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Primary care needs more flexibility around ARRS funding, says Covid recovery report


By James Hacker
11 May 2021

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Practice teams need to be able to use the Additional Roles Reimbursement Scheme (ARRS) funding ‘more flexibly’ as the country moves out of the pandemic, a report has warned.

The NHS Confederation report, published today (10 May), said primary care is likely to have ‘underspends as a result of delays in recruitment’ and this could be ‘usefully deployed’ to help tackle the backlog and manage waiting lists.

It comes after NHS England retained 40% (£173m) of ARRS funding at the end of last year and said CCGs would be able to claim the extra money if they provided evidence that PCNs had used up their allocation so far and could show plans for future roles recruitment.  

The NHS Confederation report, which outlined 10 priorities for primary care recovery, added that primary care is no longer a ‘GP-first’ service and its approach ‘needs to be defined by the individual’s needs being met by the right professional’.

It also warned that staff as well as services ‘need support to recover’ and said this must be recognised. 

More management support needed

The NHS Confederation called for sustained investment in infrastructure such as IT systems, management support and estates to better manage demand and create capacity.

‘Primary care continues to provide huge numbers of high-quality consultations but is limited in progress by infrastructure. We are building new services based on our patients’ needs, but this requires us to expand our workforce and we have insufficient space within our premises,’ the report said.

It added that innovation around supporting underserved communities was being hampered by a lack of management support and joined-up IT systems with health and care partners.

‘We need to be forward planning together with more responsive, less bureaucratic processes to get to the right solutions for our workforces and populations,’ the report said.

‘No measures of primary care pressure’

The report also said that primary care needs a metric for measuring workload pressures similar to the operational pressures escalation level (OPEL) in secondary care.

It said that during the pandemic primary care did not see the same level of detail evidencing the pressures faced by services as secondary care – and that a system is needed for this.

‘Along with a comprehensive measure of workload, we also need to look at developing the operational pressures escalation level (OPEL) system used in secondary care for primary care so that we can manage our work safely and work within a system that recognises pressure right across it, not just within individual parts,’ the report said.

 ‘Open and honest discussion’

Ruth Rankine, director of primary care at the NHS Confederation, said that during the pandemic public focus has been largely centred on the strain faced by hospitals, despite rising demand and complexity in primary care.

She added: ‘Primary care leaders are committed to working together and doing everything they possibly can for their patients, but an open and honest discussion needs to be had, coupled with a clear set of achievable priorities. Otherwise, there is the very real risk of care becoming disjointed and services being overwhelmed.’

The report also recommended that national bodies should:

  • ‘Trust primary care to do what it does best’ and provide flexibility and resources to deliver care.
  • Provide clarity on national and local priorities.
  • Redefine service delivery, reduce duplication and maximise economies of scale.
  • Be transparent with the public about waiting lists and backlogs.
  • Improve system-wide collaboration, with more seamless pathways between primary and secondary care.
  • Retain ‘regulatory permissiveness’, balanced with proper accountability.
  • Address disproportionate investment.

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