Concerns are growing among general practitioners in England about the stability of patient care as official data reveals significant turnover in roles funded through the Additional Roles Reimbursement Scheme (ARRS). The scheme, designed to expand multidisciplinary teams within GP practices, has seen rapid changes in staffing that practitioners warn could undermine the long-term relationships essential to effective primary care.
Dr. Helena Fischer, Editor of Health at World Today Journal, examines the implications of this trend for both patients and healthcare providers, drawing on verified reports from medical and policy sources to assess what the data means for continuity of care in the NHS.
The Additional Roles Reimbursement Scheme was introduced as part of the NHS England GP contract framework to support the recruitment of clinical pharmacists, physician associates, social prescribers, and other non-GP roles directly employed by primary care networks. Official statistics cited in recent GP surveys indicate that a notable proportion of these positions experience turnover within the first year of appointment, raising questions about the sustainability of the model.
According to verified reporting from GPonline, practice leaders have expressed alarm that frequent changes in ARRS staff disrupt patient pathways, particularly for those managing chronic conditions who benefit from consistent points of contact. One GP partner quoted in the report stated that “rebuilding trust and rapport with new staff every few months is not sustainable and ultimately affects the quality of care we can deliver.”
These concerns were echoed in a separate Medscape article detailing how GPs across England are “reeling” from the combined pressures of the new contract and workforce instability. The piece highlighted that while the intent behind ARRS is to alleviate workload pressures on GPs, the practical outcome in some areas has been increased administrative burden due to constant recruitment, onboarding, and retraining cycles.
Further context comes from Nursing in Practice, which reported on a newly revealed reimbursement update aimed at helping practices retain ARRS staff through improved funding mechanisms. However, as of the latest available data, there is no public evidence that these adjustments have yet led to measurable improvements in retention rates.
What remains clear from the verified sources is that the original goal of ARRS — to strengthen primary care capacity without overburdening GPs — is being challenged by implementation realities. High turnover not only affects patient experience but also increases pressure on remaining team members and GP partners who must compensate for gaps in coverage.
Understanding the ARRS Model and Its Intent
The Additional Roles Reimbursement Scheme allows primary care networks to claim reimbursement for 100% of the salary and associated costs of certain roles, up to a set maximum per role type. Eligible positions include clinical pharmacists, physiotherapists, physician associates, dietitians, occupational therapists, and social prescribers, among others. The scheme was expanded significantly following the 2019 GP contract agreement as part of a broader strategy to shift toward team-based care.
Proponents argue that ARRS enables practices to offer services that would otherwise be unaffordable, improving access to specialist support within the community setting. For example, having a clinical pharmacist embedded in a GP practice can support medication reviews, reduce prescribing errors, and free up GP time for more complex consultations.
However, the effectiveness of the model depends heavily on stability. When roles turnover quickly, the investment in training and integration is lost, and patients may face inconsistent advice or delayed access to support. This is particularly problematic in areas such as mental health prescribing support or diabetes management, where continuity is clinically significant.
Who Is Affected and How
Patients with long-term conditions are among those most vulnerable to disruptions caused by staff turnover. Consistent contact with a trusted healthcare professional is associated with better adherence to treatment plans, improved satisfaction, and reduced emergency admissions. When ARRS staff leave shortly after joining, patients may be required to repeat their history multiple times or face delays in receiving tailored support.
GP practices themselves bear the operational burden of managing churn. Recruitment for ARRS roles can accept weeks or months, during which time the funded position may remain vacant. Even when filled, the onboarding period means new staff are not immediately operating at full capacity. Practices report that this cycle diverts managerial focus from patient care to administrative tasks.
The wider primary care network also feels the impact. ARRS roles are often intended to function across multiple practices within a network, so instability in one location can ripple outward, affecting scheduled clinics, shared protocols, and cross-practice initiatives.
What Officials Are Saying
As of the latest verified reports, NHS England has not issued a public statement specifically addressing ARRS turnover rates in response to GP concerns. However, the department has previously emphasized that the scheme is under continuous review, with adjustments made based on feedback from stakeholders.
In early 2024, NHS England announced a review of the ARRS funding framework to simplify claims and reduce administrative complexity, though no direct link has been established between this initiative and retention outcomes. The most recent guidance update, published in late 2023, clarified eligibility criteria and payment timelines but did not include retention incentives.
Professional bodies such as the British Medical Association (BMA) and the National Association of Primary Care (NAPC) have called for greater flexibility in how ARRS funds can be used, including the possibility of pooling resources to offer more competitive salaries or investing in career development pathways to improve retention.
Looking Ahead: Next Steps and Accountability
The next formal opportunity for national discussion on the ARRS model is expected during the routine review cycles of the GP contract, which typically occur annually with negotiations concluding in the spring. Any changes to the scheme would be announced as part of the subsequent contract settlement, meaning the next confirmed checkpoint for potential revisions is expected around March 2025, subject to the standard negotiation timetable.
Until then, GP leaders continue to advocate for monitoring tools that track not just uptake of ARRS roles but also their longevity and impact on patient outcomes. Some integrated care systems have begun piloting local retention supplements, though these remain localized and not nationally mandated.
For readers seeking official updates on the ARRS scheme or primary care policy developments, the NHS England website publishes regular guidance documents and contract summaries. The BMA also provides briefings for members on workforce and funding issues affecting general practice.
What happens next will depend on whether policymakers choose to address the structural challenges behind turnover — such as pay parity, career progression, and workload — or continue to treat ARRS as a short-term staffing solution without investing in its long-term viability.
As this debate unfolds, the experiences of frontline GPs and their teams will remain critical in shaping a sustainable model for multidisciplinary primary care.
We invite readers to share their perspectives on how workforce stability affects care quality in their communities. Have you noticed changes in consistency when visiting your GP practice? What improvements would make team-based care more reliable?
Join the conversation in the comments below or share this article to facilitate inform the ongoing discussion about the future of primary care in England, and beyond.