The ‘Levelling up’ general practice in England report from the Health Foundation thinktank found that networks in more affluent areas were ‘more able’ to recruit staff through the additional roles reimbursement scheme (ARRS) – and would ‘derive the greatest benefit’ from incoming staff.
Report authors suggested that the PCN contract should be amended to ensure ‘equitable distribution of new staff’, while staffing allocations should be based on the demographics of populations.
Levelling up general practice will also require updating the GP funding formula, according to the report, which said that the current mechanism ‘underestimates need associated with deprivation’.
The report comes as NHS leaders warned last week that general practice needed more investment and a ‘radical overhaul’ of its funding formula to allow primary care teams to shape services appropriately.
A total of £746m is available to PCNs in 2021/22 – around £600k per network – to recruit staff from a list of 10 roles through the additional roles reimbursement scheme (ARRS). The average PCN is expected to employ around 21 extra staff by 2023/24.
However, the report warned that PCNs in less affluent areas may not feel the benefit of increased government funding into general practice through the recruitment scheme because of difficulty with attracting these staff.
It said: ‘The government has promised an additional 26,000 allied health professionals working in primary care by 2023/24, funded through PCNs… But there is no mechanism in the PCN contract to ensure equitable distribution of new staff, or indeed any weighting according to population need.
Additional roles staff
‘Early evidence suggests that PCNs in more affluent areas are more able to recruit these new roles. If continued, the expanded primary care workforce is likely to be skewed towards wealthier areas, which will derive the greatest benefit from the extra staff. Health inequalities may widen further.
‘Policymakers must urgently explore ways to prevent this from happening… includ[ing] offering additional recruitment support to PCNs in deprived areas, varying funding/staffing allocations based on the demographics of the populations they serve, and supporting networks to develop appropriate premises to accommodate the additional workforce.’
Clinical directors warned in 2019 that increased competition for ARRS staff meant that some networks could be left behind and fail to benefit from available funding – worsening health inequalities.
The Health Foundation report also suggested that the Carr-Hill funding formula needed reforming to reduce inequalities, but acknowledged ‘stubborn’ barriers such as ‘political will, and getting GPs to agree to change’.
Authors suggested that GP funding could be adjusted using a ‘distance from target’ approach. It said: ‘Using this method, a new, more equitable funding formula could be applied, but with adjustments made gradually and with an overall increase in funding.
‘The income of all practices would increase over time, but the income of some practices would increase more, and faster. Extra funding would be required, otherwise GPs would likely resist a reform that would reduce income to some practices.’