PCN team in Protected Learning Time events and PCN meetings
Line management of the roles depends on your employment model. Responsibility will typically fall to:
The PCN Clinical Director
The PCN Manager
The lead practice
The ARRS provider
Alternatively, practices may share their roles and consequently, line management of these.
Your network may also have a different arrangement.
No model is better or worse. They all work.
There is no direct funding for the time required to provide supervision but I know of some PCNs who have made use of core funding, IIF funding, and leadership and management funding to fill this gap.
Some networks also point to the PCN engagement fund, which gets paid directly to practices to support the cost of supervision.
If you want to get the most from your PCN team, and help your practices remain compliant with CQC requirements, supervision is a must.
For more support in this area, check out the guidance released on 16 May 2023 to support primary care networks (PCNs) and GP practices to provide effective supervision for their growing multidisciplinary teams (MDTs).
It sets out the principles of supervision for roles new to general practice; identifies best practice to support the development of good clinical governance and provides guidance on training and developing the workforce.
The guidance document can be accessed here.
The Additional Roles Reimbursement Scheme:
Enables PCNs to recruit additional roles, to help increase access to patients.
Provides a range of roles that networks can recruit to.
Helps foster collaboration amongst PCNs by encouraging joint working between practices.
Provides professional development opportunities for general practice staff looking to increase their Primary Care experience.
Can help practices and PCNs generate income by utilising these roles to support QOF, enhanced access, the Impact and Investment Fund and other locally-based enhanced services.
Whilst many networks have embraced the PCN's extended workforce; they have trained them to increase appointments, generate income (related to the QOF and the Impact and Investment Fund (IIF) indicators) - and provide a greater range of healthcare professionals to support their patient's health and wellbeing. That said, it hasn’t been a positive experience for everyone.
Pulse PCN hosted a roundtable to discuss the Additional Roles Reimbursement Scheme in 2021 with five clinical Directors who shared their experiences, and some of the pros and cons of the scheme. This is an interesting, helpful, and balanced discussion. Check out it out here.
Ben Gowland, writer, consultant, and host of The General Practice Podcast, shares: 'Three Things Practices Can Do to Make the Most of the Additional Roles Reimbursement Scheme (ARRS)'.
On top of all the advice provided above, our advice at THC when things aren’t quite working is to STOP repeating the same mistakes.
If your network is struggling to see the benefit in a role, don’t recruit to the same role until you have addressed the following.
🎯 What is currently working well?
🎯 What data do we have to review and inform the service being delivered?
🎯 Where do we need to increase/decrease the provision?
🎯 What do we need to start, stop and continue doing?
🎯 What feedback has been provided about the service to date?
This being said, even when the role is adding value through increased appointments and patient feedback, sometimes the network just doesn’t see value in the role.
In this instance, I would help the person to seek employment in another network who does value the expertise the role brings, or the network would decommission the service.
This isn’t a quick or easy decision. We usually reach this point after months of discontent.
Focus on what will drive your network forward, versus, what will keep the network stuck in the present.
We promise not to spam you!
Find out more about THC Primary Care at www.thcprimarycare.co.uk
And follow THC on X @THCPrimarycare
I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast, where we have now published over 290 episodes.
I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 120 PCNs by providing interim management, training and consultancy.
I have managed teams across multiple sites and countries; I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care, and I am the author of over 250 blogs.
I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.