GPs in the Additional Roles Reimbursement Scheme (ARRS)

Challenges and considerations for GP ARRs

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The employment of GPs under the Additional Roles Reimbursement Scheme (ARRS) continues to be a topic of considerable discussion among GPs and Primary Care Networks (PCNs) across England. There are ongoing concerns about the implications of this scheme, particularly with the structure and pay associated with the roles. The British Medical Association (BMA) has outlined that GPs in these roles are employed under a model contract and paid on a sessional basis, with a full-time equivalent (FTE) of nine sessions capped at £73,114, which PCNs can augment to £92,462 (outside London) to cover additional costs. However, these rates are generally perceived as uncompetitive, potentially fostering a two-tier salary system within PCN member practices.

Some Local Medical Committees (LMCs) have advised PCNs and GPs to forgo using this ARRS funding, viewing it as underfunded and inadequately structured, which reflects NHS England’s broader undervaluation of GPs. Concerns have been raised about the roles these newly qualified GPs would undertake; multiple practice deployments may not offer the practice team integration and supportive environment ideal for early-career GPs. The flexibility for PCNs to shape the job role exists, but it requires mutual agreement among member practices, especially since there is no specific job description for GPs under ARRS, unlike other ARRS roles.

PCNs may choose to supplement the sessional funding allocation for GPs, as they can for other ARRS roles, but they cannot use ARRS funding for cross-subsidisation between roles. Overspending in these allocations requires PCNs to draw on other income streams, such as PCN Core Funding, with member practices bearing the financial risk.

The flexibility within the BMA Model Contract allows PCNs to adapt the terms of employment and workload associated with these GP roles. However, there is concern over how Integrated Care Boards (ICBs) and NHS England might monitor the use of this funding. For example, if a PCN claims the maximum ARRS allocation, it implies nine sessions per week for a GP, including Continuing Professional Development (CPD) as part of the Model Contract. Currently, PCNs are not required to submit job plans, though it remains uncertain if NHS England might request monitoring to confirm the deployment of sessional commitments.

The BMA suggested funding specialist GP roles, such as safeguarding, through ARRS during the 2024/25 negotiations but expressed reservations about including generalist GP roles under this funding scheme. The BMA will continue to engage with NHS England, seeking clarification on these matters and advocating for appropriate funding and recognition of GP roles within PCNs. Further guidance will be circulated to PCNs and GPs as it becomes available.

I am writing to all colleagues regarding the letter sent by NHS England to remind all PCNs about their 2024/25 GP in ARRS funding.

Colleagues will recall that from October 2024, the ARRS was amended and additional funding provided to allow the recruitment of GPs under the ARRS. This was a response to the widespread concerns about GP unemployment and under-employment at a time when the demand for General Practitioners’ skills and expertise has never been higher.

However, there were a number of criteria applied to such recruitment, including that the salary scale was set at the lowest point of the BMA sessional doctors salary scale, and that such GPs needed to be within two years of their CCT when appointed. Such GPs are entitled to BMA Model Contract terms and conditions.

Recruitment of GPs under this Scheme has been lukewarm; the DHSC and NHS England are apparently under the misapprehension that the primary barrier to recruitment was uncertainty over the Scheme following March 2025, and as part of proposals for the 2025/26 GP Contract, the Secretary of State wrote to all GPs confirming this additional GP funding would continue into financial year 2025/26. Obviously, this is helpful, but it is unlikely that such uncertainty is the main barrier to GP recruitment and more fundamental concerns may include:

  • The reimbursement salary cap: it is not feasible to recruit GPs at a sessional rate of £8124 (£73.114 annually with nine sessions equalling FT) Instead, PCNs are supplementing such colleagues’ salaries via other PCN income streams, which they are entitled to do, but, by doing so, are subsidising the real cost to NHS England of securing GPs to work within General Practice.
  • The requirement that limits recruitment to GPs within two years of their CCT. Whilst it is important to support recently qualified colleagues, this restriction ignores the opportunity for such funding to enable GPs at many different stages of their career to secure work.
  • The cap on the number of GPs that can be recruited under the scheme : whilst this can work for a single practice : single PCN, PCNs have a median number of five member practices. Recently qualified GPs should ideally have the support and assurance of working closely with a practice-centred team of colleagues. Trying to deploy recently qualified GPs to multiple practices or other working environments, such as Enhanced Access appointments, does not represent the best use of their experience and also professional needs. Loosening the cap (and eligibility criteria) completely means PCNs would be able to recruit a range of GPs to cover multiple roles within their practices and PCN.

These approaches, which would substantially increase the potential recruitment of GPs, would be further enhanced if more PCNs adopted that approach many already do, devolving a proportionate ARRS spending budget to each member practice and allowing autonomy of ARRS recruitment decisions amongst each practice.

When considering recent NHS England/ICB correspondence, PCNs should be reminded that they are under no obligation to recruit GPs under their remaining 2024/25 GP in ARRS budget if member practices do not believe it is in their best interests to do so. One can only speculate why NHS England has felt it appropriate to specifically encourage such recruitment at this stage. As colleagues now have the assurance that funding will continue into 2025/26, the option remains to see if recruitment criteria, following feedback from many PCN CD and practices, are amended.

The LMC is also aware many PCN CDs and GP practices are being targeted by locum and recruitment agencies who are highlighting GPs available for recruitment under the Scheme. This often comes with required agency or commission fees which must be paid by the PCN. This cost cannot be reclaimed under ARRS funding and seems a complete waste of NHS resources.

PCNs should therefore feel no obligation to say they plan to recruit GPs under ARRS if encouraged by the ICB to do so: it is also helpful for ICBs to feed back to NHS England any comments GP colleagues have about the way the Scheme currently operates, and suggestions for improvement, as this may help shape future policies.

Dr Julius Parker, Chief Executive

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