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Add practice nurses to ARRS to tackle deprivation, suggests report

Add practice nurses to ARRS to tackle deprivation, suggests report

Being able to recruit general practice nurses (GPNs) through the Additional Roles Reimbursement Scheme (ARRS) would better support more deprived areas and ‘bring skills’ that cannot be replicated by current roles on the scheme, new analysis has suggested.

The research published today by the Health Foundation also warned of ‘longstanding difficulties’ recruiting practice nurses and that new staff recruited via ARRS were being used to ‘plug existing gaps’.

Drawing on interviews with primary care network (PCN) leaders and local commissioners, the report – Doing More for Less – suggested the most deprived areas of England are missing out on funds and additional staff because of ‘skewed’ funding arrangements.

It claimed that areas with high deprivation were missing out because the greater health needs of their populations were not adequately taken into account by current funding arrangements.

And it said practices in the poorest areas could benefit from an additional £18.6m a year if funding better accounted for deprivation.

Interviewees told researchers of examples of PCN contract ‘flexibilities’ that could ‘strengthen their ability to deliver improvements for their patients, given the additional challenges faced in areas of high deprivation’.

This included the ‘ability to recruit GPs and practice nurses as part of ARRS to account for historic under-doctoring in more deprived areas and bring skills current ARRS roles cannot replicate’, the analysis said.

In addition, some primary care leaders warned of the ‘longstanding difficulties recruiting GPs and practice nurses’ and said this was having ‘knock-on effects for PCNs’.

‘Some interviewees spoke about how new staff recruited via the ARRS were being used to plug existing workforce gaps and shore up core general practice,’ the report said.

‘They felt that more affluent areas were able to use these new staff, and the PCN agenda overall, to focus on longer term plans while those in areas of high deprivation spent much of their time “firefighting”.’

The findings come after the Royal College of Nursing’s (RCN) professional lead for primary care told Nursing in Practice that GPNs are increasingly being substituted with nursing associates – a move that she said was ‘devaluing’ the profession and their skills.

Heather Randle said the RCN was ‘seeing a lot of role substitution’ since the introduction of the ARRS in 2019, namely with nursing associates and care coordinators being used in place of GPNs.

Launched in 2019, the ARRS programme allows primary care networks to claim reimbursement for the salaries of some multidisciplinary roles into practices. While the scheme covers nursing associates and advanced nurse practitioners, it does not include GPNs.

The new research suggested that, when increased need is accounted for, there were significantly fewer ARRS primary care staff in the most deprived areas compared with the least deprived areas – six fewer per 100,000 needs-adjusted patients.

The Health Foundation said the disparity between affluent and deprived areas was particularly concerning given that PCNs have been tasked with reducing health inequalities.

And it urged NHS England to reform its funding formulas to ensure PCNs in areas of high deprivation receive the funding they need.

Dr Rebecca Fisher, a GP and a senior policy fellow at the Health Foundation, said: ‘General practice in the poorest areas, where people have the greatest health needs, is missing out on much needed funding and additional staff.

‘Without this, the health of people in more deprived areas risks falling even further behind other parts of the country.’

A version of this article first appeared on our sister publication Pulse PCN.

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