Exclusive The Asthma+Lung UK charity have been receiving calls to its helpline from staff in ARRS roles with queries on how to do a QOF review and assess asthma, its GP clinical lead has told Pulse.
The introduction of the PCN Investment and Impact Fund (IIF) has led to a ‘significant increase in respiratory workload’ for practices, yet there are not enough respiratory nurses in primary care to meet the demands, said Dr Andy Whittamore, a GP in Portsmouth and Asthma+Lung UK clinical lead.
The respiratory portion of the IIF is worth 53 points and is designed to ‘encourage PCNs to develop effective medicines regimes for asthma patients by making sure they are prescribed ICS inhalers on a regular basis’.
In accompanying guidance it says that ‘asthma patients in England experience worse outcomes than those in comparable health systems’.
There are another 27 points for switching patients from metered dose inhalers to dry-powder inhalers where possible to reduce the NHS carbon emissions.
Dr Whittamore told Pulse that the main issue they are seeing at the charity is queries from pharmacists who are being expected to work autonomously and fill gaps due to insufficient respiratory nurses in primary care.
‘Unfortunately there is no significant training in assessing and managing patients, especially for non-pharmaceutical interventions.’
He added: ‘Also little knowledge of QOF or IIF requirements. The IIF has put a significant increase in respiratory workload and shortcuts are likely to be happening to implement it.’
Asked why staff approach the helpline, rather than the GPs at their practice, he added: ‘I think there is a capacity gap – due to increased workload plus workforce pressures – and a likely skills gap.
‘For many years we have delegated the management of chronic diseases to practice nurses who have had training. This has, in some places, led to a deskilling of GPs who might not feel confident in supporting ARRS staff around respiratory reviews and respiratory prescribing.’
According to Dr Whittamore, ARRS roles are a useful addition to the primary care team but cannot just be used to fill gaps.
‘Supervision, training and support are essential and this takes time.’
In August, researchers at Manchester University reported that employing healthcare workers other than GPs or nurses leads to a drop in patient satisfaction and does not free up time for GPs.
Earlier this year a report from The King’s Fund concluded that PCNs have inadequate funding to support and implement the ARRS scheme and that roles were not being implemented effectively.
And it found a lack of agreement within PCNs about whether the roles are primarily for delivering the PCN contract or to provide extra capacity to core general practice.
Beccy Baird, senior policy fellow at The King’s Fund, said while their report did not look at specific detail around pharmacists or other ARRS roles and delivering the aspects of care like the QOF, they did find variation in the ability to access training for the ARRS roles.
Some reported that it was not necessarily seen as part of the ARRS role or adding value to the PCN – rather it was a luxury and the choice of the staff member.
‘We recommended that future national contract negotiations should address the need to adequately fund the managerial, clinical supervision and training needs of the ARRS roles,’ she said.
This week, NHS England announced that four investment and impact fund (IIF) indicators that are worth £37m in total will be deferred or scrapped, with that funding instead allocated to PCNs via a monthly support payment from October and until 31 March next year.
Note: This article was updated at 17.25 on 30 September to reflect that GPs are incentivised to switch people to dry-powder inhalers.