For PCN Clinical Directors and Practice Managers, ARRS funding has been transformational — but only for networks that approach it strategically. Too many PCNs continue to treat ARRS recruitment as a reactive, ad hoc exercise: identifying a gap, placing a job advert, and hoping for the best. The result is persistent underspend, high turnover, and ARRS staff who are underutilised or poorly integrated. This guide sets out a strategic approach to PCN workforce planning that maximises ARRS value and builds a genuinely sustainable clinical team.
Start with Patient Need, Not Job Titles
The most common mistake in ARRS workforce planning is starting with the available roles rather than with the clinical need of the patient population. The right question is not "which ARRS roles can we recruit for?" but "what are our highest-volume, highest-risk clinical demands, and which roles are best placed to address them?"
A PCN with a large elderly population in care homes has fundamentally different needs to a network in a young, urban area with high same-day access demand and a significant mental health caseload. Before any recruitment, analyse your patient data, GP appointment types, referral patterns, and QOF performance — and let that analysis drive your role decisions.
The Optimal Clinical Mix: A Framework
Most PCNs of 30,000–50,000 patients benefit from a diversified ARRS team across four core workforce areas:
ANP / ACP (1–2 WTE)
Highest GP capacity releaseAutonomous consultation across acute and chronic presentations. The most direct substitute for GP appointment demand. Prioritise independent prescribers for maximum impact.
Clinical Pharmacist (1 WTE)
Best return on investmentStructured medication reviews, high-risk drug monitoring, medicines optimisation. NHS England data shows 1 WTE clinical pharmacist can release approximately 1,500 GP appointments per year.
Paramedic Practitioner (1 WTE)
Home visit & urgent careHome visiting, same-day urgent presentations, minor illness. Dramatically reduces GP home visit burden and extends same-day access capacity across the network.
Social Prescribing Link Worker
Demand reductionAddresses social determinants of health — reducing inappropriate appointment demand from patients whose primary needs are social, not clinical. High return in deprived areas.
Recruitment Timelines: Plan for the Real World
ARRS underspend is consistently driven by one factor above all others: recruitment that starts too late. Most PCN Clinical Directors underestimate how long it takes to move from "we need an ANP" to "our ANP starts on Monday." Realistic timelines are:
- Q1 — Plan
Define roles & confirm budget
Map patient need, confirm ARRS allocation, define roles and supervision arrangements
- Q2 — Recruit
Advertise & interview
ANP/ACP: 8–14 weeks. Pharmacist: 6–10 weeks. Paramedic: 6–10 weeks. Start process no later than May
- Q3 — Onboard
Induction & supervision
New starters begin; supervision arrangements activated; induction and caseload building
- Q4 — Optimise
Review & plan ahead
Review performance, plan next year's recruitment, address any vacancies before year-end
Supervision: The Foundation Everything Rests On
Every ARRS role requires appropriate clinical supervision, and every PCN that has struggled with ARRS performance has, at its root, a supervision problem. Before recruiting any ARRS clinician, answer these questions unambiguously:
- Who will supervise this role? Name a specific clinician, not "a GP partner."
- How much time will supervision require per week? A new ANP in their first three months may need two to three hours of case review and mentoring per week.
- Is the supervisor clinically and contractually equipped to provide this supervision? Supervising an ACP with a paramedic background requires different skills to supervising a nurse practitioner.
- How will you compensate the supervisor for their time? Adding supervision to an already full GP workload without recognition or protected time is a direct route to burnout.
Retention: The Most Underinvested Priority
High turnover in ARRS roles is far more expensive than most PCNs account for. Direct recruitment costs, agency fees, the management time of a new hiring process, and the clinical disruption of an empty role typically add up to six to twelve months of the departing clinician's salary. Yet most PCNs invest heavily in recruitment and almost nothing in retention.
Structured Induction
A formal induction programme with protected learning time in the first four to eight weeks significantly improves retention at the 12-month mark
Career Development
Clear career pathway conversations at 6 and 12 months. ARRS clinicians who can see a development pathway stay significantly longer than those who cannot
Competitive Pay
ARRS covers employment costs but PCNs can top up salaries from other income streams. Benchmarking against the local market annually prevents unnecessary turnover
Team Integration
ARRS clinicians who are included in practice MDT meetings, clinical governance, and team social events report higher job satisfaction and stay longer
Regular Supervision
Consistent, quality supervision is itself a retention tool. Clinicians who feel clinically supported and professionally seen are far less likely to leave
Workload Management
Ensuring ARRS clinicians have appropriate caseloads — not being used to fill every gap — prevents burnout and demonstrates the PCN values their sustainability
Working with a Specialist Agency
For many PCNs, the fastest route to solving immediate ARRS gaps — while longer-term permanent recruitment completes — is working with a specialist primary care recruitment agency. SHR Group maintains an active network of ARRS-eligible ANPs, ACPs, clinical pharmacists, and paramedic practitioners across England, and can often place pre-verified candidates significantly faster than a standalone job advertisement process.
Agencies can also advise on role eligibility, help you sense-check your role specifications against ARRS requirements, and provide interim locum ARRS cover that counts toward your allocation while permanent recruitment is underway.
