Following the announcement of the new Network Contract DES, Pulse Intelligence outlines some of the key changes and requirements in the Additional Roles Reimbursement Scheme this year.
NHS England has outlined updates to the Additional Roles Reimbursement Scheme (ARRS) in this latest cover note on the updated Network Contract DES, published 31 March.
There is also detail on the new roles specifications in this letter from 21 January 2021.
NHSE also recently published planning guidance including directions on the ARRS funding allocation – see here.
Useful FAQs on the PCN Network DES include some important notes on the ARRS.
The new Network Contract DES for 2021/22 includes the promised increase in full-year funding for the ARRS, from a maximum of £430m in 2020/21 to a maximum of £746m in 2021/22.
NHSE has highlighted that the full funding is being made available despite the four new PCN services (on CVD diagnosis and prevention, tackling inequalities, personalised care and anticipatory care) being postponed until 1 October ‘at the earliest’ due to the ongoing pandemic response.
The ARRS has been made more flexible, including new reimbursable roles and inner and outer London weighting.
That said, NHSE has said ‘this is a critical year for PCNs to expand their workforce’ and that ‘the NHS system planning requirement is for 15,500 WTE roles to be deployed by the end of 2021/22’.
As such PCNs are under pressure to recruit and use up the funding. NHSE says: ‘Beyond an initial sum within CCG primary care allocations, CCGs will only be able to draw down on ARRS funding on the basis of PCN recruitment under the scheme: the onus is therefore on PCNs to make full use of their ARRS entitlements to ensure that general practice benefits from the funding available.’
New ARRS roles included from April 2021 are:
PCNs are required to plan their future workforce requirements in order to support claims under their ARRS each year.
As set out in the Network Contract DES Specification, PCNs must complete and return their workforce plans including recruitment updates for 2021/22 to the CCG by 31 August 2021.
Any updated indicative intentions 2023/24 must be submitted by 31 Oct.
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 2021 for 2021/22 plans, and by 30 November 2021 for indicative future plans.
The CCG has to agree with the PCN by 30 September 2021 an estimate of how much ARRS funding the PCN is unlikely to claim by 31 March 2022. The PCN will no longer have the right to claim the unclaimed funding from then on, and other PCNs will be able to bid for it.
This planning guidance explains that £415m of the total £746m funding has been allocated to CCGs, with the remainder to be held centrally and handed out ‘based on need’.
It states: In 2021/22, funding will comprise the following elements:
i) published primary medical care allocations already include £415m of the total £746m funding available for ARRS
ii) the remaining £331m will be held centrally by NHS England and NHS Improvement. Once the PCNs in a CCG area have claimed the total of their CCG’s allocated share of the £415m, and ongoing claims will cause the CCG to exceed this amount, a CCG can access additional funding based on need. The process for this was set out in the 9 October 2020 communication to commissioners.
NHS England has produced a ready reckoner to help PCNs calculate their maximum ARRS sum based on weighted population (for 2021/22, this is £12.314 per weighted patient as at 1 Jan 2021).
NHS England » General Medical Services (GMS) Ready Reckoner 2021/22
The table below provides a summary of indicative sums according to weighted population, for the next three years of the scheme.
| 2021/22 | 2022/23 | 2023/24 | |
| Total national workforce funding | £746,458,000 | £1,026,747,000 | £1,412,011,000 |
| PCN size (weighted) | |||
| 15,000 | £184,700 | £254,100 | £349,400 |
| 20,000 | £246,300 | £338,800 | £465,900 |
| 25,000 | £307,900 | £423,500 | £582,400 |
| 30,000 | £369,400 | £508,200 | £698,800 |
| 40,000 | £492,600 | £677,500 | £931,800 |
| 50,000 | £615,700 | £846,900 | £1,164,700 |
| 80,000 | £985,100 | £1,355,100 | £1,863,500 |
| 100,000 | £1,231,400 | £1,693,800 | £2,329,400 |
| 150,000 | £1,847,100 | £2,540,800 | £3,494,100 |
Table 1: Indicative Additional Roles Reimbursement Scheme Sum per PCN weighted population
An inner and outer London maximum reimbursement rate (but not London fringe rate) now applies to PCNs in the London Region for each of the additional roles – NHS London may now offer this on top of maximum current ARRS reimbursement amounts.
The rationale is that PCNs in London have up to now faced an additional recruitment challenge, by being unable to offer inner and outer London weighting available to other NHS staff in London.
PCNs need to claim reimbursement on a monthly basis for all staff recruited or engaged via the ARRS, using the national online claim portal.
They will continue to receive reimbursement on an ongoing
basis, provided they continue to meet the requirements set out as part of the Network Contract DES, in place until at least 31 March 2024. (As set out in Investment and Evolution: Update to the GP contract agreement 2020/21–2023/24, staff employed or engaged through the ARRS will be considered as part of the core general practice cost base beyond 2023/24.)
According to the FAQs document, a PCN may use its ARRS sum to reimburse additional hours worked (above the usual hours per week WTE standard for the employer) by PCN staff. This can be done at plain time rates only, however, and the increase in WTE hours must be clearly recorded in the PCN’s claim and on the National Workforce Reporting System.
Parental leave for staff employed under the ARRS will also be reimbursed, although cover for those staff will not.
If a post in the PCN’s baseline workforce becomes vacant, ARRS funding will be sustained for a ‘grace period’ of three months.
After that, PCNs will no longer be able to claim for one of the same roles under the ARRS until the baseline vacancy is filled.
For example, if a clinical pharmacist role becomes vacant among the PCN practices’ baseline staff, that PCN will not be eligible to claim for a clinical pharmacist under the ARRS, until the vacancy is filled (and in the interim will need to agree how the PCN clinical pharmacist will be resourced).
Paramedics
PCNs can now get reimbursement for paramedics. Paramedics in primary care are generally expected to work at Level 7 capability, but suitably experienced paramedics on a training pathway to that level may also be reimbursed, if working as part of a rotational model with an Ambulance Trust.
Mental health practitioner
PCNs are also now entitled to reimbursement for a WTE mental health practitioner (or two WTE MH practitioners, if over 100k list size). However, the role will be employed and provided as a service by the PCN’s local provider of community mental health services, with PCNs responsible for paying 50% of the salary and employer NI/pension costs which is reimbursable through the ARRS, while the local provider is responsible for paying for the remainder.
The role can be a registered mental health clinician at band 5-8a, as locally agreed.
NHSE emphasises that the WTE MH practitioner must be ‘fully embedded’ in the PCN and employed by the local secondary care provider of community mental health services – not another organisation such as MIND.
PCNs may also choose to embed a children and young people Mental Health Practitioner (on the same basis, with the agreement of the local provider) in addition to the adult MHP role.
Staff funded in this way will be additional to any mental health practitioners and co-located IAPT practitioners already embedded within general practice. The new obligation on mental health providers will be set out in the 2021/22 NHS Standard Contract.
Advanced Practitioner roles
The ARRS also now covers Advanced Practitioner status for the following PCN roles: Clinical Pharmacist; Physiotherapist; Occupational Therapist; Dietician; Podiatrist; and Paramedic. To be reimbursable at band 8a, the role must meet the minimum requirements and the additional responsibilities set out in the Advanced Practitioner role outlined in Annex B of the Network Contract DES Specification.
PCNs can employ one WTE advanced practitioner, or two WTEs if they have more than 100k patients.
Clinical Pharmacists
A further window, between 1 April and 30 September 2021, is available to transfer any clinical pharmacists employed under the Clinical Pharmacist in General Practice Scheme on 31 March 2021 to become part of the PCN’s multi-disciplinary team.
Job roles and reimbursement
PCNs do not have to recruit a fixed or expected number of staff in specific roles (with the exception of limits on the number of Advance practitioners per PCN). It is up to PCNs to decide the mix of workforce they need, to support delivery of the Network Contract DES requirements.
The full list of job roles that are now eligible for reimbursement under the scheme is:
Detailed role requirements and specifications are outlined in Chapter 8 of the Network Contract DES guidance document for 2021/21.
The maximum reimbursable amounts are outlined in the tables below.
NB the maximum reimbursable amount for each role includes weighted average salary for the specified band, plus associated employer on-costs
See NHSE ready reckoner for more details.
| Role | Band | Annual maximum reimbursable amount per role | Annual maximum reimbursable amount per role – plus inner HCAS* | Annual maximum reimbursable amount per role – plus outer HCAS* |
| Clinical pharmacist | 7-8a | £56,829 | £65,660 | £63,010 |
| Pharmacy technician | 5 | £36,114 | £43,581 | £41,714 |
| Social prescribing link worker | Up to 5 | £36,114 | £43,581 | £41,714 |
| Health and wellbeing coach | Up to 5 | £36,114 | £43,581 | £41,714 |
| Care coordinator | 4 | £29,726 | £35,916 | £34,577 |
| Physician associate | 7 | £54,841 | £63,673 | £61,022 |
| First contact physiotherapist | 7-8a | £56,829 | £65,660 | £63,010 |
| Dietician | 7 | £54,841 | £63,673 | £61,022 |
| Podiatrist | 7 | £54,841 | £63,673 | £61,022 |
| Occupational therapist | 7 | £54,841 | £63,673 | £61,022 |
| Trainee Nursing associate | 3 | £26,188 | £31,921 | £31,038 |
| Nursing associate | 4 | £29,726 | £35,916 | £34,577 |
| Paramedics | 7 | £54,841 | £63,673 | £61,022 |
| Advanced practitioner | 8a | £62,705 | £71,536 | £68,886 |
| Adult Mental health practitioner / CYP Mental health practitioner | 5 6 7 8a | £18,057 £22,443 £27,421 £31,352 | £21,790 £26,859 £31,836 £35,768 | £20,857 £25,533 £30,511 £34,443 |
*HCAS = High Cost Area Supplement
Or, please register for a free trial to access all of the guides and unlock all features.
© Cogora 2024
