The Additional Roles Reimbursement Scheme (ARRS) has the potential to reduce prescribing rates in primary care, according to a new study.
Published in the BJGP last week, the study looked at the general practice workforce minimum dataset and NHS Digital datasets across over 6,000 practices, analysing their activity between 2018 and 2022.
It found that the use of ARRS staff was ‘significantly associated’ with lower prescription rates and higher patient satisfaction.
The lower prescribing rates were particularly seen in mental health medications, according to the authors.
They said: ‘The lower prescribing rate could be attributed to the strong emphasis on adherence to guidelines in the training of advanced practitioners, and to the availability of a wider range of forms of help, which may reduce the need for prescribed medication. This is particularly consistent with the employment of a high number of clinical pharmacists.
‘By providing more time with a broader care team, ARRS staff may improve satisfaction, especially for patients with ongoing health conditions requiring regular monitoring and coordination.’
This implied that investing in ARRS roles, especially those supporting mental health and long-term conditions, may help to reduce prescribing and increase satisfaction, the authors said.
However, the study added that it was ‘unsurprising’ that adding more staff was likely to enhance patient experience due to improved access and increased consultation time. But that ‘this does not in itself guarantee the quality of care provided during consultations’.
The authors also highlighted patient safety when hiring non-GPs in primary care, though it recognised this was ‘difficult to measure’.
‘Ensuring proper training, guideline adherence, and outcome monitoring is essential to mitigate risks and provide high-quality care,’ they said.
‘Most ARRS staff have not undergone the same level of training, supervision, and formal assessment as GPs during their medical education, and some of these roles are not currently regulated. The absence of a standardised, primary care-specific training programme for some of the ARRS roles could be a key source of concerns regarding the safety implications of integrating these new workforce members into general practice settings.’
The BJGP study authors, from the University of Oxford and the University of Bristol, suggested more research was needed on the impact of specific ARRS roles, such as health and wellbeing coaches, as well as a return-on-investment analysis on the longer-term costs, risks and benefits of ARRS workers compared with investing in more doctors.
‘This study provides preliminary evidence that expanding the primary care skill-mix through ARRS workforce investments may contribute to lower prescribing rates and improved patient satisfaction,’ it said.
‘However, substantial unknowns persist regarding their long term return-on-investment, the ideal composition of roles, their impact on continuity and coordination, which patients are most appropriate for them to see, and potential risks from rapid integration of these new roles in primary care. These areas should be priorities for future research.’
A version of this story first appeared on our sister publication Pulse PCN.
