Network Contract Directed Enhanced Service: Additional Roles Reimbursement Scheme Guidance

  • Published On 21st February 2022

Introduction and summary

This agreement document updates and enhances the existing five-year GP contract agreement Investment and Evolution1, which stands unless otherwise amended in this update document.

Jointly developed by the British Medical Association (BMA) General Practitioners Committee England (GPC) and NHS England and NHS Improvement, the revised deal has been confirmed by Government.

More doctors working in general practice

More roles are now added to the Scheme from April 2020, at the request of Primary Care Network (PCN) Clinical Directors. PCNs can now choose to recruit from the following roles within the Scheme, in addition to those previously agreed, to make up the workforce they need: pharmacy technicians, care co-ordinators, health coaches, dietitians, podiatrists and occupational therapists. Mental health professionals will be added from April 2021 following current pilots. Some further flexibility is included in the operation of the ‘additionality’ rules.

6,000 extra staff are funded by Government, through additional investment committed in the Government’s election manifesto – for NHS England and NHS Improvement of £150m/£300m/£300m/£300m between 2020/21 and 2023/24, expanding the Scheme to 26,000. Reimbursement now increases from the current 70% to 100% for all 26,000 roles. Essential for achieving the 26,000 target, the move to 100% reimbursement frees up the existing £1.50/head to contribute to management support for PCNs. Funding entitlements increase from £257m to £430m in 2020/21 and, in 2023/24, from £891m to £1,412m.

For the average PCN in 2020/212, that means around 7 Full Time Equivalent (FTE) staff, through an average reimbursement pot of £344,000. This rises to 20 FTE staff and an average reimbursement pot of £1.13 million in 2023/24. A ready reckoner will be published on the NHS England and NHS Improvement website. Assurances made under this deal mean PCNs can recruit fully, without worry about the theoretical risk of future employment liability and redundancy costs. PCNs are encouraged to take immediate action to recruit, with additional support from their Clinical Commissioning Group (CCG), e.g. through collective/batch recruitment exercises, supporting joint or rotational roles with other community providers. Adding 26,000 extra staff in the PCN additional roles scheme now becomes a first order priority for the whole NHS.

Enhancing the Additional Roles Reimbursement Scheme

The Government is conducting an urgent review of pensions to seek to solve the taper problem. Extra Government investment funds new GP training recruitment and retention measures. GP trainee numbers increase from 3,500 to 4,000 a year from 2021. 24 months of the 36 month training period will be spent in general practice, from 2022. Together with the increase in trainees, this change will contribute over half of the 6,000 extra doctors working in general practice. The Targeted Enhanced Recruitment Scheme (TERs) will be expanded: from 276 places now, to 500 in 2021, and 800 in 2022, encouraging GP trainees to work in under-doctored areas.

A two-year Fellowship in General Practice will now be offered as a guaranteed right to all GP trainees on completion of their training. It will automatically be offered as part of signing up to GP training. Our shared goal is to achieve as close to 100% participation as possible. The Fellowship programme will also be extended to newly qualified nurses. A new national Mentors Scheme will offer highly experienced GPs the opportunity to mentor GPs, in return for a minimum time commitment. To boost the GP partnership model, from April 2020, the New to Partnership Payment guarantees first-time partners a £20,000 one off payment, plus £3,000 funding for business training. The Induction and Refresher Scheme will be expanded and enhanced to provide more support to GPs returning to general practice, including those with childcare or other caring responsibilities. A new Locum Support Scheme will provide greater support to locum GPs, in return for a minimum time contribution. Enhanced shared parental leave is introduced. A core offer for staff has been developed to support good employment practices.

Releasing time to care

The Government is committed to reviewing Cross-Government Bureaucracy in General Practice. NHS England and NHS Improvement will develop complementary proposals to reduce administrative burdens. The digitisation of Lloyd George records starts in 2020.

Improving access for patients

More people working in general practice will help achieve 50 million more appointments in general practice. An improved appointments dataset will be introduced in 2020, alongside a new, as close to real-time as possible, measure of patient experience. At least £30m of the £150m PCN Investment and Impact Fund in 2021/22 will support improved access for patients, rising to at least £100m of the £300m Fund in 2023/24. A new GP Access Improvement 5 Programme will identify and spread proven methods of improving access including cutting waiting times for routine appointments. Every PCN and practice will be offering a core digital service offer to all its patients from April 2021.