Could You Easily Justify Every PCN ARRS Role You Fund?
- Apr 18
- 4 min read
If your PCN had to justify every ARRS role it currently funds, could it? Not in theory. With evidence of impact, embedded relationships, and a clear case for why that role, in your network, is worth protecting.
I discussed this with Phin Robinson, the Managing Director of Pure Physiotherapy, when he stopped by the Business of Healthcare Podcast. Pure Physiotherapy supports nearly 250 PCNs across England and sees between 90,000 and 100,000 patients every month.
We also discussed:
The GP Contract 2026/27 and what the near-doubling of the ARRS salary threshold means for multidisciplinary roles
Why flexibility in supplier relationships has a ceiling and what happens when a commissioner pushes past it
The case for MSK physiotherapy as one of the strongest ARRS investments
The neighbourhood agenda, eighteen months on from the Lord Darzi Report, and why the funding has not followed the ambition
The GP Contract 2026/27 and the ARRS Risk
The near doubling of the salary threshold that can be drawn down for a GP within ARRS is one of the most significant changes in the 2026/27 contract. Phin was clear that the risk is not immediate but structural.
Phin’s view is that some roles have had sufficient time to embed and demonstrate value. Pharmacists, physiotherapists, and paramedics are in that category. Others, including dietitians, podiatrists, and occupational therapists, have had a less consistent experience.
Where a PCN has struggled with a role and not had the leadership bandwidth to troubleshoot it, Phin said there is a genuine risk that funding defaults back towards GP employment rather than the multidisciplinary model the system needs.
The question for PCN leaders, as Phin framed it, is not just whether to keep certain ARRS roles. It is whether you are actively communicating the effectiveness of those services, so the case for retaining them is evidenced and not left to assumption.
Flexibility in Supplier Relationships Has a Ceiling
When finances are tight, and PCNs are looking to get more from their budgets, it is not uncommon to negotiate how a service is delivered. One of the ways that plays out in practice is through reducing appointment times.
Phin shared that Pure Physiotherapy recently declined to continue a discussion with a network that wanted to reduce First Contact Physiotherapy appointments from 20 minutes to 10 to 15 minutes and remove clinical catch-up time.
The evidence from the original FCP trial period, which Phin said Pure Physiotherapy was part of, is that 20-minute appointments produce better outcomes. Patients are more likely to self-manage. Follow-up demand reduces. Compress the model too far, and you do not save money. You displace the cost, increase clinical risk, and accelerate staff burnout.
Phin described it as hypermobility in physio terms. Push past flexibility, and you get instability. That is a clinical reality being applied directly to how services are designed and commissioned.
Why MSK Physiotherapy Remains One of the Strongest ARRS Investments
Musculoskeletal problems account for up to 30% of patients walking through a GP practice door. Phin said a well-structured FCP service, with the right appointment length and clinical governance, reduces that demand, builds patient self-management, and protects GP time for cases that genuinely need it.
Phin also made a point about governance. First contact roles operate under a Roadmap to Practice Governance Framework. Phin said that structure is what allows clinicians to work safely without an initial GP triage. Remove it in the name of efficiency, and the clinical risk rises sharply.
The Neighbourhood Agenda: Brilliant in Principle, Constrained in Practice
Phin was genuinely excited when the Lord Darzi Report was published in October 2024. It made a compelling case for moving care upstream, closer to communities. Eighteen months on, his view is more cautious. The funding has not followed the ambition, and leadership capacity at the ICB level has been significantly diminished at exactly the moment it needed to be strongest.
What Phin has observed is that the networks making neighbourhood working happen are not waiting for a central funding stream. They are finding it through councils, charitable organisations, and local authority partnerships, stitching together small pots of resources to build something meaningful. The common thread, as Phin put it, is proactive leadership, not permission.
Phin’s concern is that without meaningful long-term funding, neighbourhood working risks becoming another well-intentioned policy commitment that stays at the level of conversation. Primary care has lived through enough of those.
A Note on This Episode
This post is produced in partnership with Pure Physiotherapy, now in its fourth year of working with THC Primary Care. This partnership exists because I have supported the commissioning of the service in primary care networks and helped operationalise it. No provider is perfect, but responsiveness and honesty matter enormously and Pure Physiotherapy consistently demonstrates both.
If you want to explore what a service could look like for your PCN, Phin Robinson is reachable on LinkedIn or at phin.robinson@purephysiotherapy.co.uk. Their website is pureunityhealth.co.uk.
You can listen to the full conversation on The Business of Healthcare podcast on Apple Podcasts, Spotify, and all major platforms.
Tara Humphrey is the founder of THC Primary Care and host of The Business of Healthcare podcast.
This post was produced in partnership with Pure Physiotherapy.
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