Around £64m of funding available under the additional roles reimbursement scheme (ARRS) this year is currently forecast to go unspent by April.

The ARRS scheme provides funding to primary care networks (PCNs) to employ healthcare professionals to work in general practice and PCNs, including pharmacists, physiotherapists, and paramedics, among others.

Figures obtained by our sister title Healthcare Leader via the Freedom of Information Act showed that at least 6% or around £64m of the total £1.02bn pot for the ARRS in 2022/23 is currently unclaimed, and will remain with NHS England unless it is reallocated by April 2023.

A clinical director for a Dartmoor PCN said: ‘I’m not surprised at all by the underspend. We see a lot of practices – particularly smaller practices – say they can’t use a given ARRS role and would rather opt for a doctor or nurse, over a physio. That’s probably where you’re getting underspend. And so a lot of the bidding for that underspend this year is to bolster roles for next year.’

When the money is unspent, integrated care boards (ICBs) are able to invite PCNs to bid for any unclaimed funding.

However, of that remaining total underspend, only an estimated £8.77m will be reallocated to PCNs in 14 ICB areas. And this funding will only be available if the PCNs are able to recruit into the roles.

Ben Gowland, director at think tank Ockham Healthcare and former NHS executive, said: ‘The majority of additional funds coming into general practice since 2019 have been funding through PCNs, and by far the biggest part of the PCN funding has been the ARRS funding. ARRS underspend therefore represents an underspend against the promised investment into general practice.’

Of the 36 ICBs who responded to Healthcare Leader’s request, 21 said they were inviting PCNs to bid for the unclaimed funding, and 16 had already completed the process and had approved bids (see map).

Devon ICB had approved the most bids – accepting 61 from its 31 PCNs – granting £1.2m in extra cash for staff, despite estimating it will underspend by £800,000.

A spokesperson explained that it expected a number of PCNs would not be able to recruit into the roles they submitted bids for within the limited time left in the financial year.

Similarly, Hertfordshire and West Essex invited all 35 of its PCNs to update their workforce plans, and is expecting to reallocate £1.7m, despite recording an underspend of just £54,647.

And Birmingham and Solihull ICB has approved 19 PCN bids and is planning to allocate £1.3m of its £1.7m underspend.

The data shows that Staffordshire and Stoke-on-Trent ICB recorded the greatest total underspend, with £4.46m – or nearly a quarter (23%) – of its £19.75m ARRS budget left unclaimed.

And two ICBs estimate more than a fifth (22%) of their total budget will go unclaimed. Sussex ICB is expecting to record a £6.72m underspend against its £30.8m total, while Kent and Medway has forecast a £7.07m underspend against its £32.7m total.

Five ICBs – Bedfordshire, Luton and Milton Keynes, Black Country, Greater Manchester, Staffordshire and Stoke-on-Trent, and Suffolk and North East Essex – have launched an ongoing bidding process.

One further ICB said it ‘wishes’ to reallocate all of their unclaimed funding, which would add a further £1.3m if successful. Another ICB has reallocated an undisclosed amount to 15 PCNs.

Eight ICBs estimate they will record no ARRS underspend for the financial year 2022/23: Buckinghamshire, Oxfordshire and Berkshire West, Cambridgeshire and Peterborough, Norfolk and Waveney, North East London, Nottingham and Nottinghamshire, Somerset, and South West London. Although it is not anticipating underspend, Derby and Derbyshire ICB invited and approved bids.

Healthcare Leader’s investigation found significant variation in the way systems are interpreting the PCN DES.

Surrey Heartlands ICB suggested that it was not possible at all to reallocate funding under the Network Contract.

A spokesperson from Surrey Heartlands ICB told Healthcare Leader that the system had encouraged its PCNs to ‘maximise their spend on ARRS roles’, adding that it would wait for ‘further national guidance on the future of the ARRS initiative’ to inform its approach going forward.

And a spokesperson from Cheshire and Merseyside, which also indicated it couldn’t reallocate funding, said the ICB is working ‘proactively with our practices and the LMC to ensure that practices are able to maximize the use of resource that is available’.

That just 6% of ARRS money is unspent marks a significant improvement upon spend in 2020/21 and 2021/22.

Last summer, our sister title Pulse revealed that up to 40% of funding available via the ARRS was unspent in each of the first two years of the scheme.

The latest figures from NHS Digital show that GP networks have hired nearly 4,000 pharmacists under ARRS.

A version of this article first appeared in our sister titles Healthcare Leader and Pulse.