The uptake of roles through the Additional Roles Reimbursement Scheme and associations with patient experience: Analysis of General Practices and Primary Care Networks in England 2020-2022

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

6E.2

Presenter:

Chris Penfold

Co-authors:

Dr Theresa Redaniel, Dr Jialan Hong, Prof John Macleod, Prof Frank De Vocht, Prof Chris Salisbury

Author institutions:

NIHR ARC West, Centre for Academic Primary Care, Bristol Medical School, University of Bristol

Problem

The Additional Roles Reimbursement Scheme (ARRS), commissioned by Primary Care Networks (PCNs), began in 2020 to expand the non-medical practitioner workforce in primary care. The ARRS is expected to improve primary care delivery across networks, by expediting patient access, mitigating rising demand, and providing an advanced career pathway for non-GP practitioners. At present there are 14 direct patient care ARRS roles eligible to be commissioned through the scheme. Integration of ARRS roles into PCNs has occurred at a rapid pace, with around 12,000 full time equivalent staff in ARRS roles (September 2022). However, the implementation of the scheme has undergone limited evaluation.The aims of our study were to:1. Describe the commissioning of ARRS roles in England2. Explore associations between ARRS roles and patients’ experiences of primary care services

Approach

We used an ecological study design where outcomes and exposures were measured at the General Practice and PCN level.We used the PCN workforce data 2020-2022 to describe commissioning of these roles at PCN-level. We matched this with GP workforce and General Practice Patient Survey (GPPS) data to explore associations between Practice-level FTE in ARRS roles and GPPS outcomes (perceived access to care and satisfaction), adjusted for characteristics of the General Practices (workforce, number of patients) and registered patients (age, gender, deprivation, clinical need). Analyses included descriptive statistics and adjusted linear regression models.

Findings

By September 2022, 11,865 FTE in ARRS roles had been commissioned by 1,089 PCNs. These were predominantly pharmacists and pharmacy technicians (3,400 and 1,048 FTE), social prescribing link workers (2,047 FTE), care coordinators (1,895 FTE), and physiotherapists (972 FTE). The median PCN-level FTE ARRS roles was 1.9 per 10,000 registered patients (25%, 75%: 1.3, 2.5). PCNs from more deprived compared with less deprived areas commissioned slightly fewer ARRS FTE (median FTE/10k patients = 1.7 versus 2.0 most deprived versus least deprived PCNs respectively).An increase of one FTE in ARRS roles was associated with a roughly one percentage point increase in the proportion of patients satisfied with their care (beta=1.1, 95% CI: 0.81, 1.4) and able to make an appointment (beta=1.3, 95% CI: 0.91, 1.6).

Consequences

The commissioning of roles through the ARRS scheme has occurred rapidly since its inception and is associated with a small positive increase in perceptions of the accessibility of and satisfaction with primary medical care. Further research is needed to determine whether roles are being commissioned according to clinical need and whether these roles are extending or filling gaps in the primary care workforce.

Submitted by:

Chris Penfold

Funding acknowledgement:

This research was funded by the NHS Insights Prioritisation Programme and the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West). The views expressed in this article are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care