The British Medical Association (BMA) has accepted government proposals to add general practice nurses (GPNs) to the additional roles reimbursement scheme (ARRS).
It follows two months of negotiations between the union and the Department of Health and Social Care on the 2025-26 GP contract.
“This restriction doesn’t apply to other clinicians under the ARRS and it is not clear why nurses are being treated differently”
Crystal Oldman
The government vowed last year to remove the “red tape” in general practice and make funding available to employ hundreds more practice nurses.
It said it would do this by making further funding available through the ARRS.
The scheme, introduced in 2019, allows primary care networks to claim reimbursement for the salaries of certain roles.
It currently funds the salaries of 17 roles, including advanced nurse practitioners, ‘enhanced nurses’, nursing associates, physician associates and dieticians.
Until now, GPNs had been excluded from the ARRS, despite repeated calls from primary care leaders to include them.
NHS England previously pledged that the exclusion of GPNs nurses from the scheme would be reviewed, following concerns raised by leading nursing organisations.
The new GP contract, yet to be published in full by NHS England, will now see that GPNs can be recruited through the ARRS, provided they have not worked for any of the practices in their primary care network in the last 12 months.
GPs will also be added to the scheme permanently, after they were temporarily added last year.
The chief executive of the Queen’s Nursing Institute, Dr Crystal Oldman, welcomed the extension of the ARRS scheme for general practice nurses, but aired concerns about the conditions that had been put in place.
Dr Oldman said: “We understand there are still restrictions, for example a GPN cannot be employed under ARRS within the same primary care network as their current job for 12 months, limiting their career options.
“This restriction doesn’t apply to other clinicians under the ARRS and it is not clear why nurses are being treated differently.”
Similarly, Dr Oldman argued that GPNs “deserve a far greater profile” in the discussions around the GP contract.
“They are not even mentioned in the DHSC’s press release today nor the BMA’s, despite GPNs delivering much of the primary health care being referred to,” she added.
The BMA’s GP Committee for England (GPCE) said today it had agreed “in principle” to accept proposed amendments to the contract, following negotiations.
The deal will see an additional £889m in funding for the contract, on top of a £433m investment applied to the contract last autumn.
According to the BMA, this represents a 7.2% increase in contract funding, to support a range of reforms across practices in England.
Reforms proposed by the government include bringing back the ‘family doctor’ and reducing outdated performance targets to ensure GPs can spend more time with patients.
Further, it said that from October, GP surgeries needed to make online booking available to patients throughout the whole working day, to help free up phones first thing in the morning.
The GPCE has only accepted the contract on the condition that the government commits to renegotiating a completely new national contract within this parliament.
It said this commitment must be firmed in writing by mid-March 2025.
GPCE chair Dr Katie Bramall-Stainer said: “We hope the government seizes this once in a generation opportunity and repays the trust we are placing in them to do the right thing by England’s GPs, and by their patients.
“The government must now change the funding model for general practice and ringfence money for staff”
Patricia Marquis
“Of course, a single set of changes won’t reverse over a decade’s starvation of general practice, but it’s within the government’s gift to deliver on a new contract that will secure the longer-term future of general practice.”
Health and social care secretary Wes Streeting said: “This government is cutting the red tape that ties up GPs’ time and backing them with an extra £889m next year.
“In return, more patients will be able to request appointments online and see their regular doctor for each appointment.
“Through the prime minister’s Plan for Change, we will work with GPs to rebuild the NHS and make it fit for the future.”
Earlier this month, the Royal College of Nursing (RCN) aired concerns in a briefing paper that the government had avoided addressing “long-term inequities and pay disparities” faced by GPNs by instead directing funding through the ARRS.
It also warned that the change to the GP contract was being made “without the input of the RCN or any nursing bodies”.
As such, the union called for an “equitable and stabilising approach” to general practice nursing employment, to create a sustainable workforce that supports high-quality patient care.
It said this should include ringfenced funding to employ GPNs on permanent contracts, with at least equivalent pay and conditions to NHS Agenda for Change staff.
Today, the RCN published survey findings that found that three in 10 GPNs directly employed by a general practice in England received no pay rise in the last year, despite a 6% one being promised.
Executive director of the RCN in England, Patricia Marquis, said: “An understaffed workforce is already struggling to recruit and retain people to the profession needed to deliver high-quality care to a growing number of patients.
“The government must now change the funding model for general practice and ringfence money for staff.”
More on the additional roles reimbursement scheme
