NHS ARRS Explained

If you trained or worked in a hospital setting, "working in a GP surgery" might still conjure an image of a GP and a practice nurse and not much else. That picture is increasingly out of date. Over the past several years, general practice has absorbed a wide range of clinical professions that traditionally sat almost entirely within NHS trusts or ambulance services, and the Additional Roles Reimbursement Scheme is the specific policy mechanism that made that expansion financially possible. This guide explains what ARRS actually is, which roles it covers, and — more importantly for anyone considering a move into one of these roles — what the practical employment reality looks like compared with a standard trust contract.

What ARRS actually is

ARRS is a national scheme that provides funding for Primary Care Networks to recruit additional clinical staff into specific, defined roles, with NHS England (via Integrated Care Boards) reimbursing the PCN for the cost, up to set limits per role type. A PCN itself is a group of GP practices in a local area — typically covering a population of roughly 30,000 to 50,000 patients — that have formally agreed to work together, share some services, and pool certain kinds of funding and staffing decisions.

The scheme exists because of a straightforward workforce problem: general practice has faced a well-documented shortage of GPs relative to patient demand, and simply training more GPs is a slow, long-lead-time solution. ARRS approaches the same problem from a different angle — instead of relying solely on GPs to deliver every kind of appointment, it funds a wider multidisciplinary team so that patients with, say, a straightforward musculoskeletal complaint, a medication review, or a social need that's really a housing or isolation problem rather than a purely medical one, can be seen by a professional whose skills are a better match for that need, freeing up GP time for the appointments that genuinely need a GP.

Which roles does ARRS actually fund?

The list of roles eligible for ARRS reimbursement has grown since the scheme launched, and the exact list and any per-role reimbursement caps are set nationally and reviewed periodically. Roles that are commonly funded through ARRS include:

• • Clinical pharmacists — medication reviews, long-term condition management, and increasingly independent prescribing within general practice
• • Pharmacy technicians — supporting medicines optimisation and repeat prescribing processes
• • Paramedics (often titled 'first-contact paramedics' or similar in this setting) — seeing same-day and urgent presentations that would traditionally have gone to a GP
• • First-contact physiotherapists — assessing musculoskeletal presentations directly, without needing to go through a GP first
• • Physician associates — supporting the medical team across a broad range of clinical presentations under supervision
• • Social prescribing link workers — connecting patients with non-clinical, community-based support for issues like isolation, debt, or housing that present at the GP surgery but aren't primarily medical
• • Health and wellbeing coaches, care coordinators, and mental health practitioners — among a number of other roles added to the scheme over time

For two of the professions on this list in particular, see our dedicated career guides: NHS pharmacy pay and careers covers the pharmacist and pharmacy technician route in more depth, and NHS paramedic pay and careers covers the paramedic route, including how a move from ambulance service work into a first-contact primary care role tends to look in practice.

The practical employment reality: who's actually your employer?

This is the single most important thing to get straight before taking an ARRS role, because it shapes almost everything else — your contract, who you escalate pay or HR queries to, and what your pension and leave arrangements actually are.

Unlike a hospital job, where your employer is unambiguously the NHS trust, an ARRS role can sit with several different types of employer depending on local arrangements:

• ✓ A single GP practice employs you directly, and you may work mostly or entirely within that one practice
• ✓ The PCN itself employs you as a distinct legal entity (most PCNs now have, or operate through, a formal employing structure), and you work flexibly across the member practices in that network
• ✓ An NHS trust or GP federation employs you and 'hosts' you out to work across PCN practices — a model some areas use specifically so staff retain a more trust-like employment relationship

None of these arrangements is inherently better or worse, but they are genuinely different, and the difference matters in ways a job advert doesn't always spell out clearly. A sensible, direct question to ask at interview or offer stage is simply: "Who, specifically, is my employer, and is it the PCN, a named GP practice, or a trust/federation hosting this role?"

Pay: benchmarked to Agenda for Change, but not automatically identical

In practice, most ARRS roles are advertised with a pay range that references a familiar Agenda for Change band — a clinical pharmacist role, for example, is very often pitched somewhere in the Band 7 to 8a range, similar to where you'd expect an equivalent hospital pharmacist role to sit. This benchmarking is deliberate: it's meant to keep ARRS pay broadly competitive with trust employment for the same skill set, so PCNs can actually recruit against NHS trusts for the same candidates.

But "benchmarked to" is not the same as "identical to." Because the employer is a PCN or GP practice rather than an NHS trust, that employer isn't automatically bound by every detail of the Agenda for Change Terms and Conditions Handbook in the way a trust is. In practice this means:

• • The base salary offered may sit anywhere within, or occasionally outside, the referenced band range, and increments may not follow exactly the same automatic annual progression you'd see in a trust
• • Unsocial hours payments, on-call arrangements, and enhancements can be structured differently, or may not apply in the same way, particularly for roles that don't involve shift patterns comparable to hospital rotas
• • Annual leave entitlement is often set to mirror Agenda for Change terms but is contractually determined by the individual employer, not guaranteed to be identical
• • Local terms around CPD funding, professional registration fees, and expenses vary considerably between individual PCNs and practices

None of this means ARRS pay is worse — many people find it comparable, and some find specific elements (working patterns, autonomy, or a particular practice's local benefits) genuinely better suited to their circumstances than an equivalent trust role. The point is simply that "benchmarked to Agenda for Change" is a starting reference point for a negotiation and comparison, not a guarantee of trust-identical terms — read the actual contract offered, not just the band quoted in the advert.

Pension: usually accessible, but confirm rather than assume

This is the area where the gap between "usually true" and "guaranteed" matters most, because getting it wrong has long-term financial consequences. General practice has been part of the wider NHS Pension Scheme arrangements for a long time — GPs themselves have always had their own route into the scheme — and staff employed by GP practices and PCNs can generally still access the NHS Pension Scheme through their employer. For a lot of people moving from a trust role into an ARRS role, pension continuity is one of the less disruptive parts of the move.

That said, "generally" is exactly the word that should prompt a direct question rather than an assumption. Whether a specific employer has NHS Pension Scheme access set up correctly, which section applies, and how continuous service and transfers are handled if you're moving from a trust, are all things worth confirming explicitly with the actual employer (the PCN, practice, or hosting trust) before you sign anything — rather than assuming it works identically to a trust HR department's standard onboarding, where NHS Pension Scheme enrolment is automatic and well-trodden. For the underlying mechanics of how the pension itself builds up once you are in the scheme, see our NHS Pension Scheme (2015) explained guide.

Why this part of the NHS workforce is worth understanding properly

ARRS has been one of the fastest-growing parts of NHS-funded clinical employment in recent years, and that growth shows no sign of reversing — primary care's reliance on a multidisciplinary team beyond GPs and practice nurses is now a settled direction of travel, not a temporary pilot. For clinicians in professions like pharmacy, paramedicine and physiotherapy, an ARRS role in general practice is now a completely mainstream career option alongside traditional hospital or ambulance service employment — in many areas it's one of the more common routes into primary care work for those professions.

Precisely because this is a newer and structurally different part of the NHS landscape than trust employment, it's an area where checking your specific offer, rather than relying on assumptions carried over from trust experience (yours or a colleague's), pays off. The band on the advert, the pension arrangement, the leave entitlement, and — fundamentally — who your actual employer is, are all worth confirming in writing before you commit to a move.

Regulation, supervision and indemnity: the parts a job advert often glosses over

Pay and pension get most of the attention when people weigh up an ARRS role, but three quieter practical questions matter just as much day-to-day, and are worth asking explicitly before you accept an offer rather than discovering the answer once you've started.

• • Your professional registration doesn't change — whichever body regulates your profession (HCPC, GPhC, NMC, or the relevant regulator) continues to apply exactly as it would in a trust role, since registration is tied to you as an individual rather than to your employer; what can differ is the administrative support around it, since a small practice may not have the dedicated professional standards infrastructure a large trust does
• • Clinical supervision needs a named answer — particularly for more autonomous roles like first-contact physiotherapists, paramedics and physician associates, ask specifically who your named clinical supervisor will be (often a GP), how much protected supervision time is built in, and what the escalation route looks like for cases outside your scope of practice
• • Indemnity cover is worth confirming, not assuming — general practice has its own indemnity landscape that has evolved somewhat separately from NHS trust arrangements, so ask your prospective employer directly what clinical negligence indemnity scheme applies to your specific role, rather than assuming it mirrors trust cover
• • CPD and training support genuinely varies by employer — some PCNs and practices offer well-developed CPD funding and protected learning time, others (being smaller organisations) have less formal provision, so ask about this explicitly rather than assuming it will match a trust's learning and development offer

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This guide is provided for general information only. FrontlinePay is not affiliated with NHS England, NHS Pensions/NHSBSA, or the Department of Health and Social Care, and this is not a substitute for reading your own contract of employment or getting advice specific to your circumstances.

Frequently asked questions

Is ARRS pay the same as NHS trust pay? +

Not automatically. ARRS roles are typically benchmarked against Agenda for Change pay bands — a clinical pharmacist role, for example, is usually pitched around the same band range you'd see in a trust — but the employer isn't an NHS trust, so the actual salary, increments, unsocial hours payments and other terms are set by the employing Primary Care Network (PCN) or GP practice. Two ARRS roles with the same job title, even in neighbouring PCNs, can have meaningfully different pay packages. Always check the specific offer rather than assuming it mirrors trust terms exactly.

Do I still get the NHS Pension in a PCN or GP practice role? +

Generally, yes — staff employed by GP practices and PCNs can usually still access the NHS Pension Scheme, because general practice has long been part of the wider NHS pension arrangements. But 'usually' is doing real work in that sentence: eligibility and the exact arrangements can depend on the specific employer, so it's worth explicitly confirming NHS Pension Scheme access, and the section you'd join, with your specific employer before assuming it, rather than treating it as automatic in the way it is for a trust employment contract.

What roles are covered by the Additional Roles Reimbursement Scheme? +

The list has grown over time, but commonly funded ARRS roles include clinical pharmacists, pharmacy technicians, paramedics, first-contact physiotherapists, physician associates, social prescribing link workers, health and wellbeing coaches, care coordinators, and mental health practitioners, among others. The exact list of eligible roles and any reimbursement caps are set nationally and can change year to year, so treat this as an illustrative list rather than a definitive one.

Who actually employs someone in an ARRS role? +

It varies. Some ARRS staff are employed directly by a single GP practice, others by the Primary Care Network itself (PCNs are usually a formal legal entity in their own right, or operate through a lead practice), and in some areas an NHS trust or a GP federation employs the individual and hosts them out to work across PCN practices. The employment relationship — and therefore who you'd query pay, leave and pension questions with — depends on the specific local arrangement, so it's genuinely worth asking 'who is my employer' as an explicit question at interview.

Does ARRS funding mean the role is temporary or insecure? +

Not inherently — many ARRS roles are permanent substantive posts, and the scheme has been running long enough that most PCNs treat these as core, ongoing parts of their workforce rather than short-term pilots. That said, because the funding flows through a national reimbursement scheme with its own rules and cap, it's fair to ask any specific employer how the role is funded and whether it depends on annually renewed national scheme parameters, particularly if you're considering a move from a permanent trust contract.

Can I move between an ARRS role and a trust role later in my career? +

Yes, and it happens in both directions. Many clinicians move into primary care ARRS roles after starting their career in a trust (a paramedic moving from ambulance service work into a first-contact paramedic role in general practice is a common example), and others move the other way, back into trust employment, later on. Continuous NHS service, pension continuity and any impact on redundancy entitlement can depend on the specific employers involved on each side of the move, so it's worth checking those points explicitly rather than assuming full continuity, especially where a GP practice rather than a trust is one side of the move.

Do I need to be professionally regulated to work in an ARRS role? +

Yes, in the same way you would for the equivalent role in a trust — your professional registration (with bodies such as the HCPC, GPhC, NMC or the relevant regulator for your profession) is tied to you as an individual, not to your employer, so it doesn't change or lapse because you've moved into a PCN or GP practice role. What can differ is the local governance around how that registration is checked, renewed and supported administratively, since a smaller employer like an individual GP practice may not have the same dedicated professional standards infrastructure a large trust does — worth asking about at interview if it matters to you.

Who provides clinical supervision in an ARRS role? +

This varies by role and by local arrangement, but ARRS roles — particularly newer or more autonomous ones like first-contact physiotherapists, paramedics and physician associates — are typically expected to have a named clinical supervisor, often a GP, who provides oversight, escalation support and sign-off for cases outside your scope of practice. The specifics of how supervision is structured, how much protected time is allocated to it, and who your named supervisor actually is, can vary considerably between PCNs, so it's a reasonable and important question to ask explicitly before accepting a role.

What about clinical indemnity cover for an ARRS role? +

Because your employer is a PCN or GP practice rather than an NHS trust, it's worth explicitly confirming what clinical negligence indemnity arrangement covers you in the role, rather than assuming it's identical to a hospital's arrangement — general practice has its own indemnity landscape that has evolved somewhat separately from trust indemnity over the years. Ask your prospective employer directly what indemnity scheme applies to your role and whether any additional personal indemnity cover is expected or recommended for your profession.

Can I access the same CPD funding and training opportunities as I would in a trust? +

It depends on the individual employer rather than being standardised the way it might feel in a large trust with a dedicated learning and development department. Some PCNs and practices have well-developed CPD support, protected training time and funding for courses or further qualifications; others, being smaller organisations, have less formal arrangements. This is genuinely one of the more variable parts of the ARRS employment picture, so ask specifically about CPD funding, protected learning time and career progression support before accepting an offer, rather than assuming it will mirror trust provision.