In the 2024/25 financial year, Primary Care Networks (PCNs) across England have underspent nearly £20 million of their allocated Additional Roles Reimbursement Scheme (ARRS) funding. This significant gap between allocated resources and actual expenditure highlights critical challenges in workforce recruitment and financial planning within primary care.

The underspend represents a substantial missed opportunity for enhancing patient care delivery and expanding clinical capacity at a time when primary care faces unprecedented demand. Understanding the factors behind this funding gap is essential for PCN leaders, practice managers, and healthcare professionals working to optimise their network's financial resources.

Understanding the ARRS Scheme

The Additional Roles Reimbursement Scheme forms a cornerstone of PCN funding, designed to support networks in recruiting additional healthcare professionals to improve patient access and clinical outcomes. In 2024/25, the scheme provided £534 million specifically for ARRS roles, with an additional £82 million allocated for GP recruitment within the programme.

ARRS funding enables PCNs to recruit a diverse range of healthcare professionals, including:

• Clinical pharmacists and pharmacy technicians
• Physician associates and advanced nurse practitioners
• Physiotherapists and occupational therapists
• Dietitians and health and wellbeing coaches
• Care coordinators and social prescribing link workers
• Newly qualified GPs through enhanced reimbursement rates

The scheme operates on a reimbursement basis, with PCNs receiving funding to cover salary costs for eligible roles up to specified limits. This funding model requires PCNs to actively recruit and deploy staff before accessing the financial support, creating a direct link between workforce expansion and funding utilisation.

Key Factors Behind the Underspend

Several interconnected factors have contributed to the substantial ARRS underspend across PCNs in 2024/25:

Recruitment Challenges

Many PCNs have encountered significant difficulties in recruiting suitable candidates for ARRS-funded positions. The healthcare workforce shortage affects all sectors, with competition for skilled professionals particularly intense in areas with high demand for clinical expertise. GP recruitment has proven especially challenging, with some networks unable to attract candidates despite available funding.

Salary Expectations and Market Rates

The reimbursement rates provided through ARRS may not always align with current market expectations for certain roles. This mismatch can make it difficult for PCNs to compete effectively for talent, particularly in high-cost areas or for specialised positions where demand exceeds supply.

Funding Uncertainty

Until recently, PCNs faced uncertainty about the continuation of ARRS funding beyond 2024/25. This uncertainty may have influenced recruitment decisions, with some networks hesitant to commit to long-term staffing arrangements without guaranteed funding security.

Administrative and Operational Barriers

The complexity of managing ARRS funding, including compliance requirements and reporting obligations, can create administrative burden that may deter some PCNs from fully utilising their allocations. Additionally, the need to coordinate recruitment across multiple practices within a network can present logistical challenges.

Financial Impact and Implications

The £20 million underspend represents approximately 3.7% of the total ARRS allocation for 2024/25, indicating that whilst the majority of funding has been utilised, there remains significant scope for improvement in budget deployment. This underspend occurs against a backdrop of increasing demand for primary care services and ongoing workforce pressures.

The financial implications extend beyond immediate budget concerns:

• Reduced clinical capacity compared to potential levels with full staffing
• Missed opportunities for service expansion and patient access improvement
• Potential impact on PCN sustainability and long-term planning
• Questions about resource allocation efficiency within the primary care system

It remains unclear whether unused ARRS funds can be transferred between PCNs to optimise utilisation, highlighting the need for greater flexibility in funding deployment mechanisms.

Funding Continuation and Future Allocations

The Secretary of State for Health and Social Care has confirmed that ARRS funding will continue into 2025/26, providing crucial certainty for PCN planning and recruitment activities. This commitment addresses previous concerns about funding continuity and should enable networks to make longer-term staffing decisions.

NHS England has announced increased allocations for 2025/26, reflecting growth in ARRS entitlements as part of a broader £889 million increase in contract funding for primary care. These enhanced allocations demonstrate the government's commitment to strengthening primary care capacity through workforce expansion.

Recent modifications to the Network Contract DES in October 2024 introduced additional income streams for recruiting newly qualified GPs, specifically aimed at reducing GP unemployment and improving care delivery. These changes provide PCNs with enhanced financial incentives to recruit and retain medical professionals.

Strategies for Improved Budget Utilisation

PCNs can implement several strategies to maximise their ARRS funding effectiveness and reduce future underspends:

Proactive Workforce Planning

Developing comprehensive workforce plans that align with patient needs and service priorities can help PCNs identify recruitment priorities early and plan their ARRS utilisation more effectively. This includes conducting regular skills gap analyses and forecasting future staffing requirements.

Collaborative Recruitment Approaches

Working with neighbouring PCNs or local healthcare providers can create economies of scale in recruitment and potentially share resources for difficult-to-fill positions. Collaborative approaches may also help address geographical workforce disparities.

Flexible Role Design

Designing roles that can be filled by professionals with varying levels of experience or different professional backgrounds can increase the pool of potential candidates and improve recruitment success rates.

Enhanced Support Systems

Providing robust support systems for new recruits, including mentorship programmes and professional development opportunities, can improve retention rates and make positions more attractive to potential candidates.

Moving Forward: Optimising ARRS Allocation

The £20 million underspend in 2024/25 provides valuable lessons for improving ARRS funding utilisation in future years. PCNs should view the confirmed funding continuation as an opportunity to refine their recruitment strategies and workforce planning approaches.

Key recommendations for PCNs include:

• Conducting regular reviews of ARRS allocation utilisation and identifying barriers to full deployment
• Engaging with local training providers and educational institutions to create recruitment pipelines
• Developing retention strategies that maximise the long-term value of ARRS investments
• Collaborating with NHS England and local system partners to address systemic recruitment challenges

The healthcare sector's ongoing transformation requires PCNs to maximise every available resource. By addressing the factors that contributed to the 2024/25 underspend, networks can better position themselves to deliver enhanced patient care and build sustainable workforce capacity for the future.

For PCNs seeking support with budget management and workforce planning, professional guidance can help optimise resource allocation and ensure full utilisation of available funding opportunities. The confirmed continuation of ARRS funding into 2025/26 provides a stable foundation for strategic planning and service development.