Additional Roles Reimbursement Scheme (ARRS) -FLEXIBILITY REQUIRED.
The Additional Roles Reimbursement Scheme (ARRS) is transforming the primary care workforce across England. It is providing ring-fenced funding to bring more clinical pharmacists, pharmacy technicians, mental health practitioners, paramedics, physician associates, physios, dieticians and social prescribers into GP practices and Primary Care Networks (PCN)
There is no doubt that this is happening, albeit at different speeds across England.
As a clinical pharmacist, I’ve watched, Cinderella-like, like every other profession, seemed to be getting ready for the primary care Ball. I’m not complaining about funding being provided for pharmacists to enter primary care. My issue is with the lack of flexibility of the scheme. Too much is being dictated from ivory towers in Leeds and London with limited opportunities for innovation.
GPs buckling under the workload
Even before COVID, GP Practices were buckling under the pressure of workload. Many GPs were at the end of their tether. However, the national emergency that is COVID has meant that we have all pulled together for the good of the whole. As the benefits of the Vaccination programme take effect and we return to a new normal, those GPs who were buckling under the pressure pre-COVID are now thinking about the future and whether they want to continue.
Not reducing GP workload yet.
ARRS funding should be bringing in clinicians that can reduce GP workload as the recent Primary Care Networks – Two Years On document from the NHS Confederation states Staff hired through the multi-million-pound additional roles reimbursement scheme (ARRS) have brought ‘little reduction in GP workload in the first instance.’
In my profession, the initial cohort of pharmacists recruited by PCNs included a high proportion of pharmacists with previous experience in Primary Care and GP Practices, many with Independent Prescriber status. Unfortunately, the later cohorts are mainly being recruited from community pharmacies. These pharmacists have to undertake the Primary Care Pharmacy Education Pathway. (PCPEP)
Can you wait 3 years?
If you are lucky and time your recruitment perfectly, it will take these pharmacists 18 months to complete the PCPEP, but it can be well over 2 years after recruitment if your pharmacist starts in between programmes. After that, the pharmacist has to complete their non-medical prescribing qualification. So, in reality, the pharmacists recruited today will not realise their full potential for 2.5-3 years. GPs want help now, not in 3 years. If I was buckling under pressure, I’m sure I wouldn’t wait 3 years.
How to speed things up?
There are several ways to speed things up:
- More flexibility on pay and reward within the ARRS budget.
- Encourage innovative providers like Medacy who can provide a pharmacist-led clinical service and reduce GP workload from day 1.
- Redesign of the PCPEP so it’s designed around the needs of each pharmacist, not a one-size-fits-all approach.
- Bring in other providers for PCPEP to stimulate innovation.
- For clinical pharmacists – focus on activities that use their skills and free up GP time rather than SMRs which are a “nice to do” rather than a “need to do.”
- Include experienced coal-face clinicians in designing the Contract DES. Too often, the documents smell of ivory towers rather than coal face clinicians.
In conclusion, I’m a big fan of ARRS funding, but we are missing the opportunity to use the funding to make a difference now. We need more flexibility in the system.
