Evaluating the use of non-GP health professionals in primary care

Project aims

We used interviews and anonymous patient records from GP practices to find out how effective ARRS roles are in primary care.

Working with three Integrated Care Boards (ICBs) in the South West, primary care networks (PCNs) and ARRS staff themselves, we wanted to understand:

• How uptake of ARRS roles varies
• The enablers and challenges in implementing ARRS roles
• Whether these roles had unintended consequences, such as taking away staff from other parts of the healthcare system

What we did

In our patient record analysis, we used NHS Primary Care Network (PCN) and GP workforce data, combined with data from the GP Patient Survey. This helped us understand the uptake in ARRS roles across England between 2020 and 2022.

We are also using patient-level data from the Clinical Practice Research Datalink to see what types of patients were seen by staff in ARRS roles. We want to compare the outcomes of their consultations with GP and practice nurse consultations.

In our interviews, we recruited 37 participants including healthcare professionals in an ARRS role, those involved in educating staff or implementing the scheme. This included workforce leads, PCN managers, and representatives from primary care training hubs.

What we found and what this means

Our data analysis showed the scheme grew rapidly. In March 2020 there were 280 full-time equivalent (FTE) staff in ARRS roles, while in September 2022 that jumped to 12,335. By this time, on average PCNs had 10 of these FTE roles.

Some PCNs said they had trouble recruiting ARRS roles to more deprived areas. However, this wasn’t reflected in the workforce data, where we found no commissioning variation by level of deprivation.

The interviews revealed that most ARRS staff felt valued. The value of the scheme was more about broadening expertise in primary care than reducing the burden on GPs.

Having multiple roles in one PCN or practice was most effective. Administrative roles were particularly desirable to address high workloads.

We identified several challenges:

• The scheme could be inflexible
• Creating a sustainable workforce with career progression and appropriate supervision
• Managing expectations of roles and scope creep
• Progression roadmaps weren’t appropriate
• Infrastructure and integration issues

Unintended consequences included impacts on secondary care and existing primary care staff.

What next?

Our study covers a small geography and is a snapshot of the scheme, and we didn’t interview GPs or patients. Nevertheless it has demonstrated the need for:

• Improved engagement between Health Education England and the policymakers who introduced the scheme
• Recommendations on the scheme for local ARRS staff, decision makers, training hubs, GP federations and third-party employers
• Increased support (clinical and emotional) for personalised care workers

We are continuing our work to analyse patient data to understand the patients who consult with ARRS staff.

Further research is needed to:

• Explore the viability of recommendations
• Further understand the impact of health inequalities
• Investigate ARRS staff wellbeing