ARRS and Independent Providers: Essential Pillars for Sustainable Neighbourhood Primary Care

Editor's note: This is a guest article from Pure Physiotherapy (Pure Unity Health Group). As neighbourhood health reshapes primary care, here's their perspective on how ARRS roles and independent providers can work alongside General Practice.

As debate intensifies over the future of primary care in England, it's easy to cast the shift towards neighbourhood models as a zero-sum contest between PCNs, practices and new contractual forms. It shouldn't be.

The Additional Roles Reimbursement Scheme (ARRS) and the accountable use of independent providers are not threats to General Practice. They are vital enablers of a sustainable, multi-professional system, provided we protect core functions, lock in continuity, and design governance that keeps General Practice at the heart of local care.

ARRS: From Stopgap to Strategic Workforce

ARRS began as a response to GP shortages and spiralling demand, but it has rapidly become integral to modern General Practice. Clinical Pharmacists, First Contact Physiotherapists, Social Prescribers, Physician Associates, Health and Wellbeing Coaches, Paramedics and Care Coordinators have enabled practices to redesign pathways, redirect patients to the right professional first time, and free up GP time for complex, undifferentiated needs.

The scheme has exceeded its headline targets, recruiting over 34,000 new patient-facing staff and delivering an additional 50 million appointments ahead of schedule. Dismantling or dislocating these roles would be a strategic error. They are now embedded in patient expectations and practice operating models, from same-day MSK assessments to deprescribing programmes and anticipatory care.

Rather than extracting these roles into detached neighbourhood entities, neighbourhood care should be designed around them, with clear anchoring in General Practice and shared operating frameworks across PCNs.

Independent Providers: Partners in Capacity and Innovation

Independent providers in primary care can spark contention, yet in practice, they often do three things particularly well: create surge capacity, standardise high-volume pathways, and scale innovations quickly. Properly commissioned and governed, they complement General Practice rather than replace it

Capacity smoothing: Independent providers can deliver time-limited programmes, backlog triage, medication reviews, and virtual group clinics without diverting core practice teams from continuity.

Specialist interventions at scale: Pharmacist-led optimisation clinics, proactive AF detection, or community diagnostics hubs run by experienced operators can standardise quality across a neighbourhood and reduce unwarranted variation, integrated with practice records and recall systems.

Innovation and workforce development: Many providers bring CPD opportunities, digital infrastructure and data reporting capabilities. When aligned to PCN priorities, they can accelerate upskilling of ARRS teams and support analytics for population health.

Making It Work: Design Principles for Stability

Moving towards neighbourhood contracts, whether single-neighbourhood or multi-neighbourhood providers, need not destabilise practices. But it will if funding is reallocated without safeguards or ARRS roles are detached from day-to-day practice care. A better path is available:

Anchor ARRS in General Practice. Maintain line management, clinical supervision and daily accountability within practices and PCNs while allowing ARRS teams to contribute to neighbourhood-level programmes.

Ring-fence core capacity first. Establish a continuity baseline for GP sessions, ARRS capacity for same-day demand, and essential Long Term Condition reviews before commissioning upstream work.

One data model, shared metrics. Underpin neighbourhood models with shared dashboards co-designed by practices, tied to access, continuity and outcomes. Align any independent provider contracts to the same metrics.

Commission for outcomes, not activity alone. Where gain-share models are used, distribute benefits back to practices to support core capacity, ARRS supervision and tools that reduce administrative burden.

Addressing the Core Concerns

"We risk hollowing out General Practice." Not if ARRS remains within practice teams with protected capacity for core work, and if independent providers are commissioned to augment, not replace, access and proactive care.

"Budgets will be pooled, and practices will lose discretion." Pooling can be a strength when paired with minimum allocations for continuity and transparent, practice-endorsed prioritisation.

"Roles will drift into prevention at the expense of access." Prevention is only sustainable if it rests on stable access. Hard-wiring minimum access and continuity standards into neighbourhood plans keeps the balance.

The Path Forward

Primary care can have both: resilient, relationship-centred General Practice and neighbourhood-level capability to manage demand, improve outcomes and reduce avoidable downstream care.

The route is not extraction or fragmentation, but anchoring ARRS within practices, commissioning independent providers as true partners, and aligning everyone to common outcomes with clear governance.

Author

Jon Edmondson      

Head of Region

jon.edmondson@purephysiotherapy.co.uk

References

DHSC (2025). Fit for the Future: 10 Year Health Plan for England.

NHS Confederation (2024). Assessing the impact and success of the Additional Roles Reimbursement Scheme.

NHS Confederation (2025). The contractual mechanisms to deliver a neighbourhood health service.

NHS England (2024). Network Contract DES 2024/25 – Part B Guidance.

NHS England (2025). Update to the GP contract agreements 2025/26.

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