Additional Roles Reimbursement Scheme (ARRS)

NCL Wide

Under the Primary Care Network (PCN) DES, PCNs are able to recruit new roles to expand their care team with NHSE&I, with a forecast of 26,000 additional staff working in general practice by 2024. 

The aim of the scheme is to build and use the additional roles to solve the workforce shortage in general practice. While the funding will be for new roles being introduced within PCNs, each network will have the flexibility to determine which roles form the core list that they require based on their patient population requirements.

The maximum reimbursable amounts for the 2022-23 period are in the ARRS max reimbursement 2022-23 sheet (see Useful resources).

The DES document and BMA's PCN handbook also include useful information about the ARRS scheme (see Useful resources).    

The ARRS roles are:

Clinical pharmacists work as part of a multi-disciplinary team in a patient-facing role to clinically assess and treat patients using their expert knowledge of medicines for specific disease areas.

Clinical pharmacists can be prescribers or undertake training to become one. All practice pharmacists should be signed up to the primary care pharmacy education pathway (PCPEP) to align the education requirements of pharmacists and pharmacy technicians to the PCN DES. NHSE has commissioned the Centre for Pharmacy Postgraduate Education (CPPE) to deliver this.

Visit the CPPE website for more information about PCPEP.

There is a list on the website about which prior qualifications would be exempt from this. It requires 28 days of study over 18 months. See the Primary Care Pharmacy Association (PCPA) website for more information.

Where a PCN employs or engages one or more clinical pharmacist under ARRS, the PCN must ensure that each clinical pharmacist has the following key responsibilities in relation to delivering health services:

  • work as part of a multi-disciplinary team in a patient facing role to clinically assess and treat patients using their expert knowledge of medicines for specific disease areas;
  • be a prescriber, or completing training to become a prescriber, and work with and alongside the general practice team;
  • be responsible for the care management of patients with chronic diseases and undertake clinical medication reviews to proactively manage people with complex polypharmacy, especially the elderly, people in care homes, those with multiple co-morbidities (in particular frailty, COPD and asthma), and people with learning disabilities or autism (through the Stop Over Medication Programme (STOMP));
  • provide specialist expertise in the use of medicines while helping to address both the public health and social care needs of patients at the PCN’s practice(s) and to help in tackling inequalities;
  • provide leadership on person-centred medicines optimisation (including ensuring prescribers in the practice conserve antibiotics in line with local antimicrobial stewardship guidance) and quality improvement, while contributing to the quality and outcomes framework and enhanced services;
  • through structured medication reviews, support patients to take their medications to get the best from them, reduce waste and promote self-care;
  • have a leadership role in supporting further integration of general practice with the wider healthcare teams (including community and hospital pharmacy) to help improve patient outcomes, ensure better access to healthcare and help manage general practice workload;
  • develop relationships and work closely with other pharmacy professionals across PCNs and the wider health and social care system;
  • take a central role in the clinical aspects of shared care protocols, clinical research with medicines, liaison with specialist pharmacists (including mental health and reduction of inappropriate antipsychotic use in people with learning difficulties), liaison with community pharmacists and anticoagulation;
  • be part of a professional clinical network and have access to appropriate clinical supervision.

Appropriate clinical supervision means that:

  • each clinical pharmacist must receive a minimum of one supervision session per month by a senior clinical pharmacist;
  • the senior clinical pharmacist must receive a minimum of one supervision session every three months by a GP clinical supervisor;
  • each clinical pharmacist will have access to an assigned GP clinical supervisor for support and development;
  • a ratio of one senior clinical pharmacist to no more than five junior clinical pharmacists, with appropriate peer support and supervision in place.

Social prescribing link workers (SPLW) connect people to community groups and agencies for practical and emotional support, and complement other approaches such as care navigation and active signposting.

Peer support across London and SPLW education sessions can be accessed through the Bromley by Bow Centre website, or by contacting Lianna Martin, London Regional Learning Coordinator for Social Prescribing at NHS England.
t: 07446 383 875
e: lianna.martin@bbbc.org.uk

See the NHSE SPLW reference guide for PCNs for more information.

Where a PCN employs or engages a SPLW under ARRS, the PCN must ensure that the SPLW: 

  • has completed the NHSE/I online learning programme hosted by the HEE eLearning for Health platform; 
  • is enrolled in, undertaking or qualified from appropriate training as outlined by the Personalised Care Institute Core Curriculum and SPLW competency framework; 
  • attends the peer support networks delivered at place or system by the ICS and/or NHSE/I in the region.

Physician associates are healthcare professionals with a general medical education who work alongside and under the supervision of GPs providing clinical care as part of a wider multi-disciplinary team. Currently. they are restricted on being able to sign prescriptions, fit notes and requests for ionising radiation. 

Find out more on the Faculty of Physicians Associates website.

Where a PCN employs or engages a physician associate under ARRS, the PCN must ensure that the physician associate: 

  • has completed a post-graduate physician associate course (either PG Diploma or MSc); 
  • has maintained professional registration with the Faculty of Physician Associates and/or the General Medical Council following implementation of statutory regulation, working within the latest code of professional conduct (CIPD); 
  • has passed the UK Physician Associate (PA) National Re-Certification Exam, which needs to be retaken every six years; 
  • participates in continuing professional development opportunities by keeping up to date with evidence-based knowledge and competence in all aspects of their role, meeting clinical governance guidelines for continuing professional development (CPD);
  • is working under the supervision of a doctor as part of the medical team.

First contact physiotherapists can assess, diagnose, treat and manage musculoskeletal (MSK) problems, and can discharge a person without a medical referral. Those working in these roles within a PCN can be accessed through direct referral by staff in GP practices.

Where a PCN employs or engages a first contact physiotherapist under ARRS, the PCN must ensure that the first contact physiotherapist: 

  • has completed an undergraduate degree in physiotherapy; 
  • is registered with the Health and Care Professional Council; 
  • holds the relevant public liability insurance; 
  • has a Masters level qualification or the equivalent specialist knowledge, skills and experience; 
  • can demonstrate working at Level 7 capability in MSK-related areas of practice or equivalent (such as advanced assessment diagnosis and treatment); 
  • can demonstrate ability to operate at an advanced level of practice.

ARRS is expanding to include paramedics from April 2021. A letter was published by NHSE on 21 January 2021, stipulating the requirements for recruiting a paramedic to be eligible for reimbursement through the scheme. 

Download the briefing note from Healthy London Partnership for more information.

Where a PCN engages a paramedic to work in primary care under ARRS, the PCN must ensure that the paramedic:

  • is educated to degree/diploma level in Paramedicine or equivalent experience;
  • is registered with the Health and Care Professions Council (HCPC);
  • has completed their two-year Consolidation of Learning period as a newly qualified paramedic;
  • has a further three years’ experience as a Band 6 (or equivalent) paramedic;
  • is working towards developing Level 7 capability in paramedic areas of practice and, within six months of the commencement of reimbursement for that individual (or a longer time period as agreed with the commissioner), has completed and been signed off formally within the clinical pillar competencies of the Advanced Clinical Practice Framework.

Care co-ordinators work closely with GPs and other primary care professionals within the PCN to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers.

An induction guide is available on the NHSE website for care co-ordinator workers in primary care networks.

Where a PCN employs or engages a care co-ordinator under ARRS, the PCN must ensure that the care co-ordinator: 

  • is enrolled in, undertaking or qualified from appropriate training as set out by the Personalised Care Institute;
  • works closely and in partnership with the social prescribing link worker(s), the social prescribing service provider and/or the health and wellbeing coach(es).

Pharmacy technicians will complement the work of the clinical pharmacist by using their pharmaceutical knowledge to help patients to get the best from their medicines. This is done by switching medications to agreed and approved protocols, improving repeat prescribing processes in general practice (including promotion of repeat dispensing and online ordering), minimising clinical risk and aiming to reduce wasted medicines. This role will be under the supervision of the clinical pharmacist and part of a wider PCN pharmacy team.

Where a PCN employs or engages a pharmacy technician under ARRS, the PCN must ensure that the pharmacy technician:

  • is registered with the General Pharmaceutical Council (GPhC);
  • meets the specific qualification and training requirements as specified by the GPhC criteria84 to register as a pharmacy technician;
  • is enrolled in, undertaking or qualified from an approved training pathway (e.g. the Primary Care Pharmacy Educational Pathway (PCPEP) or Medicines Optimisation in Care Homes (MOCH));
  • is working under appropriate clinical supervision to ensure safe, effective and efficient use of medicines.

Dietitians diagnose and treat diet and nutritional problems. Dietitians can support patients of all ages with their food intake to address diabetes, food allergies, coeliac disease, metabolic diseases and weight loss.

See the British Dietetic Association (BDA) website for more information about first contact dietians.

Where a PCN employs or engages a dietitian under ARRS, the PCN must ensure that the dietitian: 

  • has a BSc or pre-reg MSc in Dietetics under a training programme approved by the BDA; 
  • is a registered member of the Health and Care Professionals Council (HCPC); 
  • is able to operate at an advanced level of practice;
  • has access to appropriate clinical supervision and an appropriate named individual in the PCN to provide general advice and support on a day-to-day basis.

Health and wellbeing coaches use health coaching skills to support people with self-identifying existing issues and encourage proactive prevention of new and existing illnesses. They may also provide access to self-management education, peer support and social prescribing.

Where a PCN employs or engages a health and wellbeing coach under ARRS, the PCN must ensure that the health and wellbeing coach: 

  • is enrolled in, undertaking or qualified from appropriate health coaching training that covers the topics outlined in the NHSE/I Implementation and Quality Summary Guide, with the training delivered by a training organisation listed by the Personalised Care Institute;
  • adheres to a code of ethics and conduct in line with the NHSE/I Health Coaching Implementation and Quality Summary Guide; 
  • has formal individual and group coaching supervision which must come from a suitably qualified or experienced individual;
  • works closely in partnership with the social prescribing link worker(s) or the social prescribing service provider to identify and work alongside people who may need additional support, but who are not yet ready to benefit fully from social prescribing.

Nursing associate is a new support role that bridges the gap between healthcare assistants and registered nurses. The role will be part of the PCN nursing team under the supervision of a nurse.

Where a PCN employs or engages a nursing associate under ARRS, the PCN must ensure that the nursing associate: 

  • meets the specific qualification and training requirements as specified in the Nursing Midwifery Standards of Proficiency by having undertaken and completed the two-year Foundation Degree delivered by a Nursing and Midwifery Council (NMC) approved provider;
  • is registered with the NMC and revalidation is undertaken in line with NMC requirements.

Where a PCN employs or engages a training nursing associate (TNA) under ARRS, the PCN must ensure that the TNA: 

  • has a minimum of GCSE Maths and English at grade 9 to 4 (A to C), or Functional Skills Level 2 in Maths and English; 
  • is working towards completion of the Nursing Associate Apprenticeship Programme;
  • is enrolled on a foundation degree awarded by a Nursing and Midwifery Council (NMC) approved provider over a two-year period.

The PCN must ensure that the postholder has access to appropriate clinical supervision and an appropriate individual within the PCN to provide general advice and support on a day-to-day basis.

Occupational therapists support people of all ages with problems arising from physical, mental, social or developmental difficulties. Occupational therapists can help GPs across the network with frail patients, those with complex needs, those who live with chronic physical or mental health conditions, and those who need help with managing anxiety or depression.

Where a PCN employs or engages an occupational therapist under ARRS, the PCN must ensure that the occupational therapist:

  • has a BSc in or pre-reg MSc in Occupational Therapy under a training programme approved by the Royal College of Occupational Therapists; 
  • is a registered member of the Health and Care Professionals Council (HCPC); 
  • is able to operate at an advanced level of practice;
  • has access to appropriate clinical supervision and an appropriate named individual in the PCN to provide general advice and support on a day-to-day basis.

Podiatrists can help diagnose and treat foot and lower limb conditions.

Where a PCN employs or engages a podiatrist under ARRS, the PCN must ensure that the podiatrist: 

  • has a BSc or pre-reg MSc in Podiatry under a training programme approved by the College of Podiatry; 
  • is a registered member of the Health and Care Professionals Council (HCPC); 
  • is able to operate at an advanced level of practice;
  • has access to appropriate clinical supervision and an appropriate named individual in the PCN to provide general advice and support on a day-to-day basis.

The mental health practitioner role may be undertaken by any practitioner (registered or non-registered) operating at Agenda for Change Band 4 up to 8a, including but not limited to:

  • community psychiatric nurses
  • clinical psychologists
  • mental health occupational therapists
  • peer support workers
  • mental health community connectors
  • other roles as agreed between the PCN and community mental health service provider.

The postholder will support adults and older adults with complex mental health needs that are not suitable for IAPT provision.

The PCN must ensure that the postholder is supported through the local community mental health services provider (or by the employer of the postholder, where the local community mental health services provider has subcontracted the service to another organisation) through robust clinical governance structures in order to maintain quality and safety, including supervision where appropriate.

Advanced practitioners are designated to the PCN DES roles for clinical pharmacists, first contact physiotherapists, dietitians, podiatrists, occupational therapists and paramedics. 

Where a PCN employs or engages an advanced practitioner as outlined in B15.1 under ARRS, the PCN must ensure that the advanced practitioner: 

  • has a Master’s degree level in the relevant area of expertise; 
  • is working at a Master’s level or equivalent that encompasses the four pillars of clinical practice, leadership and management, education and research, with demonstration of core capabilities and area-specific clinical competencies.

Review date: Wednesday, 10 May 2023