Up to 40% of funding available for hiring additional roles staff was unspent in each of the first two years of the scheme, figures obtained under the Freedom of Information Act have revealed.
The figures show a 36% underspend of ARRS funding in 2019/20, with £39.6m spent out of a possible £62m, based on responses from 117 CCGs to a Freedom of Information (FOI) request.
In 2020/21, 110 CCGs spent a total of £212.2m out of a possible £354.9m, leaving 40% unspent.
The figures also show that there could be an underspend of around 25% in 2021/22*.
In the first year of the scheme, CCGs were advised to redistribute any unused funds to neighbouring primary care networks to help them carry out further recruitment of ARRS roles.
According to the contract specifications for the past two years, PCNs have been able to bid for funding left unused by other PCNs in their area, where the CCG gives the opportunity to do this.
But in 2020/21 and 2021/22, NHS England also retained around 40% of the total ARRS allocation for CCGs, with PCNs only able to request this based on ‘need’ after the baseline funding had been spent.
NHS England did not respond to requests for comment.
The latest NHS Digital figures show that as of March this year, 18,221 more direct patient care staff – which includes ARRS roles – have been recruited since March 2019.
But some networks are still finding challenges with recruiting to the roles available via the scheme.
Clinical directors reported that a lack of flexibility within the scheme has meant they cannot recruit the staff they need, such as advanced nurse practitioners and extra mental health workers. Others commented that there are not enough staff to go around, leaving them competing with other PCNs and organisations – and the funding available is not always sufficient to attract staff to the roles.
Cannock North PCN clinical director Dr Manu Agrawal said: ‘We are losing 30% of the funding in our area, which could have been used for patient care if it was given to practices.’
This comes as a King’s Fund report on the scheme found that PCNs have ‘inadequate funding’ and support to implement the scheme, with many networks lacking ‘a clear, shared overall purpose’.
Dr Claire Fuller’s recent stocktake on next steps for integrating primary care also said that NHS England should ‘simplify guidance and address common misunderstandings’ regarding the ARRS, and look at what other flexibilities could be introduced to ‘support recruitment in the short term’.
*Pulse’s FOI request asked CCGs about ARRS allocations in each of the three years, how much had been spent and where any underspends were allocated. For 2020-21 and 2021-22 we used NHSE figures on total ARRS budgets. For 2019-20, our calculations are based solely on CCG responses to the FOI. The 2021-22 figures are made up of actual spend from 29 CCGs and forecasted spend from 42 CCGs.