Michael Bowyer

As the financial year draws to a close, General Practitioner (GP) Practices are keenly focused on maximising their Quality and Outcomes Framework (QOF) funding. A significant element of this endeavor is the effective utilization of the Additional Roles Reimbursement Scheme (ARRS), which offers GP practices the opportunity to expand their multidisciplinary teams through financial support for specific roles.

Understanding the bands and reimbursable amounts for each role is crucial for GP practices aiming to make the most out of their QOF funding. This blog provides an overview of these bands and amounts, aiming to help practices plan their staffing and budgeting more effectively.

Role	Incentive Band (AfC)	Annual equivalent maximum reimbursable amount per role	Annual equivalent maximum reimbursable amount per role
Adult MHP & CYP MHP	4	£15,873	£16,698
Adult MHP & CYP MHP	5	£19,094	£20,080
Adult MHP & CYP MHP	6	£23,551	£24,760
Adult MHP & CYP MHP	7	£28,733	£30,201
Adult MHP & CYP MHP	8a	£32,501	£34,157
Advanced Practitioners	8a	£65,002	£68,315
Apprentice Physician Associates	5	£38,187	£40,159
Care Co-Ordinator	4	£31,746	£33,396
Clinical Pharmacist	7-8a	£59,312	£62,340
Community Paramedics	7	£57,465	£60,401
Dietitians	7	£57,465	£60,401
Digital and Transformation Lead	8a	£65,002	£68,315
First Contact Physiotherapists	7-8a	£59,312	£62,340
General Practice Assistant	4	£31,746	£33,396
Health & Wellbeing Coaches	Up to 5	£38,187	£40,159
Nurse Training Associates	3	£28,177	£29,649
Nursing Associates	4	£31,746	£33,396
Occupational Therapists	7	£57,465	£60,401
Pharmacy Technician	5	£38,187	£40,159
Physician Associates	7	£57,465	£60,401
Podiatrists	7	£57,465	£60,401
Social Prescribing Link Worker	Up to 5	£38,187	£40,159

The calculations for the Additional Roles Reimbursement sum are based on the Network satisfying the requirements in the Network Contract Specification and Guidance. Calculations for 2023/24 for the indicative maxima for PCN entitlements have also been included to further support future PCN ARRS workforce planning. The calculation of the indicative funding available per weighted patient for 2023/24 is based on total national ARRS funding available per Investment and Evolution (£1,412.0m), divided by the national patient population at 1 January 22 – 61,495,302 uplifted by 0.5% population growth per year.”

Strategic ARRS Utilisation

The ARRS funding is a pivotal resource for GP practices, allowing them to enhance their service offerings and patient care through a multidisciplinary team approach. By understanding the bands and reimbursable amounts for each role, practices can strategically plan their staffing needs and make informed decisions to maximize their QOF funding. This strategic approach not only aids in financial planning but also significantly contributes to the improvement of patient care and the efficiency of practice operations. As the financial year ends, it’s an opportune time for GP practices to review their ARRS utilisation and plan for the upcoming year, ensuring they continue to provide high-quality care while maximizing funding opportunities.

In a significant update, NHS England has announced that Primary Care Networks (PCNs) must fully utilise their Additional Roles Reimbursement Scheme (ARRS) allocations or risk losing the funding. The new contract specifies that the redistribution mechanism for unclaimed ARRS funds will be removed, meaning that any unclaimed funds will no longer be available to PCNs.

Dr. Amanda Doyle, NHS England’s primary care national director, stated in a letter:

“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.”

Previously, Integrated Care Boards (ICBs) could invite PCNs to bid for any unclaimed funding. However, last year, it was forecasted that at least £64 million of ARRS funding would go unspent. This unclaimed funding will not revert back to primary care under the new regulations.

The changes made to ARRS Roles and Funding:

Changes have also been made to ARRS roles, with the introduction of the enhanced nurse role. Initially, this role will be capped at one per PCN, or two for PCNs with a patient list size of over 100,000. Enhanced nurses are defined as being between registered level nurses and advanced level nurses, holding a postgraduate certificate or diploma in one or more specialist areas of care.

Additionally, NHS England has removed the cap on the number of advanced practitioners (APs) that PCNs can recruit under ARRS. Previously, PCNs with a list size under 100,000 could recruit up to three APs, and those with a list size over 100,000 could recruit six.

The contract also outlines changes to the employment of mental health practitioners (MHPs), allowing them to be fully funded by the ARRS scheme. Currently, MHPs are funded 50:50 by the PCN and mental health provider, but moving forward, they will continue to be “employed or engaged” by the mental health provider.

Dr. Doyle emphasised that these changes are intended to increase the flexibility of the ARRS by widening reimbursable roles and removing certain restrictions. “We know that the ARRS has been hugely successful in expanding teams, increasing appointments, and supporting the delivery of proactive care, but we have heard that PCNs would welcome more flexibility in how the scheme operates,” she added.

As of 31 January 2024, the top three recruited roles under ARRS were pharmacists, care coordinators, and social prescribing link workers.

Despite the inclusion of enhanced nurses, general practice nurses are not included in ARRS. This decision follows an online petition that received 10,967 signatures. The Government responded on 22 February, stating that the 2024/25 GP contract arrangements are still under consultation with the British Medical Association and that it would be inappropriate to comment further at this stage.

Furthermore, changes made during Covid-19 to the medical performer’s list (MPL) will be made permanent, allowing PCNs to employ doctors other than GPs who are already employed by an NHS trust or foundation trust.

For more updates and detailed information, stay tuned to Key Medical Services.

As of January 30, 2024, the medical community welcomes the updated Good Medical Practice Guidelines issued by the General Medical Council (GMC). This update subtly enhances routines, significantly advancing our collective commitment to healthcare excellence.

These guidelines highlight a renewed focus on the human aspects that define our profession, beyond just operational practices. It’s a call to action for every healthcare professional to not only maintain but elevate the standards of patient care and collegial relationships.

Cultivating a Supportive and Collaborative Environment

Central to the new guidelines is the emphasis on fostering a workplace culture that values support, respect, and collaboration. The GMC articulates this vision through the principle of providing care “with courtesy, compassion, and empathy.” This approach is not just a directive but a reflection of the core values that should underpin every interaction within the healthcare setting.

The reality of medical practice often presents challenging scenarios, where the pressures of workload and patient demands test our resolve.

A Closer Look at the Updated Domains and Duties

The revised guidelines are structured around four domains, each accompanied by specific duties that guide conduct and interactions. I.e., Domain 3, titled ‘Colleagues, Culture and Safety,’ outlines duties that emphasise collaboration, knowledge sharing, and creating a nurturing work environment. Among these duties are:

• Engaging with colleagues in a manner that prioritises patient welfare, adapting leadership roles as necessary.
• Sharing expertise through informal and formal channels, including mentoring and coaching.
• Fostering a respectful, supportive, and equitable workplace, where open dialogue about concerns and errors is encouraged.
• Acting decisively to protect patient safety and dignity.
• Prioritising personal health and wellbeing to ensure professional competence.

These duties not only outline our responsibilities but also highlight the pathways through which we can contribute to a culture of safety, learning, and mutual respect.

Looking Ahead: The Appraisal Process and Beyond

The implications of the new guidelines extend to the appraisal process, with a revised template reflecting the updated domains set to be introduced. This transition, expected to be completed by April 2025, signifies a holistic approach to professional development, emphasising knowledge, partnership, and professionalism.

A Journey of Continuous Improvement

The updated GMC Good Medical Practice Guidelines represent more than a regulatory update. They signify a collective journey towards achieving the highest standards of care and professional integrity. Let these guidelines guide us towards a future marked by compassion, collaboration, and excellence in our profession.

For support and further information you can visit their website here. Remember that your consultant at Key Medical Services is always available to assist you. Together, let’s embrace these changes as a pivotal step toward a brighter, more compassionate future in healthcare.

Stay safe, stay compassionate, and here’s to our continued growth and excellence in medical practice.

General practitioner (GP) practices and primary care networks (PCNs) will soon be able to hire pharmacist trainees and access the NHS England (NHSE) pharmacist training grant from 2025. Although some GP practices and PCNs have previously hosted pharmacist trainees as part of their placements, this was under a memorandum of understanding with community and hospital pharmacy employers.

In a recent webinar hosted by the Primary Care Pharmacy Association (PCPA), NHSE representatives announced that GP practices and PCNs would now be considered a pharmacist “patient-facing setting.” This designation allows them to become the primary employer for pharmacist trainees in accordance with General Pharmaceutical Council (GPhC) requirements.

GP practices and PCNs will receive £26,500 per training post

Under newly harmonised funding arrangements outlined by NHSE, GP practices and PCNs will receive £26,500 per training post to support training and employment costs. They will also have access to an NHSE-funded training course. Community and hospital pharmacy employers will be eligible for the same funding, along with health and justice settings designated as patient-facing.

To employ pharmacist trainees, GP practices and PCNs must upload their training programs and plans for meeting training requirements to ORIEL, NHSE’s recruitment platform, by 1 March.

Graham Stretch, the PCPA president and a pharmacist GP partner, expressed his optimism about these changes, considering them a significant step forward for the sector. He emphasised the importance of the pharmacy profession working collaboratively to meet training requirements, including access to a designated prescribing practitioner (DPP) and dispensary, even before multi-sector placements become mandatory in 2026.

Mr. Stretch highlighted the potential for PCNs to act as the lead employer and second their employed trainees to various healthcare sites, including GP practices, community pharmacies, and hospitals. This approach could further enhance integration and strengthen community pharmacy’s role within PCN networks.

Response from GPhC

The PCPA also shared a response from GPhC Chief Executive Duncan Rudkin, affirming that general practice and primary care networks should be regarded as patient-facing, allowing them to serve as the “lead employer” for Foundation Training purposes.

This development is seen as a positive step toward expanding the role of pharmacists and promoting integration within the healthcare sector.

Depending on your choices, you can earn significantly more pay and have more flexibility than you could ever dream of when training to become a GP. If you plan properly and choose what really interests you, you can build a long and lasting career – and remember, it is not ‘one size fits all’. None of these options are the best option, and you need to experience a few to find out what will  work for you.

General Practitioners brings together physical, psychological, and social aspects of healthcare and a GP is most people’s first point of contact when seeking healthcare treatment. GPs operate in the communities in which they live, and they work with a wider multi-discipline team including practice nurses, midwives, health visitors, pharmacists, physiotherapists, and other specialists. GPs typically work out of a GP surgery to help promote health, prevent illnesses, and provide medical treatment and plans. GPs are the backbone of the NHS but they can face many challenges, and we are going to take an in depth look at the GP career path, from training right through to choosing your first GP role.

Back to the beginning – what GCSE’s and A-Levels do you need to become a GP?

Most medical universities in the UK have their own unique admissions criteria, so entry requirements will be different for each school. To apply, you will need a combination of GCSEs, AS levels and A levels, and most universities will seek students who have strong grades in subjects such as science and maths. You can also help your application by securing a spot in some healthcare related work experience. In general, to help increase your chances of being accepted onto a medical degree you should aim for:

• 7 GCSEs including science, with at least 5 subject grades 9-7 (A* / A) and English and Maths at least grade 5 -6 (B)
• 3 A Levels at grade A in chemistry and either biology, physics, or maths, plus one other academic subject

How to become a GP in the UK

Once you have been accepted onto your medical degree, there are a few more steps that you will need to take in order to become a fully qualified GP

1. Complete your degree – this is an obvious one, but if you are looking to become a GP in the UK then you will need to finish a medical degree that is recognised by the General Medical Council. This usually takes 5 years studying as an Undergraduate, although if you already hold a BSc degree you could start a year later. Depending on which course you choose to take, you will qualify with an MB (Bachelor of Medicine) or with an MBBS ( (Bachelor of Medicine, Bachelor of Surgery)
2. Undergo foundation training – Once you have completed your degree, you will then need to complete the Foundation Programme. This is a 2-year programme that allows you to try out different specialities (all complete supervised)
3. Complete your GP Specialist training – Once Foundation Training is complete, you will then need to undertake specialist training in general practice. You will spend 18-24 months working as a specialist registrar in a hospital. This will allow you to gain experience in a wide range of jobs whilst in the hospital setting, including general medicine, paediatrics, elderly care medicine, psychiatry, ENT accident and emergency, obstetrics and gynaecology, dermatology, ophthalmology, and palliative care.
4. GP Speciality Registrar – You will then have to work for 12-18 months as a GP Speciality Registrar in General practice, where you will receive personal tuition from a seasoned GP. To successfully complete your training, you will need to gain a CCT (certificate of completion of training), whilst doing workplace-based assessment throughout.
5. Register with the GMC – To work as a GP in the UK, you will need to hold a licence to practice medicine from the General Medical Council (GMC).
6. Apply to become a member of the Royal College of General Practitioners – You will also need to gain a membership to the Royal College of General Practitioners. IN order to become a member of the RCGP, you will need to pass 3 exams – Applied knowledge test, clinical skills assessment, workplace-based assessment.
7. Continuous Professional Development – Like all medical professionals, GPs should keep their training up to date long after their initial training has finished. The RCGP states that 250 credits are required for GP revalidation every 5 years, and GPS build up these credits by attending courses and conferences, and by doing e-learning through the RCGP

Life after training

Overall, it can take between 9-11 years to fully train as a GP in the UK, but the length of training will vary from person to person. Once it has been completed, there are several different career routes that you can choose to take. For some people, these options will offer higher pay or better working opportunities, whilst other options offer flexibility, and some are excellent for building a career.

Salaried GP

As a salaried GP, you will be employed by the general practice. This option will not feel so different from GP training, and you will have a clearly defined role. A salaried GP will give you a fixed timetable and a fixed income. As an employee of the general practice, you will have certain rights and benefits, including sick pay, holiday pay and maternity/ paternity pay, and you will not have to worry about tax, NI, or pension contributions as this will all be taken care of. You will generally work 37.5 hours (or 9 sessions) a week, but you will get less of a say as to how the practice is run. This is a good path for people who want a solid and stable career path.

GP Partners

As a GP partner, you will have a stable career path and help to run the practice with other team members. It can prove to be very lucrative to become a GP partner as you must take up more responsibility and step in if the need arises. You and your team will essentially run a private health practice, but you must ‘buy in’ to have this role. As well as clinical work, you will be responsible for the business as a whole, including management, staff, the building and ensuring that the practice meets all the legal requirements. As a GP partner, you will have a more flexible role than a salaried GP as you are only required to do a minimum of 2 clinical sessions per week, but you will have to take on other responsibilities such as CCG and PCN meetings (the bodies that govern primary care).

Freelance Sessional GP

This option offers you the most control over where you work and can also be potentially extremely lucrative. You will be self employed if you choose GP work, and you will be responsible for your own tax, NI, and pension contributions (which can put a lot of people off). You can choose to arrange the clinical sessions yourself with a local practice, join a chambers, use an introduction service or work through a GP medical services. Choosing this option means that you can pick and choose the days that you want to work, and you will have no binding contracts keeping you somewhere.

Portfolio GP

A Portfolio GP is the term used for GPs who have multiple roles within their working week – for example you have a primary job as a partner but you will have additional jobs in your portfolio. These additional jobs could include both clinical and non-clinical roles, and they can earn you a significant salary. This option provides a refreshing break for many, and the experiences in each role can help you perform better overall.

GP with Extended Roles (GPwER)

GP with Extended Roles (GPwER)

Life after GP training can be extremely rewarding and offers a lot of choice and flexibility for it to work how you want to. Depending on your choices, you can earn significantly more pay and have more flexibility than you could ever dream of when training to become a GP. If you plan properly and choose what really interests you, you can build a long and lasting career – and remember, it is not ‘one size fits all’. None of these options are the best option, and you need to experience a few to find out what will  work for you.