More than a third of ICBs are reallocating money to primary care under the addition roles reimbursement scheme (ARRS) with a further five inviting bids for funding.
The data, obtained by Healthcare Leader via the Freedom of Information Act, show that of the 36 ICBs who responded, 21 are inviting PCNs to bid for the unclaimed funding, and 16 have already completed the process and have approved bids (see map).
As set out in the Network DES, ICBs are able to invite PCNs to bid for any unclaimed ARRS funding for use in hiring under the scheme.
The figures show that at least 6% or £64m of the total £1.02bn pot for the ARRS in 2022/23 is currently unclaimed, and will remain with NHS England unless it is reallocated by April 2023.
However, of that remaining total underspend only an estimated £8.77m will be reallocated to PCNs in 14 ICB areas. And this funding will only be available if the PCNs are able to recruit into the roles.
One further ICB said it ‘wishes’ to reallocate all of their unclaimed funding, which would add a further £1.3m if successful. Another ICB has reallocated an undisclosed amount to 15 PCNs.
Eight ICBs estimate they will record no ARRS underspend for the financial year 2022/23: Buckinghamshire, Oxfordshire and Berkshire West, Cambridgeshire and Peterborough, Norfolk and Waveney, North East London, Nottingham and Nottinghamshire, Somerset, and South West London. Although it is not anticipating underspend, Derby and Derbyshire ICB invited and approved bids.
How much is going where?
Devon ICB has approved the most bids – accepting 61 from its 31 PCNs – granting £1.2m in extra cash for staff, despite estimating it will underspend by £800,000.
A spokesperson explained that it expected a number of PCNs would not be able to recruit into the roles they submitted bids for within the limited time left in the financial year.
Similarly, Hertfordshire and West Essex invited all 35 of its PCNs to update their workforce plans, and is expecting to reallocate £1.7m, despite recording an underspend of just £54,647.
And Birmingham and Solihull ICB has approved 19 PCN bids and is planning to allocate £1.3m of its £1.7m underspend.
The data shows that Staffordshire and Stoke-on-Trent ICB recorded the greatest total underspend, with £4.46m – or nearly a quarter (23%) – of its £19.75m ARRS budget left unclaimed.
And two ICBs estimate more than a fifth (22%) of their total budget will go unclaimed. Sussex ICB is expecting to record a £6.72m underspend against its £30.8m total, while Kent and Medway has forecast a £7.07m underspend against its £32.7m total.
Five ICBs – Bedfordshire, Luton and Milton Keynes, Black Country, Greater Manchester, Staffordshire and Stoke-on-Trent, and Suffolk and North East Essex – have launched an ongoing bidding process.
Unclaimed funding is an underspend in general practice
Ben Gowland, director at think tank Ockham Healthcare and former NHS executive, said: ‘The majority of additional funds coming into general practice since 2019 have been funding through PCNs, and by far the biggest part of the PCN funding has been the ARRS funding. ARRS underspend therefore represents an underspend against the promised investment into general practice.’
He added: ‘While ICSs are relatively new, they do mark a significant departure away from CCGs which were rooted in primary care in a way that ICSs are not. We are starting see the impact of this – the use of general practice investment to balance system books is a prime example. It something that is likely to get worse as ICSs become more and more distant and distinct from their predecessor CCGs.’
Variation in ICB approach
Healthcare Leader’s investigation found significant variation in the way systems are interpreting the PCN DES.
In its response, Surrey Heartlands ICB suggested that it was not possible to redistribute the underspend in this way as a portion of the total funding available sits with NHS England.
A spokesperson from the ICB told Healthcare Leader that the system had encouraged its PCNs to ‘maximise their spend on ARRS roles’, adding that it would wait for ‘further national guidance on the future of the ARRS initiative’ to inform its approach going forward.
They said: ‘Whilst Surrey Heartlands has not implemented a formal bidding process, funding can be reallocated between PCNs – a PCN can overspend if another PCN has underspent. As an ICB we encourage our PCNs to bring forward planned ARRS recruitment in order to minimise the underspend for the financial year.’
And a spokesperson from Cheshire and Merseyside, which also indicated it couldn’t reallocate funding, said the ICB is working ‘proactively with our practices and the LMC to ensure that practices are able to maximize the use of resource that is available’.
That just 6% of ARRS money is unspent marks a significant improvement upon spend in 2020/21 and 2021/22.
Last summer, our sister title Pulse revealed that up to 40% of funding available via the ARRS was unspent in each of the first two years of the scheme.
Launched as a major source of funding behind the PCN DES, the ARRS provides money for networks to hire and create multi-disciplinary teams, against the Government’s target to introduce 26,000 non-GP staff into primary care.