The Government has announced that all GP practices in England will have the opportunity to join a Primary Care Network (PCN) by 1 July 2019. One of the incentives for participating in a PCN is that practices will be able to benefit from the Additional Roles Reimbursement Scheme which was announced in the 2019 GP Contract Framework. Under this scheme, additional funding will be made available to PCNs to reimburse 70% of the employment costs for clinical pharmacists, physician associates, first contact physiotherapists and first contact community paramedics and 100% of the employment costs of social prescribing link workers, up to the relevant maximum amounts.

Additionality

Because the scheme is seeking to grow additional capacity through new roles, reimbursement will only be available for “demonstrably additional people”. The Contract Framework makes it clear that NHS England will expect CCGs to continue any local schemes which fund posts in the five reimbursable roles. What is less clear is how readily PCNs will be able to modify existing roles in order to enable current staff to take up posts within the funded categories.

The only exception to the ‘additionality’ rule is existing clinical pharmacists reimbursed under either (i) the national Clinical Pharmacists in General Practice scheme, or (ii) the national Pharmacists in Care Homes scheme. Both of these schemes will be subsumed into the new funding arrangements.

Employment arrangements

The framework makes it clear that each PCN can determine the employment arrangements for additional staff funded under the scheme. Options include employment by a “host” practice; an existing Federation or other “at scale” entity such as a limited company; an NHS body such as a community or mental health trust, or a voluntary sector organisation. Different documentation will be needed depending on the option chosen by the PCN, but some common issues that will need to be addressed are:

• How will the additional staff be managed on a day to day basis?
• How will employment liabilities be shared between PCN member practices?
• Will the chosen option enable the additional staff to join the NHS Pension Scheme?
• Is there a risk that the employment arrangements will lead to a taxable supply of services for VAT purposes?

What happens when the funding ends?

The national funding for the Additional Role Reimbursement Scheme will run until 2024. From that point, it is likely that PCNs will bear the full cost of the additional staff themselves. This means that in setting up employment arrangements, consideration should be given to whether the appointments can be made on a fixed term basis linked to the available funding, and how any redundancy costs that arise when the funding ceases will be apportioned between members of the PCN. 

For more information or to discuss any support that you may need in setting up your local Primary Care Network please contact Peter Edwards or Neha Shah, or view further information about our GP expertise here.