Management in Practice spoke with Dr Tom Rustom, a GP partner and PCN clinical director in Horley, Surrey.
Dr Rustom is set to speak about strengthening the practice team with ARRS roles at Management in Practice Birmingham on 9 November.
Why is it important right now to understand the ARRS scheme?
When PCNs were introduced two and a half years ago, part of the reason for having them was to try and stop primary care from falling over: to try and reduce the gap in numbers of GPs, practice nurses, etc, coming through the system. One of the primary goals was to support and strengthen general practice.
Giving resources in the form of people was quite a smart move by NHS England. From my experience in our PCN, we’ve been very fortunate in recruiting and we’ve managed each year to maximise our ARRS recruitment with very little under spend leftover. I’m aware that there’s some areas where you can give people funding resources and you still won’t be able to get the clinical pharmacists, physios or paramedics that you feel that you need as a PCN.
We are fortunate as we have a strong GP Federation who does the recruitment for us – so our role as GPs in the practice is to get these people embedded in.
If you take the time to support these people; if you give them protected time to embed them into the practices, encourage them to get involved and allow them to be flexible and autonomous in their working, then they can be extremely valuable additional members of the team.
Are the funding and roles available through the ARRS scheme flexible enough to support existing staff and patient needs?
One of the challenges is that if you’ve got 3% pay rise happening each year through NHS staff pay rises, that’s not taking the ARRS into account, and so practices are in the position where they have to pick that up. It doesn’t give you the flexibility to afford people a progressive pay scale as they get better.
So, if you want to get the best clinical pharmacists that you can, you have to offer them the maximum salary reimbursement through the scheme – because they will have read about it and that’s what they’ll be expecting. But if they take on additional training and become a prescriber, for example, and you want to pay them an extra certain amount a year, it doesn’t allow for that. Again, that’s got to be picked up either by the practices or through PCN core funding.
I’m not saying that’s a bad thing, we’ve certainly done that with some of our staff because that’s right and fair thing to do. But it’s a limitation, and may dissuade some PCNs from taking people on.
How can managers support ARRS workers entering general practice?
It’s important to give them an on-the-ground mentor or supervisor who has some protected time to meet with them, initially at least weekly, to give them that focal point. This should be someone clinical — separate from their line manager who deals with all their finances – they can go to for support in general practice.
One approach that I have found quite effective is introducing a ‘triage room’. So, we might have the triage GP or senior GP in a room with an administrator; then you might also have the clinical pharmacist there for the minor illness bit – so they can learn from each other. It creates lots of opportunities for communication.
For general practice to survive longer term, it needs to adapt to the multidisciplinary way of working in primary care. A patient’s first contact might not always be the GP, but the GP will be the nucleus to guide, educate and communicate with the team.
Demand will continue to outstrip supply until we have more GPs in the system. ARRS will hopefully allow us to cope until then. It is genuinely a good initiative, and a good move forward for primary care to have this mix of skill sets coming in.