New roles have been introduced into primary care through a funding scheme called the ‘Additional Roles Reimbursement Scheme’ (ARRS). These roles are in addition to GPs and nurses, and are intended to improve the care of patients. They are also intended to expand the primary care workforce, reduce pressures on GPs, and broaden the types of clinicians patients see.
Some of these roles existed before the ARRS started, but the number of staff in these roles has increased a lot since 2020, partly as a result of the response to and recovery from the pandemic. In England it is expected that there will be around 26,000 staff in these roles by 2023/24. These roles are expected to have a positive impact on primary care and to provide advanced careers for clinical staff working in primary care who are not GPs.
The overall aim of this project is to evaluate the impact of these roles on primary care. We will do this by:
1. Looking at the staff roles working in primary care over time
2. Comparing consultations with staff in ARRS roles with consultations with GPs and nurses. We will consider the type of patients seen, how many patients are seen, the diagnoses seen by each role and whether there are differences in how many medicines patients are prescribed or how often they are referred on to see other specialists
3. Comparing the cost of delivering primary care using staff in these ARRS roles compared with GPs and nurses
New primary care roles have been introduced through the ‘Additional Roles Reimbursement Scheme’ (ARRS) funding scheme. Some roles fundable through ARRS existed before the scheme but the number of staff in these roles has increased substantially since April 2020, with ~26,000 staff expected to be in these roles in England by 2023/24. These staff are in addition to GPs and nurses, and are intended to improve patient care, expand the primary care workforce, reduce pressures on GPs, and facilitate a more multidisciplinary approach to patient care.
The overall objective of this project is to evaluate the impact of these roles on primary care. In order to do this we will:
1. Describe the uptake of these roles between January 2015 and December 2021 across GP practices and CCGs
2. Describe the temporal trends in the characteristics of patients seen in primary care (age, gender, area-level deprivation, number of presenting problems) and consultation outcomes (re-consultation within 14 days, onward referrals) to determine whether the expansion of these roles has led to changes in the delivery of care. We will model trends in age and sex-standardised consultation rates and all other outcomes with joinpoint analysis, with separate models for each outcome and staff role.
3. Compare patient-level outcomes of consultations (prescriptions, investigations, referrals to secondary care/other professionals, 14-day re-consultations) with ARRS roles compared with GPs and nurses using multilevel regression models (patients in GP practices and/or CCGs)
4. Estimate the change in resource use including prescribing since the introduction of ARRS.
Index of Multiple Deprivation (IMD) data will be linked to patient-level consultations to describe the area-level deprivation of patients being seen in primary care.
The study will increase our understanding of the impact of the ARRS roles including their potential benefits, implementation challenges, and likely consequences for workload and resource utilisation.
• Whether a consultation was with staff in an ARRS role or with a GP or nurses [CPRD job role coding]
o Number of consultations (overall and by staff role)
o Consultation rate (per 10 000 person-years)
• Patient demographics at the time of their consultation:
o Age
o Gender
o Area-level deprivation of home address (IMD)
• Number of presenting problems (number)
• Consultation outcomes:
o Length of consultation (minutes)
o Mode of consultation (face-to-face, telephone, video, home visit)
o Prescription given (number)
o Investigation requested (y/n)
o Onward referral to secondary care (y/n)
o Onward referral to other professionals (y/n)
o Re-consultation within 14 days (y/n)
• Resource use including prescriptions for consultations by practitioner role type (both ARRS and non-ARRS) and consultation outcomes
Theresa Redaniel - Chief Investigator - University of Bristol
Chris Penfold - Corresponding Applicant - University of Bristol
Chris Salisbury - Collaborator - University of Bristol
Gareth Myring - Collaborator - University of Bristol
Hugh McLeod - Collaborator - University of Bristol
Jialan Hong - Collaborator - University of Bristol
John Macleod - Collaborator - University of Bristol
Nicola Walsh - Collaborator - University Of the West of England
Jialan Hong - Collaborator - University of Bristol
Patient Level Index of Multiple Deprivation;CCG Pseudonyms