Around £64m of funding available under the additional roles reimbursement scheme (ARRS) this year is currently forecast to go unspent.
An investigation by Management in Practice’s sister title Healthcare Leader found that less than a fifth of that sum is set to be reallocated to PCNs, meaning that the remaining money could be lost to general practice.
Under the scheme, which is part of the Network DES, PCNs are funded to hire non-GP staff, including pharmacists, physiotherapists and paramedics among others, and represents a significant funding stream for general practice.
But figures acquired under the Freedom of Information Act show that only around £8.77m (13%) of the estimated underspend for 2022/23 is set to be released back into primary care.
Furthermore, this money will only be reallocated in 14 ICB areas, with any unclaimed funding remaining with NHS England.
One further ICB said it ‘wishes’ to reallocate all of their unclaimed funding, which would add a further £1.3m if successful. Another ICB has reallocated an undisclosed amount to 15 PCNs.
And only 21 of the 36 ICBs who provided data are inviting PCNs to bid for the money at all.
The maximum ARRS fund for 2022/23 stood at around £1.02bn.
As the Network DES’s largest funding mechanism, concerns have been raised that any unclaimed funding represents an underspend against investment into general practice.
Devon ICB has approved the most bids – accepting 61 from its 31 PCNs – granting £1.2m in extra cash for staff, despite estimating it will underspend by £800,000.
A spokesperson explained that it expected a number of PCNs would not be able to recruit into the roles they submitted bids for within the limited time left in the financial year.
Similarly, Hertfordshire and West Essex invited all 35 of its PCNs to update their workforce plans, and is expecting to reallocate £1.7m, despite recording an underspend of just £54,647.
And Birmingham and Solihull ICB has approved 19 PCN bids and is planning to allocate £1.3m of its £1.7m underspend.
A large number of bids in Devon were for digital transformation leads, according to Caroline Sandford, who leads the Northern Primary Care Collaborative Board (NPCCB), which represents all PCNs across North Devon, and was involved in planning the ICB’s bidding process.
The digital lead role was announced as a new entry into the ARRS in September last year: midway through the current financial year, meaning it was absent from initial workforce plans. The locality is now considering hiring just one digital transformation lead to work with all PCNs in the region.
Ms Sandford, who is also the manager for Torridge Health PCN, said the NPCCB also bid for clinical and admin roles to support its anticipatory care work, and a cost-of-living programme intended to support developing an approach around patients with significant long-term conditions and fuel poverty.
Another clinical director for a Dartmoor PCN said: ‘I’m not surprised at all by the underspend. We see a lot of practices – particularly smaller practices – say they can’t use a given ARRS role and would rather opt for a doctor or nurse, over a physio. That’s probably where you’re getting underspend. And so a lot of the bidding for that underspend this year is to bolster roles for next year.’
Ben Gowland, director at think tank Ockham Healthcare and former NHS executive, said: ‘The majority of additional funds coming into general practice since 2019 have been funding through PCNs, and by far the biggest part of the PCN funding has been the ARRS funding. ARRS underspend therefore represents an underspend against the promised investment into general practice.’
He added: ‘The most important thing for PCNs is to ensure that next year’s full amount is committed as early as possible, as the ongoing recurrent expenditure will likely be capped at the committed amount, not the budget itself, beyond March 2024. It is highly unlikely we will see anything like the growth in the ARRS funds in future that we have seen over the course of this five-year contract.’
Mr Gowland added that general practice is beginning to see the impact of ICSs’ departure from the primary care-focused CCGs: an issue that is ‘likely to get worse as ICSs become more and more distant and distinct’.
The investigation has also identified significant variation in the way systems are interpreting the PCN DES.
Surrey Heartlands ICB suggested that it was not possible at all to reallocate funding under the Network Contract.
A spokesperson from Surrey Heartlands ICB said that the system had encouraged its PCNs to ‘maximise their spend on ARRS roles’, adding that it would wait for ‘further national guidance on the future of the ARRS initiative’ to inform its approach going forward.
And a spokesperson from Cheshire and Merseyside, which also indicated it couldn’t reallocate funding, said the ICB is working ‘proactively with our practices and the LMC to ensure that practices are able to maximize the use of resource that is available’.
The data also showed that Staffordshire and Stoke-on-Trent ICB recorded the greatest total underspend, with £4.46m – or nearly a quarter (23%) – of its £19.75m ARRS budget left unclaimed.
And two ICBs estimate more than a fifth (22%) of their total budget will go unclaimed. Sussex ICB is expecting to record a £6.72m underspend against its £30.8m total, while Kent and Medway has forecast a £7.07m underspend against its £32.7m total.
That just 6% of ARRS money is unspent marks a significant improvement upon spend in 2020/21 and 2021/22.
Last summer, it was revealed that up to 40% of funding available via the ARRS was unspent in each of the first two years of the scheme.