The Additional Roles Reimbursement Scheme (ARRS) was introduced by NHS England in 2019 to support expansion of the primary care workforce. It allows Primary Care Networks (PCNs) to claim reimbursement for the salaries of 17 new roles within multidisciplinary teams, with a focus on improving general practice services. The scheme was expanded to include enhanced practice nurses in April 2024.

A proposed change to the GP contract for 2025/26 would further expand ARRS to include reimbursing employment of general practice nurses. To be eligible a new ARRS role cannot replace an existing role within a Primary Care Network. This proposal is now contingent on the BMA’s agreement. Concerningly, this change to nursing could be without the input of the RCN, or any nursing bodies.

While the proposed change recognises additional investment is needed to increase the nursing workforce within general practice we have concerns about: 

1. how the ARRS scheme is used today, 

• Patient care and safety: ARRS, if implemented badly may not align with the principles of continuity of care and personalised care, as it requires nursing staff to work across multiple practices.
• Short-term: ARRS works well to move nursing skills from one part of the General Practice system to another. It does not address the root cause of the nursing staff shortage in General Practice or offer a long-term solution.
• Unstable employment: ARRS employment contracts are sometimes fixed term and or “subject to available funding rather than permanent.
• Difficult to engage with: The ARRS credentialing process can be a barrier for some nursing staff to apply for these roles. This limits engagement and opportunities to progress if specialist skills are reserved for ARRS roles. Pay: While ARRS employment contracts are often aligned to Agenda for Change pay, terms and condition – there is no consistency or additional funding to support nursing staff employed on ARRS to receive or maintain fair pay, terms and conditions. In 2024/25 any pay uplifts to ARRS staff came from existing PCN budgets with no additional funding provided.

2. and the impact of proposed changes. 

• Patient safety: Practice Nurses are a core part of the general practice workforce. They are not additional roles and positioning practice nursing roles within this scheme puts establishment staffing at risk.
• Nurse to patient ratios: Without any nurse to patient ratios or safe staffing minimums the expansion of this scheme could see practices replace nursing roles with other professions without clear evidence of impact on patient safety or need.Pay: By channelling additional funding to general practice through ARRS, government has avoided addressing the long-term inequities and pay disparities in general practice nursing.

The RCN calls for an equitable and stabilising approach to General Practice Nursing employment to create a sustainable workforce that supports high-quality patient care. This would include ringfenced funding to employ General Practice Nursing staff on permanent contracts with at least equivalent pay and conditions to NHS Agenda for Change staff. This should include entitlement to and provision for the annual NHS pay uplifts. 

If additional nursing roles are added to the ARRS scheme this should be done to support core practice nursing staff for example focused on quality improvement or mentorship or reintroduction of the GPN Fellowship Programme .