Background The Additional Roles Reimbursement Scheme (ARRS) was introduced by NHS England in 2020 alongside Primary Care Networks (PCNs) with aims of increasing the workforce and improving patient outcomes.

Aim Describe the uptake of direct-patient care (DPC)-ARRS roles and its impact on patients’ experiences.

Design and Setting Ecological study using 2020-2023 PCN and Practice workforce data, registered patient characteristics, the General Practice Patient Survey, and the Quality and Outcomes Framework (QOF).

Methods Descriptive statistics with associations examined using quantile and linear regression.

Results By March 2023, 17,588 FTE DPC-ARRS roles were commissioned by 1,223 PCNs. PCNs with fewer constituent practices had more DPC-ARRS roles per population (p<0.001) as did PCNs with more FTE GPs per population (p=0.005). DPC-ARRS commissioning did not vary with age, proportion female or deprivation of practice populations. DPC-ARRS roles were associated with small increases in patient satisfaction (0.8 percentage points increase in patients satisfied per one DPC-ARRS FTE) and perceptions of access (0.7 percentage points increase in patients reporting ‘good’ experience of making an appointment per one DPC-ARRS FTE), but not with overall QOF achievement.

Conclusions The commissioning of DPC-ARRS roles was associated with small increases in patient satisfaction and perceptions of access, but not with QOF achievement. DPC-ARRS roles were employed in areas with more GPs rather than compensating for a shortage of doctors. Single practice PCNs commissioned more roles per registered population, which may be advantageous to single practice PCNs. Further evaluation of the scheme is warranted.

How this fits in

Primary Care Networks (PCNs) commissioning of non-GP direct-patient care (DPC) roles via the Additional Roles Reimbursement Scheme (ARRS) has expanded rapidly, with an allocated budget of £110m in 2019/2020 employing 279 full time equivalent (FTE) DPC-ARRS staff in March 2020, to £1,027m in 2022/2023, employing 17,588 FTE DPC-ARRS staff in March 2023.

Previous research, using NHS England data prior to 2020, had reported associations between increased Healthcare Associate Professionals employment and reductions in patient satisfaction and perceptions of access, with no impact on Quality and Outcomes Framework (QOF) achievement, but it was not known if these trends remained after the implementation of ARRS.

This study found a small increase in both overall patient satisfaction and perceptions of access, which equates to approximately 240-400 patients satisfied with their care and 210-350 patients able to make appointments for each FTE in ARRS roles employed in a typical PCN (30,000-50,000 patients), but no association with overall QOF achievement.

Further evaluation is required to identify if the observed associations can be attributed to the ARRS roll-out and if this represents value for money.

The authors have declared no competing interest.

This research was funded by the NHS Insights Prioritisation Programme and supported by the National Institute for Health Research (NIHR) Applied Research Collaboration West (NIHR ARC West). PJE was funded by a NIHR In-Practice Fellowship (NIHR302692). MK is an NIHR Academic Clinical Fellow in Primary Care. CS is supported as an NIHR Senior Investigator (NIHR 201314). 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.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study used only publicly available data originally located at: NHS Digital. Primary Care Network Workforce [Internet]. 2023 [cited 2023 Dec 1]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/primary-care-network-workforce NHS Digital. General Practice Workforce [Internet]. [cited 2023 Dec 1]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services NHS England, IPSOS MORI. GP patient survey [Internet]. 2022. Available from: https://www.gp-patient.co.uk/ NHS Digital. QOF 2022-23 [Internet]. 2023 [cited 2023 Dec 1]. Available from: https://qof.digital.nhs.uk/ NHS Digital. NHS Digital. [cited 2023 Feb 15]. Patients Registered at a GP Practice. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice Ministry of Housing, Communities and Local Government. The English Indices of Deprivation 2019. London; 2019 Sep.

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