The 2026/27 PCN DES introduces one of the most significant shifts since ARRS began. While most headlines have focused on GP reimbursement uplifts and neighbourhood alignment, the real change is the clearer and more flexible route for practices to consider directly employing ARRS staff.

For years, ARRS employment has been a mixture of PCN-level contracts, host-practice arrangements, and federation-run models. Many practices relied on external employers because the rules felt ambiguous, and the risks felt too high. The new DES clarifies the framework and makes practice-level employment more viable, although not without risk.

What Has Changed?

Direct practice employment is now explicitly permitted. The DES confirms that ARRS roles may be employed by the PCN, by a Core Network Practice, or through another provider with commissioner approval. This removes years of uncertainty and gives practices a clearer legal footing.

Reimbursement ceilings have risen significantly. The most notable increase is for ARRS GPs, rising from around £105k in 2025/26 to £152.9k in 2026/27 outside London. This reduces the financial exposure practices previously faced when employing ARRS staff directly.

There is new flexibility in ARRS roles. PCNs can now recruit non-direct patient care roles with commissioner approval, including PCN managers, data analysts, digital transformation leads, and administrative coordinators. These roles often sit more naturally within practices than at PCN level.

Governance expectations are tightening. Neighbourhood alignment is becoming contractual, commissioner oversight is increasing, and the direction of travel suggests the early formation of neighbourhood hubs. Some practices see direct employment to secure stability and reduce dependency on PCN-level structures.

Why Practices Are Bringing ARRS Employment In-House

Across England, more practices are exploring taking ARRS roles in-house. Some federations are stepping back due to rising HR costs, pension complexity, and organisational changes. Practices also want greater control over recruitment, performance, and day-to-day integration.

Practice-employed staff are more embedded in the team, aligned with local workflows, and less likely to be rotated across the PCN. This improves continuity for patients and stability for staff.

Practices can direct ARRS staff to support access, same-day demand, chronic disease management, medicines optimisation, and QOF-style metrics. This level of alignment is harder when staff are centrally employed.

Many ARRS staff prefer the identity and belonging of a single practice rather than a PCN-wide role.

The Reality on the Ground: Hybrid Models and Risks

Some PCNs are adopting a hybrid model where existing ARRS staff remain with the federation and new roles are employed by a practice. Deployment decisions remain PCN-wide, and funding still flows through the PCN. This creates several risks.

1. Employment liability shifts to the practice. Even though the PCN controls deployment, the practice becomes legally responsible for redundancy, sickness costs, grievances, disciplinary processes, maternity leave, pension obligations, and TUPE if structures change in the future.

2. The workload for the host practice should not be underestimated. Management time can be substantial, particularly when dealing with HR issues, payroll, and cross-practice deployment.

3. Governance becomes blurred. Without clear agreements, confusion arises over who line-manages, supervises, appraises, signs off leave, and handles performance issues. There can also be uncertainty about whether other practices in the PCN can use the staff.

4. Financial complexity increases. Practices must manage payroll, pension contributions, ARRS reimbursement claims, on-cost calculations, cross-practice deployment costs, sickness reimbursement, and backfill arrangements.

5. PCN decisions can create practice liabilities. If the PCN reduces a role or changes deployment, the practice still holds the employment contract.

6. Staff can become confused in hybrid models because different employers have different policies, expectations, and processes.

Additional Considerations

The future of PCNs beyond 2026 seems uncertain. Neighbourhood models are emerging, commissioner oversight is increasing, and PCN footprints may change. Practices taking ARRS roles in-house may be doing so to secure workforce stability before further structural changes occur.

Commissioners will expect PCNs to demonstrate safe governance, clear deployment plans, workforce stability, alignment with neighbourhood priorities, and risk-sharing arrangements.

ARRS staff often experience uncertainty when employment arrangements change. Clear communication is essential to maintain morale and avoid confusion.

TUPE may apply when ARRS roles move from a federation to a practice, or if PCN structures change. TUPE protects employees’ rights, meaning staff transfer with existing terms and liabilities transfer to the new employer.

PCN fragmentation poses risks. If one practice employs ARRS staff and another practice leaves the PCN, questions arise about redundancy, salary costs, and deployment. Without a clear agreement, the employing practice may be left carrying liabilities created by PCN decisions.

What Should PCNs Have in Place?

• A Workforce MoU defining employment, deployment, supervision, leave cover, performance management, and exit arrangements.

• A financial recharge agreement covering reimbursement, on-costs, rule changes, and dispute resolution.

• A shared workforce plan showing how ARRS roles support neighbourhood delivery.

• Redundancy indemnity protecting practices from financial exposure.

• Clear line-management structures.

• Financial safeguards including guaranteed reimbursement and clarity on pension and sickness reimbursement.

• Adequate HR and payroll capacity.

What Practices Can Do Next

• Review current ARRS hosting arrangements.

• Map which roles could move in-house.

• Assess HR and payroll capacity.

• Discuss risk-sharing with PCN partners.

• Draft a Workforce MoU.

• Agree a PCN-wide employment strategy.

• Seek legal advice on TUPE if relevant.

• Ensure financial modelling is robust.

Conclusion

The shift from federation-hosted ARRS roles to practice-hosted roles is happening quietly but rapidly. The 2026/27 DES has accelerated this by clarifying employment routes and increasing reimbursement ceilings. Done well, this shift strengthens the workforce and improves integration. Done poorly, it exposes practices to significant legal, financial, and operational risks. Clarity, governance, and written agreements are essential.

A final question remains. If, over time, all ARRS roles are shifted to a single practice within the PCN, will all ARRS funding eventually be routed through that practice? I experienced this in the early days of PCNs, and like all NHS funding, it quickly became a challenge to track and account for the money. Practices should consider this carefully before agreeing to take on large-scale ARRS employment.

References and Further Reading

• NHS England. Primary Care Network Directed Enhanced Service (DES) Specification 2026/27.
• NHS England. Additional Roles Reimbursement Scheme (ARRS) Guidance.
• British Medical Association. PCN Handbook. NHS England. Integrated Neighbourhood Working:
• Workforce and Delivery Guidance. ACAS. TUPE: Transfer of Undertakings (Protection of Employment) Regulations.

Related Thornfields Courses

• Social Prescriber, Link Worker Activation
• Introduction to PCN Finances 
• Introduction to Practice Finance and Contracts