The move to enable primary care networks (PCNs) in England to recruit one general practice nurse working at an ‘enhanced’ level through the Additional Roles Reimbursement Scheme (ARRS) has been met with widespread confusion and calls for clarification.
NHS England announced on Wednesday that enhanced practice nurses will be included in the list of roles that PCNs can claim salary reimbursement for under the ARRS – capped at one per PCN or two for those with 100,000 patients.
An enhanced practice nurse has been defined loosely by NHS England as a nurse with ‘a level seven or above postgraduate certification or diploma in one or more specialist areas of care’.
It is not currently a job role recorded by practices or PCNs for workforce data collection and there are no further details from NHS England about the new ARRS role at present.
However, it is understood to be in line with the Primary Care and General Practice Nursing Career and Core Capabilities Framework, which states enhanced practice nurses are a level above registered nurses and below advanced and consultant level practice nurses.
According to the framework, which is supported by the Royal College of Nursing (RCN) and Queen’s Nursing Institute, nurses at this level ‘require a critical understanding of detailed theoretical and practical knowledge, which can be generalist with a special interest and/or have management and leadership responsibilities’.
Those at an enhanced level must have the independent/supplementary nurse prescribing (V300) qualification, and have completed modules or learning that ‘enable the delivery of general practice nursing at a specialist/enhanced level that are aligned to scope of practice’, the framework states.
It also suggests the role is suitable for senior practice nurses, nurse practitioners, specialist nurses and nurse managers.
NHS England’s primary care lead Louise Brady also stated on social media that enhanced practice is ‘usually delivered by mid-career experienced GPNs with postgraduate certifications or qualifications in long-term condition care and/or public health spheres’.
In December, Ms Brady had appealed to nurse leaders in England to help her map existing educational resources for general practice nursing staff against this framework.
Today, GPNs have expressed concerns about the enhanced nurse role being open to interpretation and that it could potentially cause further disparities in pay. Many have called for further details on who is applicable.
Ellen Nicholson, a Queen’s Nurse and co-chair of the RCN GPN Forum, told Nursing in Practice that ‘how “enhanced” is interpreted will be the interesting point’.
‘Will this be a GPN with a level seven in independent prescribing or a GPN with a level seven in diabetes management or respiratory management? Or it could be a nurse coming in to provide a specific identified service who has not previously worked in general practice,’ she said.
When it was first revealed earlier this month that nurses were to be added to the ARRS it was believed this would be GPNs more widely, and not just an enhanced position. However, it emerged this week that the move had ‘not been signed off’.
Ms Nicholson said she thought the move ‘presents opportunity’, adding: ‘It was unlikely to have included a GPN role rather than enhanced – imagine the demand for that. Plus, GPN is a core role, it’s not ARRS.’
Meanwhile, Sandra Dyer, an advanced nurse practitioner in primary care, also said she was ‘not completely clear what the definition of enhanced level GPN is’ and felt this ‘needs clarification’.
Ms Dyer and others among the profession have also aired concerns that only ‘a small number’ of enhanced nurses will be added to ARRS, given there are 1,250 PCNs in England.
Lead GPN in Lincolnshire Ali Nixon said while it was ‘early days’ she found the announcement ‘disappointing’.
‘One enhanced practice GPN per PCN, perhaps two. We need more details, a clear plan and understanding of how they think this will work.’
She added: ‘We are one of nine practices in our PCN. Are we expecting to share this enhanced practice GPN between the nine?
‘More information is needed and lack of communication seems to be what we get.’
Meanwhile, Jan Gower, GPN Fellowship Lead, Cambridgeshire and Peterborough Training Hub, questioned where these enhanced practice nurses would be recruited from.
‘Unless they take on a new specialist nurse, say a diabetes nurse specialist – but who has no GPN experience – then the only pool of staff they could recruit from are existing GPN staff already in posts,’ she told Nursing in Practice.
‘My concern is that they will move an existing GPN into that role, who has a postgraduate level seven diploma, and then backfill with a nursing associate or healthcare assistant.’
Separately, she was also concerned that the move could see nurses in GP practices ‘on completely different terms and conditions’.
The maximum reimbursable amount per ARRS role is typically linked to Agenda for Change pay bands and in recent years ARRS staff have been eligible for pay rises in line with Agenda for Change. Meanwhile, GPNs are typically employed by the GP practice.
The RCN’s director for England Patricia Marquis expressed similar concerns.
‘Including enhanced nurses within the ARRS should give practices more flexibility to bring skilled and qualified nursing staff into primary care networks,’ she said.
‘However, without due care the move could exacerbate the two-tiered nature of nursing pay between general practice and the NHS.’
She too stressed it ‘remains to be seen what the role and responsibilities of these positions will be’.
‘Enhanced nurses in a primary care network must be able to grow nursing leadership within primary care, not plaster over gaps in services,’ added Ms Marquis.
The news came within a letter from NHS England’s primary care director Amanda Doyle on Wednesday, outlining details of the 2024/25 GP contract.
This included an overall increase in investment of £259m taking overall contract investment to £1,186m – a 2.23% increase, as reported by our sister title Pulse.
This story was updated on 5 March to clarify that the maximum reimbursable amount per ARRS role is typically linked to Agenda for Change pay bands and in recent years ARRS staff have been eligible for pay rises in line with Agenda for Change. ARRS staff are not on full Agenda for Change terms and conditions.
