‘Enhanced level’ nurses latest to be added to ARRS

General practice nurses (GPNs) working at an “enhanced level” are the latest to be added to the additional roles reimbursement scheme (ARRS).

Following the announcement earlier this month from the government that GPNs would be added to the ARRS, a letter from NHS England has now confirmed that only “enhanced nurses” will be eligible to be recruited via the scheme.

“The changes for the upcoming year will do little to improve the working lives of general practice nursing staff”

Patricia Marquis

The letter, addressed to all GP practices and primary care networks (PCNs) in England, has outlined changes to the GP contract for 2024-25.

The announcement comes as some members of the profession have been calling for GPN inclusion in the ARRS, in order to support the recruitment of nurses into primary care.

However, nurse leaders today warned that the proposed changes would do little to address the “deep inequalities” that GPNs were facing, particularly around pay.

The ARRS is a scheme that entitles PCNs to claim reimbursement for the salaries of certain roles, to support recruitment into multidisciplinary teams within general practice.

NHS England has confirmed that enhanced nurses will now be added to the scheme.

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An enhanced nurse is someone who holds a level seven or above postgraduate certification or diploma in one or more specialist areas of care, according to the letter.

A capabilities framework by Skills for Health said an enhanced nurse works at a level above GPN but below advanced practice nurses and nurse consultants.

Examples of enhanced nurse roles cited in the framework included senior practice nurse, nurse practitioner, specialist nurse and nurse manager.

Under the 2024-25 GP contract, the role will “initially be capped” at one enhanced nurse per PCN, or two where the PCN patient list is 100,000 or more.

The ARRS will now fund the salaries of 18 roles, which includes advanced nurse practitioners, nursing associates, physician associates, dieticians and occupational therapists.

In the letter, NHS England’s national director for primary care and community services, Dr Amanda Doyle, said: “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.”

Patricia Marquis

As such, the contract will also see caps removed on the number of advanced practitioners a PCN can recruit through ARRS, as well as caps on other direct patient care roles.

There will also be greater flexibility around funding arrangements for mental health practitioners.

However, some nurse leaders have argued that the new GP contract did not do enough to address the challenges that GPNs are facing.

The Royal College of Nursing director for England, Patricia Marquis, said: “The changes for the upcoming year will do little to improve the working lives of general practice nursing staff or improve access to care for patients.

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“It will also do next to nothing for the thousands of general practice nurses who have still not received any pay increase for 2023-24 despite being promised a 6% uplift by government last year.”

It comes as a recent RCN survey found that 44% of GPNs did not receive any uplift to their pay for the 2023-24 financial year.

Ms Marquis argued that there were “deep inequalities” in general practice nursing pay which needed to be addressed.

She added: “Including enhanced nurses in the ARRS should give practices more flexibility to bring skilled and qualified nursing staff into primary care networks.

“However, without due care the move could exacerbate the two-tiered nature of nursing pay between general practice and the NHS.”

Meanwhile, Ms Marquis also noted that it “remains to be seen” what the role and responsibilities of an enhanced nurse will be.

“Enhanced nurses in a primary care network must be able to grow nursing leadership within primary care, not plaster over gaps in services,” she added.

Also responding, the director of primary care at the NHS Confederation, Ruth Rankine, said: “We welcome the increased freedoms and flexibilities being introduced in this contract which reflects what our members have long been asking for to enable them to deliver services in a way that meets local need.

“The inclusion of additional nurses to the ARRS scheme and removal of caps to recruiting to patient care roles will help bring additional staff into primary care.”

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