The Queen’s Nursing Institute (QNI) has significant concerns about the principles and implementation of the Additional Roles Reimbursement Scheme (ARRS), in particular the impact on General Practice Nurses (GPNs).

With NHS England’s ARRS now funding 17 multi-disciplinary team roles in primary care, the QNI is disappointed to see the continued exclusion of GPNs from the scheme. Many practices are now employing large numbers of staff through the ARRS, and many GPNs are being required to support new starters, despite nurses themselves being excluded from being recruited into the scheme.

It is well documented that many GPNs, alongside GPs, are spending a substantial part of their clinical time developing and delivering induction programmes, supervision, and training schemes for new starters, but are receiving no additional benefit or recognition for this, and there are minimal resources to deliver these induction programmes.

Indeed, the impact is one of longer working hours to enable GPNs to continue providing their clinical care alongside these additional responsibilities. This can be addressed by NHS England, with an allocation of resources to support the comprehensive induction and supervision of new members of the general practice team recruited through the ARRS.

This level of support is required particularly where those who join general practices through the ARRS have no prior experience in primary care. Advanced Nurse Practitioners, who are now included in the scheme, are often routinely named as the lead nurse over GPNs, even when they have not previously worked in general practice.

There is a clear need to develop robust clinical guidance to accommodate the practice and supervision of those joining general practice with no previous knowledge of the sector. Moreover, the additional work that GPNs are currently undertaking to help ARRS staff with limited experience must be recognised.

There is also an emerging risk of deskilling expert GPNs in favour of the new roles introduced through the ARRS, where clinical practice becomes divided into tasks and the continuity of care with a holistic approach currently provided by GPNs is diminished.

A unique part of a GPN role is the ability to deliver holistic, personalised care for the whole population; many other roles are providing care that is chiefly task orientated, risking duplication, omissions, or unnecessary interventions.

By recruiting such a high proportion of new staff through the ARRS, the role of a GPN is being devalued. ARRS roles are perceived as the ‘life savers’ of primary care – and there is no doubt that they have value – but GPNs have been central to the delivery of excellent care in general practice for decades.

A clear acknowledgement of the value of GPNs is needed, along with a plan to support GPNs to stay, grow, and develop in general practice alongside their colleagues. We risk losing GPNs to other areas of health and social care if attention is not turned to retaining their considerable skills and expertise. This loss would be hugely detrimental to the communities served by general practice.

The QNI is a solution-focused organisation and we look forward to working with NHS England and other key stakeholders such as the Royal College of General Practitioners on the implementation of the GP Access and Recovery Plan. We are keen to work with NHSE to determine what further support is needed now and into the future to retain, recognise and value the central role of GPNs in primary care.

ARRS Workforce Impact Survey

The QNI has carried out a national survey of GPNs to establish more clearly how the introduction of ARRS has impacted on their work. The results of this survey were published in January 2024 (link on website home page).

For media or stakeholder communications please contact:

Matthew Bradby
Head of Communications


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