Transforming Primary Care in the UK: The Impact of ARRS Roles on Reducing GP Pressure and Improving Patient Care – What Have We Learned So Far?
Primary care in the UK is undergoing significant changes with the introduction of Additional Roles Reimbursement Scheme (ARRS) roles. These roles are designed to alleviate the workload on GPs while enhancing patient care. But what insights have emerged since their implementation? This blog explores what we know so far about the implementation of ARRS roles in twelve Primary Care Networks the challenges faced, and the opportunities for further development in primary care.
What are ARRS Roles?
The Additional Roles Reimbursement Scheme (ARRS) is an initiative in primary care, particularly within the context of the National Health Service (NHS) in England. The scheme aims to expand the workforce in primary care networks (PCNs) by providing funding to hire a range of healthcare professionals. The purpose of the scheme was to relieve pressure on GPs and other primary care staff, improve patient care, and broaden the range of services offered by primary care networks (PCNs). The Additional Roles Reimbursement Scheme represents a strategic effort to modernise and strengthen primary care by leveraging a diverse workforce, ultimately aiming to improve patient care and support the sustainability of primary healthcare services.
1. Workforce Expansion: To alleviate the workload on general practitioners (GPs) by diversifying the skill mix within primary care teams.
2. Improved Patient Care: To enhance the quality of patient care by providing access to a wider range of services and expertise within primary care settings thereby addressing health inequalities.
3. Enhanced Access: To improve patient access to healthcare professionals and reduce wait times for appointments.
Eligible Roles
The scheme now funds 17 different roles that GPs can choose from; some examples are provided below:
· Clinical Pharmacists: Manage medication reviews, provide advice on medicines, and support chronic disease
management.
· Pharmacy Technicians: Assist with medication management and patient education.
· Social Prescribing Link Workers: Connect patients with non-medical support services in the community.
· Health and Wellbeing Coaches: Help patients set and achieve health and wellness goals.
· Care Coordinators: Assist patients in navigating the healthcare system and managing their care plans.
· Physician Associates: Support GPs with clinical assessments, diagnoses, and treatment plans.
· First Contact Physiotherapists: Provide initial assessment and management of musculoskeletal conditions.
· Dietitians: Offer dietary advice and management plans for various conditions.
· Podiatrists: Manage foot and lower limb conditions.
· Occupational Therapists: Support patients with activities of daily living and rehabilitation working in frailty,
vocational rehabilitation and mental health.
· Mental Health Practitioners: Provide mental health support and interventions.
· Nursing Associates: Support nursing care under the supervision of registered nurses.
Funding and Implementation
The reimbursement scheme enables PCNs to claim reimbursement for the salaries and on-costs of the additional roles, subject to certain conditions and caps. PCNs have some flexibility to determine which roles best meet the needs of their patient populations. The scheme took a phased approach with additional roles and funding being rolled out over time. Each Network has a different complement of ARRS roles determined by historical arrangements, population health needs and local partnerships working with voluntary sector organisations.
Evaluation of the utilisation of ARRS roles in Sheffield
I conducted an evaluation of ARRS roles to understand the impact of the scheme across 12 primary care networks in the city of Sheffield. The objectives of the evaluation were:
Understand the utilisation of ARRS roles by PCNs: Explore how Primary Care Networks (PCNs) are leveraging Additional Roles Reimbursement Scheme (ARRS) roles to optimise general practice, address health inequalities, and enhance the quality of care.
Showcase best practices: Highlight successful examples of how these roles contribute to general practice and the value they bring.
Identify gaps and areas for improvement: Pinpoint any shortcomings or opportunities where improvements can be made.
Facilitate shared learning: Promote the exchange of insights and experiences.
Make recommendations for improvement: Provide actionable recommendations to enhance the effectiveness of ARRS roles.
I interviewed 56 stakeholders which included practice and locality managers, twelve PCN Clinical Directors and people working in ARRS roles (Occupational Therapists, Physiotherapists, Paramedics, Pharmacists, Mental Health Practitioners, and Physicians Associates). This also included three people who had left their ARRS posts within the first year.
Link to report:
https://primarycaresheffield.org.uk/2022/12/21/elementor-7968/
What attracts people to apply for multiprofessional roles in primary care?
ARRS employees shared personal impact examples, illustrating how their roles added value in primary care. These employees were motivated to work in primary care for a variety of reasons, including:
· Managing complex caseloads: The challenge and satisfaction of handling complex patient needs.
· Collaborating within a primary care team: The opportunity to be part of a multidisciplinary team.
· First Contact Practitioner training: Access to specialized training that enhances their clinical skills.
· Training to become an Advanced Clinical Practitioner: Career development opportunities in advanced practice.
· Assets-based approaches: The ability to work within frameworks that emphasise community strengths and
resources.
· Improved work-life balance: More favourable hours and shift patterns, contribute to a better quality of life.
· Increased autonomy and service development: Greater independence in decision-making and the ability to
influence and shape the services they deliver.
These examples highlight the diverse motivations driving ARRS employees and the positive impact they are having in primary care settings.
The potential benefits of ARRS roles include:
The report details six narrative case studies which provided evidence of how the ARRS roles were benefiting patients and networks. One of the Dieticians was working with GP practices to perform clinical searches and actively invite patients with type 2 diabetes in for a guided discussion about lifestyle and medications.
"I had a patient with Type 2 Diabetes on 1000mg Yaltormin BD, HbA1c static at 61 mmol/mol for eight months and weighing 112.7kg before dietetic intervention. She had a poor dietary intake, missing 1-2 meals during the day, then grazing at night due to hunger and boredom, and limited physical activity outside her occupation due to needing a knee replacement. I provided diabetes dietary education, and following the request by the patient, I liaised with the GP regarding her prescription and Orlistat was initiated. She lost 16.3kg (14.6% body weight) over four months. HbA1c reduced to 51 mmol/mol. She had requested a change to a weekly GLP-1 during dietetic input; however, with the reduction in HbA1c, there was no longer a clinical need to consider it at the current time, thus providing a cost-saving to the GP's budget".
One patient story shared in the report:
“It was the little things I needed guidance on, new ideas, ways of doing things. My dietician understood I worked all different hours and the challenges I faced, she gave me real suggestions, doable answers and understood the cultural implications of my families type of food. Having the support to be able to talk through alternatives, ideas, and suggestions, is more important than any book you could give a patient. Face to face, one to one, is invaluable.”.
The data from the interviews indicated that there were six areas where ARRS roles could benefit primary care these included, providing education for patients and other staff, clinical expertise, leadership, addressing health inequalities, contributing to the evidence base and service user engagement. Three specific benefits articulated were:
Relieving GP Workload: By distributing tasks among a broader team, GPs can focus more on complex cases and clinical decision-making.
Comprehensive Care: Patients receive more continuity and holistic and specialised care, addressing a broader range of health and wellbeing needs.
Efficiency: Enhanced team-based approaches can lead to more efficient use of resources and better health outcomes.
The challenges
Networks acknowledged varying levels of maturity with developing ARRS roles and saw value in further development to fully leverage ARRS roles and enhance collaboration. They sought support in building team-based working, organisational development, and time for strategic workforce planning.
Concerns were raised about recruiting for ARRS roles, especially pharmacy and care coordinator roles, and attracting talent to primary care. There was also limited knowledge about newer roles in primary care such as Occupational Therapy, Paramedics, and Dietetics, particularly in providing supervision and career development.
GP “Traditional roles are familiar and easy to recruit to, whereas new roles to primary care such as Occupational Therapy or Dietetics are harder for networks to conceptualise”.
Several Clinical Directors emphasised the need for simple referral pathways to ARRS roles, with a "no door is closed" policy to save time and improve patient experience. Clinical Directors expressed enthusiasm for workforce innovation but noted a lack of understanding about how ARRS roles can add value, limiting workforce diversification. Three key themes were:
· Integration: Ensuring new roles are effectively integrated into existing primary care teams and workflows.
· Training and Support: Providing adequate training and support for new roles to maximise their impact. Having a
clear vision for the role, a defined purpose and a job plan was high on the list of ‘must haves’ for people in
ARRS roles.
· Sustainability: Securing ongoing funding and demonstrating the value of the scheme in improving patient care
and system efficiency.
Call to Action
This evaluation and the findings are a call to action for PCNs to learn more about the benefits of the lesser-known roles or to explore how their own practice could benefit from these additional staff members. The evaluation aims to spark continued dialogue around ARRS roles, which have yet to reach their full potential. Further development is crucial to support the shift toward a new team-based working model in primary care. As highlighted by the 2022 Kings Fund research (Baird & Beech, 2022), substantial cultural, organisational, and leadership development is essential.
The report also offers practical suggestions and recommendations for networks seeking to implement ARRS roles. Networks must invest in transforming cultures, systems, and processes to build strong multidisciplinary teams and enhance communication.
The challenge for primary care is positioning itself as an attractive workplace, both to recruit top talent and retain current staff. While ARRS roles demonstrate the benefits of working in primary care, more could be done to build a future workforce pipeline, optimise the current team, and assess the impacts of these roles. Now is the time for networks to take action in shaping the future of primary care.
If you would like to hear more about the evaluation and tips for PCN networks on developing this emerging workforce check out this 20-minute video of Dr Natalie Jones and GP Ben Allen discussing the findings from the report:
https://youtu.be/UCLwkGZ7s30?si=LmgmbVdMfM3CLSYZ (20 minutes)
Reference
Baird, B., & Beech, J. (2022). Integrating additional roles into primary care networks. In The Kings Fund (Issue February). www.kingsfund.org.uk
Links Here
Leadership development in primary care
Videos
AHP superpowers Podiatrist https://youtu.be/s_vFlr1D69k
AHP superpowers Dietician https://youtu.be/BSeOyZaeFxQ
AHP superpowers Occupational Therapist https://youtu.be/hDNKwfSxXwI
AHP superpowers Paramedic https://youtu.be/Dx67lQprwRM
AHP superpowers Physiotherapy https://youtu.be/ymmu3gYylHA
