Helen Salisbury: Funding GPs through the additional roles scheme won’t solve GP unemployment

Funding for general practice has been falling since 2018,1 and the only new money available has been through the primary care networks—groups of practices covering 30 000-50 000 patients. Money has been provided in the form of the Additional Roles Reimbursement Scheme (ARRS) to pay the wages of pharmacists, physiotherapists, paramedics, physician associates, and a list of other allied healthcare staff—but, until last week, doctors weren’t included.

This omission has had several unfortunate consequences. The main one is that, although there are fully qualified GPs who need jobs—and patients crying out for GP appointments—practices can’t afford to hire those doctors. Instead, they settle for other workers (provided at no cost to the practice) who can do elements of the GP role with varying degrees of safety and efficiency. The government, when newly elected in July, promised to allow some of the ARRS money to be used to employ doctors, and last week it announced the details of the scheme.2 This seems like a step forward, but there are problems.

The scheme is aimed at newly qualified doctors, restricted to those within their first two years of qualification who are yet to hold a substantive post. Questions have been raised about age discrimination, since many unemployed and underemployed older GPs could also benefit from this scheme. Recent figures show that more than 65 000 GPs are registered with the General Medical Council, but only 37 660 are working in the NHS.34

The scheme may also not be straightforward for those who are eligible. There’s a significant difference between the relatively protected environment of GP training and that of post-qualification work, and most newly fledged GPs need support and mentoring in their first post. Because the ARRS money goes to primary care networks rather than practices, there’s a risk that these new GPs will be spread across several surgeries, perhaps working a day a week in each, and will miss out on the support they need. It will be hard for doctors working in this way to provide continuity for patients or to gain experience by offering it. There’s also disquiet about the funding proposed for these roles, which is considerably less than the current normal rate for a salaried GP.2

The scheme is intended to be short term, a stopgap to prevent unemployment among newly qualified GPs. In the long term, it clearly makes no sense to be funding GPs through an additional roles scheme: they’re not additional to general practice—they are core.

One of the advantages of the independent contractor status of GP partnerships is that we can, in theory, take the budget allocated and hire the right staff to provide the medical services our patients need. Many GPs would be happy to scrap the whole failed experiment of primary care networks. We’d like to make our own decisions about whether we need more nurses, GPs, pharmacists, or other roles. If the money currently spent on the ARRS budget was restored to core GP funding—trusting practices to use it wisely—we could then invest in more doctors, which is what patients want, and let the market decide which of the other roles have a place in general practice.