ARRS Underspend: A Missed Opportunity to Strengthen Primary Care

The Additional Roles Reimbursement Scheme (ARRS) was launched with a bold ambition: to strengthen primary care by enabling Primary Care Networks (PCNs) to recruit a broader range of healthcare professionals, from pharmacists and paramedics to physician associates. By easing the pressure on GPs and diversifying the multidisciplinary team, ARRS funding promised to enhance patient access and improve outcomes (1). Yet, despite this vision, millions of pounds budgeted for the scheme are going unspent each year.

In 2023-2024 alone, the underspend reached £88 million (2). This is not an isolated failure; since the scheme’s inception in 2019, large proportions of funding have consistently gone unused. 40% in the first two years, with underspends continuing in the 2024/25 financial year at nearly £20 million (3). These figures are particularly striking at a time when patient demand is at an all-time high and workforce pressures are eroding morale in primary care.

Why is so much money left over? The reasons for this persistent underspend are likely multifactorial. Recruitment challenges are perhaps the most pressing. PCNs across the country have struggled to attract suitable candidates for ARRS-funded roles. This reflects a wider healthcare workforce shortage, with intense competition for skilled professionals across all sectors (4). Even when staff are available, practices often lack estate capacity - consultation rooms, office space or IT infrastructure, to accommodate them (5). Over complexity in claiming ARRS funding and working out what is claimable is certainly contributing to the underspend. Navigating what can and can’t be claimed under ARRS is far from straightforward, this administrative burden has left many PCNs questioning whether it's worth the effort. Are PCNs a victim of another unnecessarily elaborate funding scheme?

Another key factor is funding uncertainty, something we have certainly seen with our client PCNs. Until recently, there was no guarantee that ARRS funding would continue beyond 2024/25. This lack of clarity has made many PCNs reluctant to commit to permanent staffing arrangements, fearing that posts might become unaffordable if central support were withdrawn. The scheme’s year-to-year fragility has undermined confidence in long-term workforce planning (4).

Supervision is another overlooked issue. Many ARRS roles require oversight by GPs or other senior clinicians, but the scheme does not reimburse the time needed for this. This has left practices reluctant to expand their teams when it risks increasing, rather than alleviating, GP workload (5).

Taken together, these barriers have created a frustrating paradox: money intended to strengthen the primary care workforce has too often been returned unspent, even as patients face longer waits and GPs struggle under unsustainable workloads.

To break the cycle of underspend, several things should be considered. Could funding be broadened to cover supervision, induction and training, ensuring that new recruits can integrate effectively without overburdening existing staff? Perhaps local flexibility could be embedded, not just in role choice but in the ability to redistribute unused funds between PCNs, so that one area’s shortfall can become another’s opportunity. Encouragingly, there are already signs of movement in this direction. From 2025/26, ARRS funding will no longer be ring fenced but will instead flow through Integrated Care Board Allocations, with PCNs given greater freedom to choose whom they recruit (6).

Flexibility shouldn’t just mean roles on a list. Creative use of different clinicians in different roles could also open up greater opportunities. In ambulance services, paramedics not only deliver care, but also perform managerial duties; pharmacists successfully run their own businesses; and nurses often manage entire clinics independently. Is there a call for more “out of the box” thinking in regards to recruitment?

An avenue that many PCNs have not explored yet is the fact that ARRS funding can also be used to commission third parties. At the PUCA, for instance, we have supported networks to use ARRS funding to outsource services, providing them bespoke, fully managed solutions without the headaches of direct recruitment and supervision.

The £88 million underspent last year could have been transformative, funding hundreds of thousands of additional clinician hours, paid for bespoke outsourced services, supported thousands more patient consultations and provided relief for burnt-out staff. With primary care in urgent need of stability and growth, these are not just missed numbers on a spreadsheet; they are missed chances to deliver care where it’s most needed.

The ARRS was never meant to be a pot of money that gathers dust. As the scheme evolves, its potential can only be realised if flexibility, infrastructure and planning security are built into its design. Otherwise, we risk repeating the same cycle of wasted potential at a time when patients and staff need it most. Let’s find a way to work together, by partnering with organisations like us, PCNs can unlock the full value of ARRs funding, maximising services and improving patient outcomes.

Authors:

Mark Murphy BSc PGcert DipPUC MCPARA FIoL FRSPH

Isabel Boniface BSc MSc

References:

1. Penfold C, Hong J, Edwards PJ, Kashyap M, Salisbury C, Bennett B, et al. Additional Roles Reimbursement Scheme uptake, patient satisfaction, and QOF achievement: an ecological study from 2020-2023. Br J Gen Pract. 2025 Jan;75(750):e35–42.

2. Parr E. GP networks underspent on ARRS by £88m, new data shows. Pulse PCN [Internet]. 2025 14 [cited 2025 Aug 19]; Available from: https://www.pulsetoday.co.uk/news/breaking-news/gp-networks-underspent-on-arrs-by-88m-new-data-shows/

3. Gault B. Exclusive: £20m ARRS money unspent in 2024/25. Pulse PCN [Internet]. 2025 Jun 23 [cited 2025 Aug 19]; Available from: https://pulsepcn.co.uk/news/exclusive-20m-arrs-money-unspent-in-2024-25/

4. Clinical Rx. Clinical Rx. 2025 [cited 2025 Aug 19]. Understanding ARRS Funding Underspend: A Complete Guide to Primary Care Network Budget Management. Available from: https://www.clinicalrx.co.uk/resources/guides/arrs-funding-underspend-pcn-budget-management-guide

5. MacConnachie. NHS Confederation. 2024 [cited 2025 Aug 19]. Assessing the impact and success Additional Roles Reimbursement Scheme. Available from: https://www.nhsconfed.org/publications/assessing-impact-and-success-additional-roles-reimbursement-scheme

6. Gault B. Pulse PCN. 2025 [cited 2025 Aug 19]. Full extent of ARRS underspend revealed by minister. Available from: https://pulsepcn.co.uk/news/full-extent-of-arrs-underspend-revealed-by-minister