The Additional Roles Reimbursement Scheme (ARRS) has become an integral component of Primary Care Network (PCN) operations across the UK, helping to expand the primary care workforce. With current funding only confirmed until 2025/26, many PCN clinical directors, practice managers and GPs are increasingly questioning what might happen next. This article explores the potential future of ARRS beyond its current funding commitment.

Current Status of ARRS

The ARRS was introduced as part of the NHS Long Term Plan and the subsequent PCN Direct Enhanced Service (DES) contract. The scheme provides funding to PCNs to recruit additional workforce capacity through specific roles, including clinical pharmacists, social prescribing link workers, physiotherapists, physician associates, and several others.

As it stands, NHS England has committed to funding the scheme until the end of the 2025/26 financial year. The scheme currently supports over 20,000 professionals across England in various roles designed to complement the work of GPs and alleviate pressure on primary care services.

PCNs can claim reimbursement for these roles at set rates, which has enabled a significant expansion of the primary care workforce without placing the full financial burden directly on practices.

Potential Scenarios After 2025/26

While no official announcements have been made regarding the future of ARRS beyond 2025/26, several scenarios could unfold:

• Full continuation: The scheme could be extended in its current form, providing continuous support for the additional roles that have been established.
• Modified continuation: The scheme might continue but with adjustments to funding levels, eligible roles, or reimbursement percentages.
• Gradual phasing out: Funding could be slowly reduced over several years, giving PCNs time to transition to alternative funding arrangements.
• Integration into core contract: ARRS funding might be incorporated into the core GP contract, potentially with less ring-fencing.
• Complete cessation: Though less likely given the widespread adoption of ARRS roles, funding could end completely, requiring PCNs to self-fund these positions or discontinue them.

The direction taken will likely depend on evaluations of the scheme's effectiveness, broader NHS financial constraints, and the evolving primary care strategy post-2025.

Workforce Planning for an Uncertain Future

Given the uncertainty surrounding ARRS beyond 2025/26, PCNs should begin developing workforce resilience strategies:

• Evaluate role effectiveness: Assess which ARRS roles have delivered the most value to your PCN and patient population.
• Develop business cases: Create detailed analyses demonstrating how each role contributes to service delivery, reduces GP workload, or improves patient outcomes.
• Consider skill mix: Review whether your current ARRS staffing model is optimal or if adjustments could enhance efficiency.
• Succession planning: Develop plans for knowledge transfer should certain roles become financially unsustainable.
• Staff retention strategies: Implement measures to retain valuable ARRS staff through professional development and career progression pathways.

PCNs that can clearly demonstrate the impact of their ARRS workforce will be better positioned to make the case for continued funding or to secure alternative resources.

Financial Implications and Budgeting

Prudent financial planning is essential as PCNs approach the 2025/26 funding cliff edge:

• Financial modelling: Create scenarios for how your PCN would manage with different levels of ARRS funding.
• Contingency reserves: Consider building reserves to cushion any transition period if funding arrangements change.
• Income diversification: Explore whether ARRS roles could generate income through service provision to other organisations.
• Shared investments: Consider partnerships with other PCNs or healthcare providers to share costs of specialist roles.
• Return on investment calculations: Quantify financial benefits of ARRS roles, such as reduced locum costs or enhanced care delivery.

"PCNs should not wait until 2025 to begin financial scenario planning. The most resilient networks will be those that have already modelled different funding outcomes and developed contingency plans." - NHS Confederation Primary Care Network advice

Making ARRS Roles Sustainable

Regardless of future funding decisions, PCNs can take steps now to embed ARRS roles more deeply into their service delivery models:

• Process integration: Ensure ARRS roles are fully embedded in clinical pathways rather than operating as separate services.
• Team development: Strengthen multidisciplinary working to maximise the efficiency of all clinical and non-clinical staff.
• Patient awareness: Increase patient understanding of and demand for services provided by ARRS professionals.
• Evidence generation: Collect robust data on outcomes, patient satisfaction, and system benefits of ARRS roles.
• Efficiency improvements: Identify ways ARRS staff could work more efficiently or expand their scope with minimal additional resources.

The more integrated these roles become into everyday service delivery, the harder it will be to unwind them, potentially strengthening the case for continued support.

What Experts Are Saying

While there is no official position yet on post-2025/26 arrangements, various stakeholders have expressed views:

• The British Medical Association has indicated that ARRS has become fundamental to primary care delivery and should be maintained in some form.
• The NHS Confederation has suggested that evaluation of the scheme's impact will be crucial in determining its future.
• Some PCN Clinical Directors have advocated for greater flexibility in how ARRS funding could be used in the future.
• Royal Colleges representing various healthcare professions have emphasised the importance of career stability for staff recruited through the scheme.

The consensus appears to be that some form of continued support for expanded primary care teams is likely, though the exact mechanism remains uncertain.

Preparing for 2025/26 and Beyond

While the future of ARRS remains unclear, PCNs can take proactive steps to prepare for any scenario. By demonstrating value, integrating roles effectively, planning financially, and advocating collectively, networks can build resilience against funding changes.

PCNs should engage with their local systems, Integrated Care Boards, and representative bodies to ensure their experiences with ARRS inform national decision-making. By starting these preparations early, networks will be better positioned to navigate whatever changes emerge as we approach and move beyond 2025/26.

For practices and PCNs looking to maximise the value of their ARRS workforce now, consider how your additional roles could support key services such as QOF achievement, medication reviews, and management of discharge letters.