Last reviewed 7 June 2021

In this feature Thoreya Swage, Healthcare Consultant, describes the various programmes that are in place to expand the primary care workforce in England.


The NHS People Plan 2020–2021 recognised the need to expand the primary care workforce as a high priority for all Integrated Care Systems (ICSs) in England in order to:

  • enhance the working lives of primary care health professionals

  • tackle the lengthening backlog of health needs that were unmet, and the health inequalities highlighted by the Covid-19 pandemic

  • restore activity where possible and expand the flu vaccination programme

  • address the challenges facing the workforce and workload facing primary care

  • support the expansion of multi-disciplinary teams providing integrated care.

Key to this is the issue of Primary Care Networks (PCNs) using the funding that has been guaranteed for this purpose. This is called Primary Care System Development Funding (SDF) and is allocated mostly directly to Integrated Care Systems and covers eight different workforce programmes including the following.

  • Additional Roles Reimbursement Scheme (ARRS)

  • General Practice Fellowships for doctors and nurses new to practice

  • The mentors’ scheme

  • New to partnership payment scheme

  • Flexible staffing

  • Digital staffing platforms

  • Local GP retention fund

  • Training hubs

  • International GP recruitment.

The Workforce Programmes

Additional Roles Reimbursement Scheme (ARRS)

This programme supports PCNs to develop bespoke multidisciplinary teams based on the needs of the local population. It is anticipated that 26,000 additional posts will be created by 2023–2024 covering different types of roles. It is estimated that each PCN will have on average 7–8 staff 100% funded by this scheme. The Clinical Commissioning Groups (CCGs) will have a share of £415 million allocated to them plus £331 million available (held centrally) for this purpose.

Roles that are covered by the ARRS include the following.

  • First contact Physiotherapists

  • Mental Health Practitioners

  • Nursing Associates and trainee Nursing Associates

  • Community paramedics

  • Social prescribing link workers

  • Clinical pharmacists

  • Pharmacy technicians

  • Physician’s Associates

  • Dieticians

  • Podiatrists

  • Occupational Therapists

  • Care co-ordinators

  • Health and wellbeing coaches.

Further information on these roles can be found here NHS England » Expanding our workforce.

The Additional Roles Reimbursement Scheme is not to be used to fill existing vacancies or subsidise the costs of staff who are already employed in primary care.

General Practice Fellowships

At least £55 million is available for General Practice Fellowships for newly qualified GPs and nurses, which includes a two-year programme of support post-registration, such as mentorship, continuing professional development and rotational placements, and other opportunities within and across PCNs. The aim is to develop understanding and experience of primary care and expand the substantive primary care workforce. It is anticipated that fellowships will be offered to 100% of GPs completing their training in 2021–2022.

Supporting mentors

This scheme offers an opportunity for experienced GPs to provide mentoring and support to less experienced GPs. For 2021–2022, £8.1 million is available to ICSs to fund the training of GP mentors to cover costs of reimbursement and mentorship sessions.

This programme enables ICSs and their PCNs to enhance the skills of experienced GPs by providing a portfolio working opportunity. It is envisaged that ICSs develop a local resource that can be called on to support more junior doctors. GPs on the supporting mentors’ scheme will have funding to train for a recognised mentoring qualification and once trained, will be reimbursed to provide one mentoring session a week.

Through the General Practice Fellowships Scheme, GP mentors will be able to connect with newly qualified doctors and facilitate their integration into the local general practice environment. It is anticipated that the “mentorship” aspect of the General Practice Fellowship Scheme, whereby GP Fellows will receive one hour of mentorship every four weeks, will be fulfilled through this initiative.

The ultimate aim of the scheme is to encourage the retention of both experienced and less experienced GPs in the workforce.

New to Partnership Payment Scheme

The aim of this initiative is to expand the number of partners working in general practice, stabilising the partnership model and increasing the participation of clinicians in primary care. Eligible participants will be entitled to up to £20,000 as well as a contribution to on-costs (up to £4000) for support to become a partner. They will also have access to up to £3000 for training in developing non-clinical partnership skills.

Flexible and digital staffing

Most individual practices are responsible for engaging locums when required. Flexible staffing pools will be set up to reduce the bureaucratic burden by, for example automatic invoicing and providing an easy matching of supply (GPs) and demand (available clinical sessions).

ICSs will be required to support and manage the running costs of a flexible staffing pool (the scheme first launched in December 2020) for primary care staff, for which they will receive up to £120,000 each.

The purpose of these flexible staffing pools is to support capacity and to provide a locally available resource in general practice, in addition to providing a structure for local GPs to work flexibly. It is for each ICS to develop the working arrangements that best suit the local working environment; however, it is anticipated that most pools will operate at the “place” level of the ICS.

These pools can be used to employ permanent GPs directly to work flexibly across an area, or temporary GPs to meet local needs. In addition, the pool, which will operate as a first point of contact for the GP workforce, will offer advice to doctors returning to practice, for example those who have had a career break or parental or adoption leave.

NHS England and NHS Improvement have developed a framework of digital staffing platforms which can be used by ICSs to support these virtual pools, although alternative providers can be used secured via a separate procurement process.

Local GP retention fund

The function of the GP retention fund is to encourage and support local action to minimise the attrition of the GP workforce. For 2021–2022, the priorities are to support GPs to work flexibly and at points of transition in their career, eg retaining those nearing retirement or returning from a career break — £12 million is available nationally for this.

Training hubs

ICSs are allocated funding (£12 million nationally) to commission the training hubs to deliver learning, training and associated work packages for primary care multidisciplinary teams.

There will be a focus on supporting the implementation of ARRS and GP recruitment and retention as well as meeting the continuing training and development needs of primary care. Specifically, the funding will be directed at supporting the training, development and supervision of the extra 26,000 (ARRS) roles new to primary care, plus the extra 6000 GPs that are being recruited.

International GP recruitment

This is to enable GPs who qualified abroad and have come to work in the NHS to gain the appropriate entry on the medical performers’ list. Currently over 100 doctors have been recruited to this programme and are receiving training.

Coaching for primary care staff

In recognition of the unprecedented challenges posed by the Covid-19 pandemic, NHS England provides individual coaching support to all primary care staff (both clinical and non-clinical) to help them maintain their psychological wellbeing.

For more information, go to NHS England » General practice – the best place to work