Why ARRS won’t be shifted to neighbourhood contracts…yet!

After seeing the Pulse PCN article on Shifting PCN resources to neighbourhoods would be destabilising I wanted to share my perspective.

I might come to eat my words, and I’ll fully hold my hands up if that’s the case. But here’s why I believe ARRS will not be redistributed into neighbourhood contracts in the near future.

It would be destabilising

I agree with Dr Luisa Pettigrew, senior policy fellow from The Health Foundation, it would be destabilising. Removing ARRS funding would undermine the progress general practice has made in becoming more multi-professional. You don’t build integrated care by dismantling what’s working.

The debate

It’s worth acknowledging the different positions in this debate. The BMA has advocated for ARRS funding to be absorbed into the GP contract, giving practices more flexibility. Others are asking whether the funding could flow through the yet to be published neighbourhood contracts instead. And then there’s the status quo, keeping ARRS with PCNs as a ring-fenced scheme.

Position	What it means	Trade-off
BMA position	ARRS absorbed into GMS contract	Flexibility, but risks losing multi-professional expansion
Neighbourhood absorption	Funding flows to neighbourhood providers	Could enable integration, but destabilising
Status quo	ARRS stays with PCNs, ring-fenced	Stability, but keeps the rigidity

This is a debate about a structure that doesn’t exist yet. But that doesn’t make it unimportant—it’s why we need to think it through carefully now.

Thinking practically

The new neighbourhood framework talks about PCNs evolving into single neighbourhood providers and hospital trusts running primary care through integrated health organisations (IHOs). Both the 10 year plan and this new framework set it out as bringing new resources into neighbourhoods, not cannibalising what already exists.

But there’s a fundamental structural issue. The ARRS funding is attached to the PCN DES. It’s not a free-floating pot that can be redirected at will. The funding flows through a specific contractual mechanism tied to PCNs.

While we could unpick where the money actually sits redeploying staff to neighbourhood structures would require adhering to employment law.

What redistribution requires

According to The King’s Fund, there are over 37,000 staff employed through ARRS—through a patchwork of arrangements including practices, PCNs, federations, and third-party providers.

If these staff were redistributed, this is what would need to happen:

• TUPE consultation: minimum 30 days for 20+ staff, with legal obligations on both outgoing and incoming employers

• Pension arrangements: navigating different schemes, with some staff in NHS Pension and others not

• Terms and conditions : ARRS staff aren’t uniformly on Agenda for Change, creating pressure to harmonise

• Clinical supervision : who provides it, who pays for GP time, what are the governance arrangements?

• Governance structures would need to be established before any transfer could proceed

Each of these is significant. Together, they represent a substantial barrier to wholesale redistribution.

Potential advantage

One potential advantage of larger organisations employing ARRS staff could be more consistent supervision arrangements. The Nuffield Trust has highlighted that supervision under the current model is patchy.

But that assumes the receiving organisation has capacity to supervise.

The political timing

The BMA has formally re-entered a dispute with the government over GP contract changes. Announcing a policy that moves the funded workforce away from practices would compound tensions.

And here’s the irony

For all the criticism ARRS has received. The complaints about roles being hard to embed, the grumbles about wanting the money for salaried GPs instead, I think if someone actually tried to take these roles away, practices would fight to keep them.

The pharmacist doing your medication reviews, the care coordinator managing your complex patients, the social prescriber taking the non-medical work off your plate, these roles have become woven into how practices function, even when that’s not fully recognised.

If it’s a choice between PCNs keeping ARRS staff or that funding flowing into neighbourhood structures, I think even its strongest critics would fight to keep it within the structures that currently exist.

Tara Humphrey is CEO of THC Primary Care, which provides interim management training to PCN leaders and has supported more than 300 PCNs.