The Additional Roles Reimbursement Scheme (ARRS) has transformed the way primary care services are delivered across England. Introduced as part of the 2019 GP contract and funded through the Network Contract Directed Enhanced Service (DES), the scheme was designed to expand the primary care workforce by introducing a wider range of healthcare professionals into General Practice and Primary Care Networks (PCNs).
Roles such as clinical pharmacists, pharmacy technicians, social prescribing link workers, first contact physiotherapists and care coordinators have all become integral to how care is provided. But with the scheme now in its sixth year, questions are being asked about what happens next. How sustainable is the current model? Will the funding continue? And what does the future look like for the professionals employed under ARRS?
A Brief Overview of ARRS
The ARRS was created to relieve pressure on GPs, improve patient access and encourage multidisciplinary working across PCNs. Rather than relying solely on GP time, practices could employ a wider team of professionals to take on more targeted roles in care delivery.
The scheme provides funding for each PCN to recruit from a set list of reimbursable roles. These include:
- Clinical pharmacists
- Pharmacy technicians
- Paramedics
- Social prescribing link workers
- First contact physiotherapists
- Mental health practitioners
- Care coordinators
- Health and wellbeing coaches
Each role is linked to a nationally defined job description and must be employed in line with NHS England’s guidance. Reimbursement covers salary, employer National Insurance and pension contributions, up to specified caps.
What ARRS Has Achieved
ARRS has helped grow the primary care workforce at a critical time. By end of March 2023, there were 29,103 more the full-time equivalent (FTE) direct the patient care staff working in the primary care than in 2019, including 26,877 hired through ARRS, according to the NHS England figures.
Patients are now more likely to speak with a pharmacist, physiotherapist or care coordinator than they were a few years ago. These professionals support long-term condition management, medication reviews, patient follow-up and much more. The result has been a shift in how care is delivered, with greater focus on prevention, proactive care and shared workloads across teams.
Challenges and Limitations
While ARRS has expanded capacity, it hasn’t been without issues. A common concern is the lack of time and resources to integrate new roles effectively. Practices need to invest in supervision, onboarding and team-building. In busy surgeries already under pressure, this hasn’t always been straightforward.
Some PCNs have also struggled to fill certain roles. Recruitment for clinical pharmacists and physiotherapists has been particularly competitive, and some professionals have moved between PCNs in search of better terms or clearer career progression. In other cases, practices have employed ARRS roles but not used them to their full potential due to limited understanding of what each role can deliver.
There have also been administrative burdens. Ensuring roles meet the criteria for reimbursement, dealing with payroll complexities and reporting on outcomes all add to the workload of PCN managers.
What Happens After 2025?
The future of ARRS became clearer in March 2025 when NHS England confirmed that the Network Contract DES, including ARRS, would continue into 2025/26. A new specification sets out updated funding structures, expanded eligibility and a greater emphasis on local flexibility.
Continued Funding and Broader Role Eligibility
ARRS funding is confirmed for another year. NHS England has allocated £186 million for 2025/26 to support both new and existing roles, including GPs recruited under the scheme in 2024/25.
From April 2025, PCNs can also recruit from a new range of nursing roles under ARRS, including:
- Healthcare Assistants (Band 3)
- New to General Practice Nurses (Band 5)
- Experienced General Practice Nurses (Band 6)
- Consultant Nurses for Primary Care (Band 8c)
This reflects a growing recognition of the role nurses play in delivering day-to-day care within general practice teams.
Updated Reimbursement Limits
To improve recruitment and retention, NHS England has raised the salary reimbursement thresholds. Including employer on-costs, the total reimbursable amounts are now:
- £105,882 per year outside London
- £108,680 per year with London weighting
These revised caps reflect the increasing experience of ARRS-funded GPs entering their second year and are designed to ensure practices remain competitive in recruitment.
Greater Flexibility for PCNs
NHS England has also removed several restrictions to give PCNs more control over their workforce:
- There is no longer a limit on the number of Digital and Transformation Leads or Enhanced Practice Nurses that can be reimbursed.
- PCNs are no longer required to use the national workforce planning template when submitting staffing plans to commissioners.
These changes allow networks to respond more effectively to local population health needs, while also cutting down on administrative workload.
What This Means for the Future
The confirmed continuation of ARRS and the expansion of its scope indicate a long-term commitment to multidisciplinary working within primary care. But the future of ARRS depends not just on funding, but on how effectively practices use the roles they’ve recruited. That means thinking long-term about team integration, supervision and the outcomes that matter most to patients.
