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ARRS guidance should be simplified and recruitment flexibilities considered, says review

by Beth Gault
30 May 2022

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NHS England should ‘simplify’ guidance and address common misunderstandings around the Additional Roles Reimbursement Scheme (ARRS), according to Dr Claire Fuller’s report on integrating general practice with other NHS services.

The report, which was published on 26 May, was commissioned by NHSE to assess how Integrated Care Systems (ICSs) and primary care could better work together.

Dr Fuller, who is a GP and chief executive of an ICS in Surrey, said that some local networks have not been able to make use of the scheme due to several reasons including lack of capacity for supervision, inadequate space in practices, lack of expertise on organisational development and confusion around the purpose of some roles.

She added that NHSE should simplify guidance around this scheme and address common misunderstandings.

Dr Fuller also called on NHSE to consider ‘further flexibilities’ that could be introduced to support recruitment in the short term and look at what will happen to the ARRS scheme after it reaches its current target of 26,000 staff by 2024.

She said: ‘We do not just need to attract new staff into primary care; we need to create the backdrop that allows their roles to be reimagined and made more flexible and attractive – ultimately supporting increased participation and retention in primary care.’

The report called for the development of innovative employment models such as joint appointments and rotational models which ‘promote collaboration’ rather than competition between employers.

It was also put forward that the NHS staff survey be rolled out to primary care ‘as soon as funding permits’ in order to allow for greater listening to staff to improve the experience of working in primary care.

Neighbourhood teams

The way that urgent same-day appointments are organised should also change, according to Dr Fuller, and should be dealt with by ‘single, urgent care teams’ across larger populations.

She said: ‘We need to enable primary care in every neighbourhood to create single urgent care teams and to offer their patients the care appropriate to them when they pop into their practice, contact the team or book an online appointment.’

To do this, Dr Fuller suggested connecting up ‘currently separate and siloed services’, such as general practice in-hours and extended hours, urgent treatment centres, out-of-hours, urgent community response services, home visiting, community pharmacy, 111 call handling and 111 clinical assessment.

She said work should be done to ‘organise them into a single integrated urgent care pathway in the community that is reliable, streamlined and easier for patients to navigate’.

The report also found that the approach to NHS 111 often resulted in duplication of effort for patients, carers and clinicians, and recommended that NHSE shift its policy towards the service.

Other recommendations in the report:

  • The ‘primary driver of primary care improvement and development of neighbourhood teams in the years ahead’ should be ‘system leadership’
  • ‘Every effort should be made to create as much local flexibility around discretionary funding as possible’, beyond DDRB and pay uplifts after 2023/24
  • The Department of Health and Social Care (DHSC) should make sure primary estate care ‘central’ in the next iteration of the Health Infrastructure Plan
  • National action is needed to help put in place data and digital infrastructure to transform primary care
  • DHSC and NHSE should ‘rapidly undertake’ work on the legislative, contractual, commissioning and funding framework to ‘enable and support new models of integrated primary care’. They should also consider improving equity in distribution of resource and health outcomes.

Amanda Pritchard, NHS chief executive said: ‘I welcome the recommendations and look forward to working with colleagues across the NHS to implement them.’

RCGP chair, Professor Martin Marshall, said the report was ‘appropriately ambitious’, however that further detail was needed around the proposals for urgent access.

‘Any new metrics will need to be thought through carefully so they have a positive impact on patient care, and avoid any duplication or perverse incentives across the system. Addressing workforce and workload pressures, improving staff morale and investing in support for change will be particularly key to achieving the report’s aspirations,’ he said.

The BMA also said elements of the report were positive but said ‘we cannot shy away from the challenges facing us’.

Dr Farah Jameel, BMA England GP committee chair, said: ‘This stocktake clearly lays out a desired direction of travel for care in our communities, setting a vision for what good looks like in primary care – while recognising the challenges and need for movement from Government and NHS England to fix the issues around workforce, estates and digital infrastructure.

‘Ministers and policymakers must now take heed, listening to, supporting and working with GPs and their colleagues to ensure they can provide the standard of care that all patients deserve.’

It comes after Health Education England is paying practices £10,000 to take on new GP trainees in one area, amid a shortage of available posts.