- clinical directors
- integrated care boards:
- primary care leads
- chief executive officers
- chief medical officers
- regional directors
- regional directors of commissioning
- regional directors of primary care and public health
- regional directors of primary care
- regional primary care medical directors
GP contract changes: government response to Doctors and Dentists Remuneration (DDRB) and the Additional Roles Reimbursement Scheme (ARRS)
Following the letter issued to general practice by the Secretary of State on 1 August, we are writing to provide additional information on how the funding and contract changes announced will be implemented.
Implementing DDRB recommendations
The Government has agreed that it will fund in full the Review Body on Doctors and Dentists Remuneration (DDRB) pay recommendations for GPs.
As the Secretary of State has stated, the GP contract will be amended to uplift the pay elements of the contract by 6% (a further 4% in addition to the 2% already included in contract funding at the start of 2024/25), which will be backdated to 1 April 2024.
NHS England will work with the Department of Health and Social Care (DHSC) and the British Medical Association’s General Practitioners Committee (GPC England) to update the Statement of Financial Entitlements (SFE) so the uplift can be passed on to practices as soon as possible via Global Sum.
The uplift to the Global Sum is calculated to cover all practice staff – not just GP partners and salaried GPs. This includes practice nurses, reception, management and other practice staff. We firmly expect GP partners to honour the intent of this uplift and award the full 6% pay rises to all their staff.
Once the details are finalised, NHS England will confirm when practices can expect to receive uplifted payments via the Primary Care bulletin.
Using the ARRS to employ GPs
In response to strong feedback from the profession, and to help solve the immediate issue of GP unemployment amongst recently qualified GPs, additional funding of £82 million has also been announced to support the inclusion of recently qualified GPs in the ARRS in 2024/25. This issue is, in part, a result of more GPs qualifying following an increase in training places 3 years ago.
This scheme is intended to relieve the pressure on employment for this expanded cohort of GP staff – and is in addition to the anticipated recruitment of recently qualified GPs we would expect to take place – and funded through the practice contract in the normal way.
We are making an amendment to the primary care network directed enhanced service (PCN DES) for 2024/25 to expand the ARRS and to reimburse the employment costs for recently qualified GPs.
NHS England is releasing extra funds for 2024/25; while this is an emergency measure and we will work with the Government on longer term solutions to GP unemployment, we recognise this as a change to your operating costs that will be considered in future budget setting, as in previous years when the ARRS has been expanded and you have recruited additional staff.
Using the ARRS will enable ring-fenced funding to get to primary care networks (PCNs) quickly to employ over 1,000 additional GPs. NHS England will communicate revised ARRS entitlements (budgets) to PCNs, reflecting the separate ring-fenced element that is available for GPs.
As the new funding for GPs is complementary to the existing scheme and separately ring-fenced, it will ensure that the reimbursement of existing ARRS staff is not impacted by the introduction of GPs.
The additional funding will be available to fund the employment of GPs who have recently obtained their certificate of completion of training (CCT).
PCNs will be able to draw down funding from October 2024 – and the exact criteria for employing GPs will be set out in a revised Network Contract DES specification, on which we will consult with GPC England over the coming weeks. This will include ensuring that the GPs employed are in addition to the existing GP workforce employed by practices.
The existing ARRS portal will be updated so PCNs can use it to claim reimbursement for employing recently qualified GPs. This will allow for the quickest operationalisation of the ARRS changes and is a familiar reimbursement mechanism for PCNs.
This move has been made to expedite the employment of some newly qualified GPs, who may be struggling to secure a practice role. We recognise the ARRS has not previously been used to fund GP employment. We will engage with the profession and stakeholders to review this approach as we look to identify longer-term solutions to GP employment and general practice sustainability – including core GP capacity – as part of the future contract reform discussions.
We also recognise that there have been calls for the scheme to be expanded to include practice nurses. While our current focus is to respond to the immediate issue of GP unemployment among newly qualified GPs, we and Government will keep the scheme under review.
Thank you for all your hard work at what we appreciate is a challenging time.
Dr Amanda Doyle, National Director for Primary Care and Community Services, NHS England
Dr Claire Fuller, National Medical Director for Primary Care, NHS England