Third of practices considering replacing non-GP ARRS staff with GPs

More than a third (37%) of GP practices in England are considering or have already started replacing non-GP Additional Roles Reimbursement Scheme (ARRS) staff – which includes nursing staff – with GPs, a survey has shown.

The Royal College of Nursing (RCN) said it continued to have ‘reservations’ about the ARRS and that any staffing changes must not come ‘at the expense of nursing roles’.

The ARRS is a scheme introduced by the government in England in 2019 which allows primary care networks (PCNs) to reimburse the salaries of staff to work across GP practices.

Changes to the GP contract for 2024/25 saw the previously ringfenced ARRS funding for GPs combined into the pot with all other roles, meaning PCNs are no longer capped on how many newly registered GPs they can recruit within the boundaries of the ARRS.

General practice nurses – both new and experienced – were also added to the list of roles that PCNs can employ under the ARRS this year.

In a survey carried out by our sister titles Pulse and Management in Practice in April, GP partners and practice managers across 501 GP practices were asked whether their PCN was considering replacing non-GP ARRS staff with GPs.

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Some 24% of respondents said they had ‘discussed’ this, while 8% said they had ‘started taking action to do so’. A further 5% said they had ‘done so already’.

One survey respondent said: ‘Our PCN is split about this and there is a real risk that the working relationship will break down.

‘We have decided that we wish to decide what roles are best for us, have them work directly for us and be part of our team, and choose who we have for those roles.’

Another said the work of non-GP staff had been of high value and had helped ‘take work away from GPs’.

‘It is more likely we will invest in more non-GP ARRS roles than the other way round,’ they said.

Latest quarterly primary care workforce figures – which combine the National Workforce Reporting Service (NWRS) submissions and the Additional Roles Reimbursement Scheme (ARRS) claims – show the number of nursing associates working in general practice and PCNs has increased by 21% in a year, with 1,115 full-time equivalent (FTE) in post as of March 2025.

The number of advanced nurse practitioners is up 1.8% in the same period, standing at 4,541 FTE as of March 2025.

Enhanced level practice nurses were added to the scheme last year – with 31 FTE in post as of March 2025. This is the first time data for this group has been published.

The data also shows there are 17,889 nurses working in general practice and PCNs in England as of March 2025 – up just 1.1% in a year. It is not yet clear how many general practice nurses have been employed under ARRS since they were only added to the scheme this year.

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Responding to the survey findings, executive director of RCN England Patricia Marquis said: ‘We continue to have reservations about whether the current model of ARRS is the right way to enhance both staffing capacity and capability in general practice.

‘We are clear, however, that there must be an increase in nursing staffing capacity at all levels in primary care to enable the delivery of the high-quality services patients need.’

She added: ‘Any staffing changes must come with an assurance that they do not come at the expense of nursing roles which could add to pressures in already overstretched health and care services.’

As reported last week, practice managers are currently pushing the government for a dedicated funding pot that will ensure general practice nurses and other staff receive pay rises equivalent to their NHS counterparts.

It comes as the RCN criticised the government for its lack of ‘clear’ messaging around a pay rise for general practice nurses for 2025/26.

A special investigative series by Nursing in Practice recently explored the negative impact the ARRS scheme has had on the practice nursing workforce since its introduction.

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This survey was open between 31 March and 14 April 2025, collating responses using the SurveyMonkey tool. The survey was advertised to readers of Pulse and Management in Practice via their websites and email newsletters, with a prize draw for a £200 John Lewis voucher as an incentive to complete the survey. Respondents were asked for practice codes or practice names and postcodes. We removed those with duplicate email addresses, and searched for duplicate IP addresses, removing obvious duplicate entries. The survey was unweighted, and we do not claim this to be scientific – only a snapshot

A version of this article was first published by our sister title The Pharmacist