PCN DES

Primary Care Networks (PCNs) are signed up to the Network Contract Directed Enhanced Service (DES), which was first introduced in July 2019. PCNs are designed to build on the core work of primary care services and ‘enable greater provision of proactive, personalised, coordinated and more integrated health and social care for our communities’ (NHS England » Network Contract DES). Part of the PCN funding includes the additional Roles Reimbursement scheme (ARRs) to provide investment for around 26,000 more health professionals. Since the ARRs were introduced the list of possible roles eligible has increased. We recognise that making best use of the ARRs funding for your PCN and community can be difficult, so the focus of this guide is to bring together resources for the ARRs to support your workforce.

Where can I find all the contract details?

(Don’t worry we have tried to summarise the relevant ARRs points in this guide for those that don’t need the minutiae of the contracts!)

• Network Contract DES- Contract Specification 2022/2023- PCN Requirements and Entitlements – To access the contract specification, guidance and also useful FAQs, please click here.

What is meant by ‘principle of additionality’?

• For full details please see section 7.2, page 35-38 in NHS England Report Template 7
• Essentially the additionality means a PCN must demonstrate the role being employed using ARRs funding is an additional role, and not being used to fund an existing role
• Initially additionality was measured on a baseline of staff in primary care as taken at 31st March 2019, against the 6 ARRs as they were at the time (clinical pharmacists, social prescribing link workers, first contact physiotherapists, physician associates, pharmacy technicians and paramedics).
• A further 9 additional roles were added later on, for which a PCN baseline was not established (health and wellbeing coaches, care coordinators, dieticians, podiatrists, occupational therapists, nursing associates, trainee nursing associates, advanced practitioners and mental health practitioners). Although the PCN baseline doesn’t include these 9 roles, additionality principles still apply. Therefore these roles must be for additional staff, engaged or employed, since 31st March 2019
• For any queries about additionality please speak with the ICB prior to offers of employment –glicb.pcn@nhs.net
• There were some exemptions to the additionality principles for clinical pharmacists and pharmacy technicians employed via the Medicines Optimisation in Care Home scheme. For full details please see the link above in the top of this section.

What is the funding for ARRS ?

• 100% of the salary per role, based on the WTE and up to the maximum amount outlined within the contract (please also see the table further down this page). The only exception is for mental health practitioners, where 50% can be claimed (due to the joint employment model stipulated)
• The ARRs sum per PCN equates to ‘£16.696 multiplied by the PCN Contractor weighted population as at 1 January 2022’. There are various online ARRs calculators that can support working out the sums.
• For social prescribing link workers only a management fee may be claimed where a social prescribing service is sub contracted, up to £200 per month, pro rata. For full details please see section 10.5.9 on pg.67 in the Network Contact DES.

What do you need?

• We understand it can seem difficult to know where to start with the additional roles. Some roles may seem ‘easier’ than others in terms of recruitment and day-to-day supervision.
• We would encourage your practice and PCN to really consider what it is you need to support your patient demand, population health needs, current workforce and future workforce (considering retirements, skill mix and more)
• You may wish to consider:
  • Patient demand audits (what are patients presenting with)
  • Workforce data packs provided by the training hub annually to PCNs
  • Population health needs and consideration of health inequalities
  • Skill mix
  • Reviewing the IIF dashboard and identifying areas that may need work or extra support
  • Speaking to existing staff and getting their views
  • Speaking to other PCNs that already employ a role of interest
  • What educator/supervision capacity do you have and how can this be developed to support ARRs (liaison with your PCN Education lead might be a good starting point)
• By understanding what is needed this can help to consider which ARRs role(s) are right for you. The following guide will hope will support more in depth discussions around each role
• Multidisciplinary Team working Toolkit – To access please click here.

What ARRs roles are available?

Below is a table of which roles are currently available under the additional roles reimbursement scheme (as at January 2022). For full details of each role please click on the role hyperlink and this will take you to the relevant section.

Why aren’t GPs and nurses included in the ARRs, when this is what we need?

• We understand this view and the question behind it and be assured that this view has been expressed to NHSE/I. However we hope this guide can provide understanding about how these roles can support practices and PCNs, and support demand and capacity in primary care
• Although GPs and nurses cannot be recruited under the ARRs that is not to say these roles cannot support GPs and nurses and free up time in other ways
• Hopefully in this guide you can see the added value that these allied health professionals (AHPs) and clinical pharmacists can bring within primary care, to our staff, patients and communities
• ARRs may also be a way of considering career development of individuals in primary care. For example trainee nursing associates are funded under the ARRs. Once qualified they are funded as nursing associates. Nursing associates provide skills above and beyond HCAs, and can provide a stepping stone into being a registered nurse
• However it is becoming ever clearer that these roles need to be fully embedded, supported and promoted in practices and PCNs for the true potential to be unlocked. This guide is there to provide ideas around case studies, induction programs, supervision needs and more.