How the Additional Roles Reimbursement Scheme is Transforming Primary Care in England
The Additional Roles Reimbursement Scheme aims to give patients access to a more diverse and specialised care team in general practice. Here, Dr Catia Nicodemo discusses new research evaluating how the scheme is reshaping prescription practices and patient satisfaction across England
In recent years, primary care in England has faced mounting pressures: a growing patient population, increased demand for services, and a chronic shortage of general practitioners (GPs). To address these challenges, the NHS introduced the Additional Roles Reimbursement Scheme (ARRS) in 2019. This bold initiative aimed to bring 26,000 additional healthcare professionals into general practice by 2024, offering patients access to a more diverse and specialised care team.
A new study, conducted by researchers at the University of Oxford, University of Brunel and the University of Bristol, delves into how the ARRS is reshaping prescription practices and patient satisfaction across England. Let us explore what the research reveals and what it means for the future of primary care.
The ARRS enables general practices to hire professionals like clinical pharmacists, paramedics, physiotherapists, and social prescribing link workers. These roles are designed to complement traditional GP services, tackling routine tasks and offering specialist care. For example, clinical pharmacists may handle medication reviews, while physiotherapists provide first-contact care for musculoskeletal issues. This approach not only eases GP workloads but also provides patients with access to a broader range of expertise. Practices can adapt their workforce to meet the unique needs of their communities, addressing challenges like chronic disease management and mental health
The study, spanning over 6,000 practices from 2018 to 2022, highlights two key outcomes of ARRS implementation:
- Reduced Prescription Rates
Practices employing more ARRS professionals saw lower overall prescription rates, particularly for mental health medications. This suggests that ARRS staff, such as social prescribing link workers and clinical pharmacists, may offer alternative solutions to medication, focusing instead on holistic care strategies. For instance, connecting patients with community resources or offering lifestyle advice can often address underlying issues without the need for pharmaceuticals. - Improved Patient Satisfaction
Practices with higher numbers of ARRS-funded staff reported significantly better patient satisfaction scores. Patients appreciated the enhanced accessibility and the diverse expertise of the care team, especially when managing long-term conditions. By spending more time with patients and providing tailored support, ARRS professionals contributed to a more positive experience.
The study found that ARRS roles were more common in larger practices and those with fewer GPs per patient. This suggests that the scheme is helping to fill staffing gaps in areas with GP shortages, offering much-needed relief to overstretched services. However, smaller practices and rural areas may face barriers in recruiting these roles, highlighting the need for equitable distribution and support.
The ARRS represents a significant step towards creating a more resilient and patient-centred primary care system. By integrating advanced practitioners into general practice teams, the NHS is addressing workforce shortages and improving care quality. However, the scheme is not without challenges. Policymakers must ensure proper training, regulation, and funding to maximise its benefits and address concerns about consistency and safety in care delivery. As the NHS continues to evaluate and refine the ARRS, further research will be essential to measure its long-term impact on patient outcomes, healthcare costs, and workforce sustainability. For now, this study offers a promising glimpse into how innovative workforce strategies can transform primary care for the better.
The ARRS is a game-changer for primary care, reducing reliance on medications and improving patient satisfaction. By embracing a multidisciplinary approach, the NHS is paving the way for a future where every patient has access to the right care at the right time. While challenges remain, the progress made so far is a testament to the potential of this ambitious scheme.
Read the full paper, 'Effect of Additional Roles Reimbursement Scheme roles on prescription patterns and patient satisfaction in England: a retrospective panel data analysis', in the BJGP.
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