This report examines the extent to which Additional Roles Reimbursement Scheme (ARRS) roles have the potential to make a significant contribution to the quality of patient care in general practice and represent a significant investment in the future sustainability of general practice. The Additional Roles Reimbursement Scheme (ARRS) was introduced in England in 2019 as a key part of the government’s manifesto commitment to improve access to general practice. The aim of the scheme is to support the recruitment of 26,000 additional staff into general practice. This represents a huge scale of ambition and requires the implementation of significant and complex change across general practice. While primary care networks (PCNs) have swiftly recruited to these roles, they are not being implemented and integrated into primary care teams effectively. This study focuses on four roles — social prescribing link workers; first contact physiotherapists; paramedics and pharmacists — to examine the issues related to the implementation of these roles, looking at the experiences of working in these roles and of the people managing them. We found a lack of shared understanding about the purpose or potential contribution of the roles, combined with an overall ambiguity about what multidisciplinary working would mean for GPs. Successful implementation of the scheme requires extensive cultural, organisational and leadership development skills that are not easily accessible to PCNs. We found examples of good practice and positive stories of implementation, but to ensure successful implementation of the roles we make recommendations including: a clearer, shared vision for a multidisciplinary model of care; a comprehensive package of support for implementation of the scheme including improved support for clinical and managerial supervision; streamlining and communicating current guidance and roadmaps in different ways that make them more accessible and practical for PCNs, practices and professionals to understand and implement; a focus on future sustainability, including funding, estates strategy and career progression; leadership and management skills development embedded in GP specialist training. (Edited publisher abstract)

Subject terms:

integrated care, primary care, general practitioners, professional role, social prescribing, service brokerage, physiotherapists, pharmacists, multidisciplinary teams;

Content type:

research

Location(s):

United Kingdom

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Drawing learning from examples of emerging, innovative practice and analysis of the literature, this report looks at innovative models of general practice from the UK and other countries. It identifies ways of working that could support general practice in England to meet the challenges it faces and to deliver high-quality services across the core dimensions of general practice. In addition, the report sets out a set of principles that should guide the development of new models of care for general practice as part of whole-system redesign. As general practice has evolved from single practitioners to multidisciplinary enterprises, an underpinning philosophy of general practice and family medicine has emerged, consisting of a series of attributes, with a renewed focus on relationships and community: accessible care - including factors such as proximity, timeliness, choice and range of services; continuity of care – relational, management and information continuity; co-ordination of care; and community focus. The report identifies the common design features that innovative models of general practice share. These include: building and maintaining strong relationships - between patients and professionals, between professionals, and between professional and communities; a shift from reactive to proactive care – using electronic records, with administrative staff contacting patients to carry out pre-appointment checks; developing skill-mix – developing new roles such as clinical pharmacists, physician associates, health coaches, behavioural health practitioners and paramedic practitioners; and using technology – ensuring digital solutions aid effective general practice and complement rather than replace team-working. The report concludes with a series of recommendations aimed to ensure new models of general practice are capable of unlocking the potential of new system-wide models of care. (Edited publisher abstract)

Subject terms:

general practitioners, primary care, innovation, case studies, multidisciplinary teams, digital technology, staff-user relationships, interpersonal relationships, prevention, staff development;

Content types:

practice guidance, research, research review

Location(s):

United Kingdom

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This report looks at patient factors, system factors and supply-side issues to see what lies behind the increasing pressure on general practice. The analysis of 30 million patient contacts from 177 practices found that consultations grew by more than 15 per cent between 2010/11 and 2014/15. The number of face-to-face consultations grew by 13 per cent and telephone consultations by 63 per cent. Over the same period, the GP workforce grew by 4.75 per cent and the practice nurse workforce by 2.85 per cent. Funding for primary care as a share of the NHS overall budget fell every year in our five-year study period, from 8.3 per cent to just over 7.9 per cent. As well as increasing demands and expectations from patients, the qualitative research identified a number of changes within the wider health and social care system that are impacting on the work of general practice, including new preventative services, increasingly complex medications, non-clinical work and relationships with the wider system. However, practices that completed the workload survey reported an average of just 2.5 referrals a week to local authority social services, compared to an average of 20 referrals to other non-NHS services and 29 referrals to NHS community services. Interviewees suggested this was mainly because referrals to social care were more likely to be managed by community health services, particularly community matrons. The report finds that despite GPs being at the heart of the health care system, a lack of nationally available, real-time data has made their changing workload largely invisible to commissioners and policy-makers. (Edited publisher abstract)

Subject terms:

primary care, general practitioners, workload, integrated care, NHS;

Content type:

research

Location(s):

United Kingdom

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ISBN print:

9781909029613

Explores how and why clinical commissioning groups (CCGs) and local authorities chose to engage with the voluntary, community and social enterprise (VCSE) sector. The report discusses how commissioners’ perceptions of their own strategic role, as well as their views on what role the VCSE sector plays in the local area, appear to exert a strong influence on commissioning decisions. It finds that there is wide variation in the way commissioners engage with the VCSE sector. Some commissioners see their role solely as stimulating a market of providers, with no particular interest in creating a strong VCSE sector. Others have made a clear choice about the value of the VCSE sector as a critical player in developing asset-based approaches to care, engaging VCSE organisations as key partners in co-production of health and care outcomes. The report suggests that the primary drivers for choosing a commissioning approach, based on co-production principles, are local, not national. Strong local leadership, often political, and relationships with the sector are important to creating a partnership-based approach in the face of sometimes seemingly conflicting national priorities. The report concludes with a cautionary note, observing that changes to the commissioning landscape may provide more challenges for successful co-production. As integrated care organisations develop, it is unclear who is responsible for supporting and developing community assets to address the needs of the population. The sector itself, it argues, has a role in coming together to provide a strong voice in these models in order to have greater impact. (Edited publisher abstract)

Subject terms:

co-production, commissioning, clinical commissioning groups, local authorities, voluntary organisations, community groups, social enterprises, joint working, integrated care, social care provision;

Content type:

research

Location(s):

England

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