Variation in NHS England’s advice to integrated care boards (ICBs) on additional roles funding may have seen some primary care networks (PCNs) lose out, a freedom of information (FOI) investigation has revealed.
The FOI was sent to ICBs by our sister title Pulse PCN, with responses from all 42 ICBs. It found variation in the way ICBs have managed the PCN bidding process for unspent additional role reimbursement scheme (ARRS) money.
In previous years PCNs have been able to bid for unspent ARRS money. However, in February, NHS England announced the mechanism for this PCN bidding process would be stopped in the 24/25 contract. However, the FOI reveals that ICBs had stopped reallocating these funds to PCNs at different times prior to this.
In a letter to PCNs dated 28 February 2024, NHS England said: ‘In 2024/25 the mechanism which allows commissioners to redistribute unclaimed funding from the Additional Roles Reimbursement Sum between PCNs will be removed from the Network Contract DES. We continue to encourage PCNs to recruit up to their individual entitlements.’
Bristol, North Somerset and South Gloucestershire ICB, which redistributed almost £600,000 said this document was how they were informed of the mechanism ceasing.
However, some ICB FOI responses stated that NHS England informed them this mechanism would cease earlier than this.
North Central London ICB said NHS England guidance was issued to them on 17 November 2023, ending the PCN redistribution ‘with immediate effect’, which meant it was not able to redistribute funds.
The ICB quoted that NHS England told them: ‘ICBs should not approve any further transfers of unclaimed funding to other PCNs including to those PCNs whose recruitment already takes them over their individual entitlements, where this has not already been agreed at the date of this communication.’
Northamptonshire, Birmingham and Solihull, South East London and South West London ICBs also had this advice in November.
However, Somerset and the Black Country said this was communicated to them in December. Black Country ICB was able to redistribute £105,475 prior to this. Staffordshire and Stoke-on-Trent, which redistributed more than £1m, said they were told in September, while Mid and South Essex and North East and North Cumbria, who did not redistribute any funds, reported they received the advice in Q3 (July-September) and August 2023 respectively.
Cornwall ICB, where £355,786 was reallocated to PCNs, said as they already had planned to reallocate funds to PCNs, there ‘wasn’t a date’ they were told to stop.
The FOI team said: ‘As we continued with the redistribution of the underspends within our ICB as planned, there wasn’t a date where we were told we weren’t allowed to do it.’
Sussex ICB, which redistributed £3.6m of unallocated ARRS funds, did this during the initial planning phase in October 2023. They confirmed to Pulse PCN that they were told the mechanism was removed from 2024/25.
When asked to clarify whether this mechanism had been taken away in 2023/24, or from the following year, NHS England told Pulse PCN: ‘Primary Care Networks are encouraged to make full use of their individual entitlements, and Integrated Care Boards are working with them to ensure that their annual staff costs remain within those entitlements, unless the PCNs are able to cover any additional costs from their own funding. Primary Care Networks should contact their ICB leads if they have questions about the process.’
Ruth Rankine, director of primary care at the NHS Confederation, said: ‘The ARRS scheme is a critical programme that has already helped improve access for patients and reduce pressure on GPs and their teams. Expanding the workforce with new roles and skills is a vital part of managing the record demand for care primary care services are facing, with patients often attending with multiple or more complex conditions.
‘These new ways of working and service delivery models have delivered tangible improvements, yet the ability to sustain or scale-up the programme is hampered when funding is insecure, short-term, or subject to approval.
‘Variation in funding can exacerbate existing inequities in access and health outcomes as well as impact on the primary care sector’s ability to recruit and retain staff, who may leave for more secure employment elsewhere.
‘We have raised the inconsistencies in access to ARRS underspend this year on behalf of our members and the impact this will have on PCNs.
‘We continue to call for greater flexibility to allow local leaders to plan and deliver the workforce that best meets local needs as well as for the release of 100% of ARRS funding to ICBs to ensure all the money is deployed for the purpose intended.’
Last month, Pulse PCN revealed that PCNs had underspent on ARRS funding by £45m in the 2023/24 financial year.
On the question of where the underspend figure was being reinvested if not back into PCNs, an NHS England spokesperson said: ‘NHS primary care networks are making good use of the Additional Roles Reimbursement Scheme (ARRS), with 37,000 roles under the programme currently in place – 43% higher than our target of 26,000 – and where underspends arise in internal budgets, NHS England seeks to invest these in frontline patient care.’
Of the 42 ICBs that responded 20 had recorded an underspend figure, five of which were able to reallocate some funds to PCNs.
An additional six said they had reallocated funds in the planning process of ARRS, and therefore did not declare that as underspend or said they could not yet define the figure due to incomplete data.
Between those 11 ICBs that were able to reallocate funding, over £15m was reallocated across 159 bids.
Alongside the ICBs that reallocated ARRS funds, an additional ICB, Kent and Medway, also received 14 bids from PCNs, with an average ask of £87,632, but none of these were approved and therefore no funds redistributed.
North West London also stated that they were able to distribute ‘not utilised’ funds to other PCNs who had overrecruited, but did not provide figures.
Last year, an exclusive investigation by Pulse PCN found that only 14 ICB areas were able to reallocate unspent ARRS funding to PCNs.
NHS England has been contacted for comment regarding the variation of advice to ICBs.
| ICB | ARRS allocation | No of PCNs in ICB | No of bids | Successful bids | Amount redistributed |
| Hampshire and the Isle of Wight | £43,352,000 | 42 | 22 | 22 | £5,801,000 |
| Sussex | £40,102,000 | 39 | 27 | 27 | £3,611,000 |
| Birmingham and Solihull | £35,200,000 | 35 | 35 | 30 part funded | £2,100,000 |
| Staffordshire and Stoke-on-Trent | £27,000,000 | 25 | 12 | 12 | £1,047,000 |
| Hertfordshire and West Essex | £34,618,349 | 35 | 8 | 8 | £906,851 |
| Bristol, North Somerset and South Gloucestershire | £22,717,323 | 20 | 13 | 11 | £593,557 |
| Cornwall and the Isles of Scilly | £14,551,651 | 15 | 14 bids from 10 PCNs | 9 | £355,786 |
| Gloucestershire | £13,938,000 | 15 | 6 PCNs for a total of 12 roles | 6 | £321,061 |
| Herefordshire and Worcestershire | £19,017,000 | 15 | 17 | 12 | £250,941 |
| The Black Country | £29,227,790 | 27 | No bids, funding split evenly | Funding distributed to 20 PCNs | £105,475 |
| Humber and North Yorkshire | £40,816,056 | 43 | 2 | 2 | £75,888 |
| Kent and Medway | £45,185,000 | 42 | 14 | 0 | £0 |
| | | | | 159 | £15,168,559 |
A version of this story was first published on our sister title Pulse PCN.
