Then roots of the ARRS can be traced back to GP shortages which began a decade or so ago. In 2011/12 reports of practices – particularly outside London – struggling to recruit started to emerge. The health secretary at the time, Andrew Lansley, announced plans in 2011 to increase GP training places by 20% to counter this.
By 2015 this had become a full-blown crisis with Lansley’s successor Jeremy Hunt announcing a 10-point plan to increase GP recruitment, which included the now infamous commitment to increase the GP workforce by 5,000 within five years, as well as a promise to increase the number of non-GP healthcare professionals.
In 2015, the first concrete policy to address a shortfall in GP numbers came in, with a £15m scheme for GP practices to employ pharmacists. This was turbocharged in 2019 by the new GP contract. Through the additional roles reimbursement scheme (ARRS), practices were incentivised to join ‘primary care networks’ (PCNs), groups of practices that would mainly cover populations of 30,000-50,000 patients.
The contract committed £938m of extra funding per year by 2023/24, with a total of £1.79bn directed towards the new PCNs, predominantly through the ARRS.
This scheme funded the recruitment of non-GPs to general practice, with the five-year 2019 contract providing pharmacists (building on the earlier scheme) and social prescribers in the first year, followed by physiotherapists, physician associates and paramedics in later years.
Since then, the ARRS has been expanded to include occupational therapists, dieticians podiatrists and mental health practitioners among others, with newly qualified GPs added in 2024 by the new Government and plans to include practice nurses the latest change to be announced.
While the number of FTE GPs has gone down, the total number of practice staff has increased, mainly due to this influx of non-GP healthcare professionals. At the same time, practice nurse numbers have been rising at a steady rate.
The addition of clinical staff who are not GPs or nurses, and a huge increase in administrative staff, has led to more people than ever before being employed in general practice.
Of course, there are caveats to this – since the introduction of the ARRS, we have gone through Covid and a major economic downturn. But this has been the key policy for all recent health secretaries and NHS England, and it is likely this would have been the direction of travel regardless of these disruptions.
There has been an obvious effect on provision of patient care. In 2024, for the first time, only half of appointments in general practice were with GPs.
This shift is likely to continue, with many ARRS staff being upskilled. For example, from 2026, all new graduate pharmacists will be qualified to prescribe.