Background

The Additional Roles Reimbursement Scheme (ARRS) was launched in 2019 as part of the government’s manifesto promise to improve access to general practice. The government committed to funding an extra 50 million general practice appointments by 2024 and to increase the staff available across primary care to increase capacity to deliver the additional appointments.

In addition to clinical staff, the manifesto included aims to extend social prescribing, which would support patients struggling with the wider determinants of health, such as housing, poverty and isolation. The ARRS addressed this promise by including social prescribing link workers as one of the first roles available as part of the scheme. These additional staff would be able to connect primary care to other local organisations and bridge the gap between community, charity and local authority services, bringing together health and wellbeing within a general practice setting. 

As primary care prepares for the 2024/25 GP contract, this report reflects on the success of the ARRS against the original aims and its progress towards overcoming existing challenges in primary care. It provides a set of recommendations for how the scheme can develop beyond 2025.

At a glance: The Additional Roles Reimbursement Scheme 
In 2019 the scheme was launched with the commitment to introduce 26,000 extra staff into primary care practice by 2023/24. Initially, primary care networks (PCNs) could choose from five roles. Over time the list has grown to 17, many of which had not previously been available within primary care. PCNs can recoup the employment costs of these roles from the scheme up to their allocated funding allowance, based on the size of the patient population. The additional staff were intended to see patients who would otherwise have seen a GP but did not require a GP intervention. As a result, GPs would have increased capacity to provide appointments to those patients who required a GP or would benefit from greater continuity of care. 

To make use of the scheme, each PCN determines a baseline staff number, agreed with the commissioner. Only recruitment into additional roles above this baseline can be claimed through the ARRS. Each PCN is then assigned a ‘single combined maximum sum’ which is the full monetary value they can claim through the scheme. This funding covers the employment costs – including wage, pension and national insurance – of the new member of staff, in theory enabling them to be employed by the PCN without incurring additional costs to practices. PCN leaders can then determine the skill mix they need and recruit into the available roles at the most appropriate pay banding covered by the scheme.