The additional reimbursement roles scheme (ARRS) has been a real game changer as far as primary care is concerned.
The initial ambition of 26,000 new entrants into the workforce to ease the burden on GPs has been smashed with 37,000 employees now under the scheme.
Its seismic effects have been felt across primary care.
Community pharmacy has reeled from a shift of the workforce into PCNs with clinical pharmacists and pharmacy technicians proving to be the most popular ARRS hires.
Having been initially excluded, nurses are now in the ARRS fold. A move which began with advanced practitioner, followed by enhanced nurses and now general practice nurses. But this generated concerns around a two tier pay system between practice staff and ARRS employees. This issue is of course not limited to nurses.
And to address the issue of GPs being unable to find work they were added to the scheme in October. But despite having called for the measure its not been implement in the way it was hoped to be. Only newly qualified GPs, who haven’t worked for the PCN practices before need apply, added to that the reimbursement is considered low.
The competency and appropriateness of staff has also been called in to question. This debate has centred around physician associates with alarm bells sounding after a high profile case involving a physician associate and an incorrect diagnosis – that and with an announcement that the Government has an ambition to increase PA number to 10,000 has seen a back lash resulting in GMC regulation and RCGP scope of practice and a decline in the numbers higher and no doubt a very disheartened sector of health professionals.
And have ARRS staff saved time – have they decrease the number of interaction with a GP and saved GP time or have they resulted in more appointments and a delay in seeing a GP? The evidence on this is lacking or ‘too early to tell’.
It appears ARRS staff have increased access and patients appreciate that but detractors will say is it the right kind of access and actually does it harm those patients who are deprived and/or less able to advocate for themselves. Experts say yes.
The there is the lack of space – 37,000 people have to be somewhere to do their job to see patients and given the general practice estate was not in perfect working order before this policy it would seem now to be completely unsustainable.
This report takes a look at these issues as highlighted in a White Paper from Pulse PCN’s publisher Cogora.