McNelly P (2025) Reluctance of PCNs to employ Mental Health Practitioner under ARRS. Ann Psychiatry Ment Health 13(2): 1203

The ARRS scheme was introduced in England in 2019, and later in other parts of the UK

Key elements were to improve access to general practice, widen the range of services on offer in primary care, and support GPs with their workload.

PCNs were able to claim reimbursement for the salaries of specific roles within their multidisciplinary teams.

The scheme more recently has allowed PCNs to employ GPs, and recent changes to funding has resulted in some PCNs considering employment of more GPs, and less other Professionals.

From the early days of the scheme, certain professional groups were more popular with PCNs and their associated GP Practices than others, Pharmacists and Physiotherapists were amongst the early groups. Mental health Practitioners were late into the game, and still lag along way behind other professional groups employed under the ARRS Scheme.

The employment by PCNs and its associated GP Practices of a MHP has been more difficult than almost any other professional group, they as a profession sit away from the “medical model”, GPs are clearly aware off the role and scope of practice of other members of the multidisciplinary team, as in the main they all trained and work under the broad medical model umbrella.

GPs along with other professionals such as ANPs and PAs will have had some training and exposure to mental health during their training, mental health is perhaps the most distance of all disciplines from the traditional medical model (along with social work), and by its very nature makes it hard for PCNs and GPs to see how MHPs might fit it to the daily business of the GP Practice.

The decision and responsibility of what professionals PCNs need and employ, require knowledge of local health/social needs, along with understanding of what professional is best placed to meet such needs, with mental health a generic need may be apparent, but what professional is best suited to meet the need is less obvious.

GPs have for years dealt with the mental health issues of their practice patients, referring onto to secondary care only a handful of these patients, ANPs and PAs have more recently supported GPs in Practice by also seeing these patients also, all these professionals come from the medical model umbrella and continue to provide excellent care.

Why then is a MHP required by a PCN. The answer is that a MHP can work with the medical model but also bring a level of knowledge, skill, and insight into a consultation with patients that embrace psychosocial components to support the medical model, outcomes should by any measure be an enhanced service for the patients.

In all the above there remains the issue of a MHP being employed to meet PCN/GP Practice needs. Fundamental to this question is that a MHP must be able and willing to adapt their scope of practice to reflect the needs of PCN/ GP Practices.

A good starting point is for the MHP to be the 1st contact professional for patients contacting the practice with a mental health issue/concern and be seen by them.

Alternative is for PCNs to employ as many GPs as they can afford, along with a limited range of other professionals, that the average GP would understand how they fit into the medical modal.