GPs and Nurses Can Be ARRS Funded - What Does It All Mean?

The landscape of primary care in England has been evolving rapidly, particularly since the introduction of Primary Care Networks (PCNs) in 2019. A central pillar of the PCN project has been the Additional Roles Reimbursement Scheme (ARRS), designed to expand the general practice workforce beyond doctors and nurses. However, the latest Network Contract Directed Enhanced Service (DES) for 2025/26 introduces a significant tweak: ARRS funding can now, under specific conditions, be used to hire some GPs and nurses. What's behind this change, and what might it mean for practices and patients?

1. Why Were PCNs Created in the First Place?

The official documentation speaks of building resilience and leveraging scale, but the specific policy objectives driving the PCN and ARRS structure weren't always explicitly highlighted. However, reading between the lines, the rationale seems to have been along these lines:

A Belief in Skill Mix: There was likely a governmental belief that diversifying the primary care team – bringing in clinical pharmacists, physiotherapists, paramedics, social prescribers, and others – could make care more efficient, potentially cheaper, and ensure patients see the most appropriate professional for their needs.
Overcoming Hurdles: Policymakers likely anticipated two key barriers to this vision. Firstly, potential resistance from GP practices accustomed to traditional models or concerned about funding and supervision. Secondly, the practical reality that the average GP practice is simply too small (often under 10,000 patients) to employ many specialist roles full-time.
The PCN/ARRS Solution: PCNs, typically covering 30,000-50,000 patients, created the necessary scale. The ARRS funding provided the resource but was crucially tied specifically to hiring these new, additional roles, mandating the workforce change rather than just encouraging it.

2. What's Changing in 2025/26?

The headline change is that the ARRS funding pot, while still primarily focused on the established additional roles (pharmacists, physios, paramedics etc. continue to be funded ), can now also be used, with restrictions, for:

Newly Qualified GPs: Practices can claim reimbursement for GPs who are within the first two years of completing their training (CCT). They must not have been substantively employed as a GP previously (subject to commissioner agreement), and locums are excluded. Maximum reimbursement caps apply.
Nurses: Funding is available for 'New to General Practice Nurses', 'Experienced General Practice Nurses', 'Consultant Nurses Primary Care', and 'Healthcare Support Workers'. However, a key restriction applies to New and Experienced GPNs: ARRS funding cannot be claimed if they have worked in any capacity within that PCN or its constituent practices in the preceding 12 months (unless moving to a more senior/specialist role). Again, maximum reimbursement caps apply.
Other Roles: There's also continued flexibility to recruit other direct patient care roles if agreed locally between the PCN and the commissioner.

Alongside this, some core PCN funding streams (Core Funding, Clinical Director, Leadership/Management) have been consolidated into a single Core PCN Funding payment.

3. Why Might the Government Have Made This Change?

While official reasoning is often multi-faceted, several factors could be at play:

Pragmatism: It might be a pragmatic adjustment acknowledging the reality that recruiting sufficient numbers across all the original ARRS roles has been challenging in some areas, or that core GP and nurse capacity pressures remained intense despite the wider team. This offers a safety valve.
Workforce Realities: With reports of newly qualified GPs struggling to find immediate posts, this change provides a clear route, using ARRS funding, for PCNs to employ this specific cohort.
Practice Experience: After five years working with diverse teams, perhaps there's a view that practices are now better equipped to integrate GPs and nurses strategically alongside ARRS roles, warranting slightly increased flexibility.
Feedback: It could also be a response to persistent feedback from primary care providers about the need for more core clinical capacity alongside the additional roles.

4. The "Nurse Swap" Phenomenon?

One of the most interesting potential consequences arises from the specific rule about nurse funding. The restriction preventing ARRS funding for nurses who worked in the PCN within the last 12 months appears designed to stop practices simply shifting their existing, practice-funded nurses onto the ARRS budget immediately.

However, consider this scenario: Nurse Smith works for Practice A in PCN 1, funded directly by the practice. She leaves Practice A. She takes a job with Practice B in different PCN 2. PCN 2 could potentially claim ARRS reimbursement for Nurse Smith, as she hasn't worked within PCN 2 or its practices in the last 12 months.

The financial incentive is clear: Practice B gets a needed nurse funded via ARRS, potentially freeing up its own core funds. Over time, this could lead to a slow, gradual "drift" where nurses move between PCNs, effectively shifting posts from being practice-funded to being ARRS-funded, albeit indirectly and with a time lag. While perhaps not the explicit intention, it seems a likely outcome driven by the financial pressures on practices.

5. Future Outlook: What Would Success Look Like?

How will this policy tweak ultimately be judged?

The Positive View: If this increased flexibility allows PCNs to better tailor their workforce, leading to tangible improvements in patient access, experience, and health outcomes, while managing demand effectively, the government will likely view it positively. Success would mean the combined team (GPs, nurses, and ARRS roles working together) delivers better results.
The Concerned View: If the main effect is simply a shifting of employment costs onto the ARRS budget without corresponding service improvements, or if practices significantly reduce their use of the diverse ARRS roles in favour of the newly fundable GPs/nurses, alarm bells may ring. Furthermore, if freed-up practice funds appear to primarily boost partner profits rather than reinvestment in services or staffing, expect scrutiny and potential reversal of this flexibility in future contract years. Commissioners will be conducting post-payment verification and audits.

Ultimately, primary care remains under intense pressure. Whether this latest adjustment helps PCNs optimise their resources for better patient care, or simply creates new ways to manage budgets, remains to be seen. It adds another layer of complexity to the ongoing experiment of PCNs and the future of general practice.