Increase in ARRS nursing roles despite total staff drop

The number of advanced nurse practitioners (ANPs), enhanced level practice nurses and nursing associates employed to work in GP practices through the additional roles reimbursement scheme (ARRS) has increased over the last 12 months, new data has shown.

There has also been a rise in community mental health nurses and trainee nurses recruited through the scheme.

This comes despite the overall number of ARRS staff – employed by primary care networks to work across GP practices – falling for the first time in 12 months.

Introduced in 2019, the ARRS enables PCNs to claim salary reimbursements for a range of primary care roles, including nursing associates, advanced nurse practitioners and, in 2024, enhanced level practice nurses.

General practice nurses (GPNs), new and experienced, were added to the scheme last year – however NHS England does not currently share data on how many have been employed through the scheme, despite publishing monthly and quarterly reports on primary care workforce numbers.

According to analysis by our sister title Pulse PCN, the latest NHS England primary care network workforce figures show that the number of full-time equivalent (FTE) ARRS staff fell by 123 from a peak of 27,890 in March to 27,767 in April.

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This is a drop of just 0.4% but is the largest monthly fall in records going back to March 2020.

The figures also show that the number of FTE staff fell in April across 14 ARRS roles, compared to eight which saw increases and 16 that remained static.

When looking at the different roles, it is noteworthy that the number of ANPs has increased from 552 in April 2025 to 716 in April 2026. However, it is unclear if all those reported under this job title are in fact ANPs. The data set notes that some PCNs may be reporting enhanced nurse practitioners as well as advanced clinical practitioner nurses under the ANP reporting line.

Changes were made in the PCN contract in 2024/25 that widened the criteria for recruiting ANPs through ARRS. The contract went even further in 2025/26 by removing the mandatory requirement for ANPs recruited under the ARRS to have a controversial NHS accreditation badge.

Meanwhile, it appears PCNs have been increasingly recruiting enhanced nurses since they were added to the scheme – with a rise from just 28 in April 2025, to 135 in April 2026.

There have also been small increases in the number of nursing associates – up from 550 to 593 in the same period – and community mental health nurses, up from 60 to 67 in the last 12-month period.

The number of trainee nurses employed through the scheme has also risen from 42 to 50 in the 12 months to April 2026.

However, a small decline in nurse specialists can be seen in the dataset – dropping from 136 to 130 in the 12 months to April 2026. And the number of trainee nursing associates has fallen from 406 to 333.

Chief executive of the Queen’s Institute of Community Nursing (QICN) Steph Lawrence said: ‘It is positive to see growth in advanced nurse practitioners, enhanced nurses, nursing associates, trainee nurses and community mental health nurses in primary care networks.

‘These roles can make an important contribution to patient care and, when deployed appropriately, can strengthen multidisciplinary working and broaden access to support in the community.’

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However, she pointed to research from the QICN from 2024 that warned ‘increasing headcount in selected roles does not, in itself, resolve the workload pressures facing nursing in primary care’.

The research had also suggested that more than three-quarters of general practice nurses (GPNs) in England were not consulted on the introduction of roles under the ARRS.

‘Where roles are introduced without sufficient planning, clarity, supervision and investment in the wider nursing workforce, there is a risk that existing pressures are simply redistributed rather than reduced,’ said Ms Lawrence.

‘The reduction in nurse specialists and trainee nursing associates is therefore concerning.’

She added: ‘A planned and resilient community nursing workforce requires sustained investment, the right skill mix, a strong training pipeline and workforce decisions based on local population need, not short-term funding mechanisms alone.

‘If policy ambitions for prevention, neighbourhood health and care closer to home are to be realised, community nursing capacity must be strengthened in a strategic and evidence-led way.’

Ms Lawrence said the QICN would also like to see data on the number of GPNs employed through the scheme.

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‘We also look forward to seeing data on general practice nurses working through the ARRS scheme, as they play a vital role in prevention, long-term condition management and delivering care closer to home,’ she said.

The increase in ARRS ANPs comes amid concerns the role is being undermined by comments made by doctors around substitution and alleged patient safety risks.

Nurses speaking at the Royal College of Nursing (RCN) Congress last month stressed that GPs ‘would drown’ without their vital ANPs.