A petition calling for practice nurses to be included within the Additional Roles Reimbursement Scheme (ARRS) has received more than 2,000 signatures.
Spearheaded by out of hours GP Dr Stephen Katona, the petition suggests GP practices should be allowed to use ARRS funding to employ experienced general practice nurses (GPNs), as well as salaried and locum GPs.
Dr Katona told Nursing in Practice he believed there was ‘no rationale’ for their current exclusion from the scheme, which allows primary care networks to claim reimbursement for the salaries of some multidisciplinary roles – including nursing associates and advanced nurse practitioners – into practices.
‘If a GP practice wants to spend practice money on practice nurses, salaried GPs and locum GPs then it has to reduce the salaries of the GP partners running the practice,’ he said.
‘Adding these roles to the list of ARRS funded roles would solve this inequality. ARRS could be known instead as RRS. Staff should not be paid from different sources of funding.’
His petition, launched in December, was about having ‘equality and the right for healthcare professionals to compete for jobs based on their knowledge and experience’, added Dr Katona.
‘A practice nurse with 20 years’ experience needs to be valued and paid appropriately,’ he said.
‘At the moment practice nurses, salaried GPs and locum GPs are being subjected to financial discrimination and this needs to end.’
However, the petition appears to have received a mixed reaction from GPNs.
Ali Nixon, lead GPN in Lincolnshire, said she signed the petition ‘as it seems to be such a sensible idea’.
She told Nursing in Practice: ‘ARRS provides extra healthcare professionals but not the right fit to provide the excellent care given by GPNs.’
Allowing GPNs and GPs to be funded through the scheme ‘might just stop some of the mass exodus of dedicated but totally demoralised and overworked doctors and nurses who are the backbone of primary care’, added Ms Nixon.
Meanwhile, Dr Helen Anderson, research fellow at the University of York and a registered nurse by background, said the exclusion of GPNs from ARRS ‘has had a number of unintended consequences’.
This included the employment of roles which she said ‘lack a strong evidence base, rather than well-established and evidenced based general practice nursing roles’.
In addition, she said the situation had seen ‘increased employment of nursing associates, rather than registered nurses, leading to potential fragmentation and ‘taskification’ of care and loss of expert nursing’.
This was an issue raised recently by the Royal College of Nursing’s primary care lead Heather Randle, who warned GPNs have increasingly been substituted with nursing associates, since the ARRS was introduced in 2019 – a move which she said was ‘devaluing’ the profession and their skills.
Dr Katona’s petition requires 10,000 signatures in order to receive a response from the government and 100,000 to be considered for debate in parliament.
However, Lee Collins, a GPN in Cornwall, told Nursing in Practice that he felt the petition does not go far enough and that the ARRS funding scheme, in its current form, should be ‘scrapped’ altogether.
Instead, he said a ‘wider stream of staff funding should be introduced’, which allowed ‘balanced recruitment to the general practice team’.
‘ARRS has focused on recruiting new roles to the practices using a financial incentive whilst turning its back on the core clinicians that have been working in the finely tuned eco-system for decades,’ said Mr Collins.
He accused the scheme of squeezing out experienced doctors and nurses and leading to ‘many inexperienced team members taking on work in long-term condition management that ticks boxes, but has led to a declination in quality of care’.
‘GPs and GPNs need to be able to stand up for and advocate for best patient care,’ he added. ‘ARRS in its current form does not do this.’
Meanwhile, Sandra Dyer, an advanced nurse practitioner in primary care, said the petition’s proposal was ‘interesting’ but that the impact of adding GPNs and GPs to ARRS was unclear, and could even ‘destabilise the workforce further by lots of movement of staff’.
Last month, research from the Health Foundation suggested that being able to recruit GPNs through ARRS would better support more deprived areas and ‘bring skills’ that cannot be replicated by current roles on the scheme.
Meanwhile, also in December, Conservative MP Andrew Rosindell asked whether the government planned to include GPs in ARRS, to which primary care minister Andrea Leadsom said that changes to the scheme ‘are made as part of wider changes to the GP contract’.