GP workload shifted to Additional Roles Reimbursement Scheme (ARRS) staff is being ‘left incomplete’ due to a lack of knowledge and skill, a report has warned.
The Queen’s Nursing Institute (QNI) report suggested that ARRS, which was intended to grow additional capacity and solve workforce shortages, has failed to substantially reduce workload pressures for existing general practice staff.
The research, based on a survey of over 500 general practice nurses (GPNs), also revealed that the profession feels ‘pushed out’ and at risk of ‘disappearing’ altogether because of ARRS.
It found that, since the introduction of ARRS:
- More than a third of GP practice nurses (37%) reported that the introduction of ARRS roles had increased their workload.
- Just 24% said their workload had decreased.
- And two-thirds (67%) said their workload had not reduced.
The research suggests that GPN workload could have increased due to ARRS staff needing more support, with almost half of respondents saying they are expected to provide education and supervision, despite, in many cases, being paid less.
On top of this, half of GPNs think ARRS colleagues are unable to practice independently in the GP practice without needing input or training.
GPNs also reported that ARRS, which began in 2019, appears to be based on ‘availability and funding’ rather than ‘local demand’.
‘The roles appear to be implemented to fill a deficit in already established roles (GPs and GPNs) rather than as an additional value-added role arising from workforce/work redesign,’ the report said.
On workload shift, the report concluded: ‘Work/care previously done by GPs and GPNs was shifted to ARRS colleagues that they could not complete due to lack of knowledge, skill, being out of scope, regulatory issues or unfamiliarity with primary care.
‘This meant care was left incomplete, with GPNs having to perform rescue work, complete the episode of care or teach colleagues.’
Respondents to the survey also highlighted the risk of ‘taskification’ – ARRS staff are unable to ‘complete episodes of care’ and are simply doing ‘task-oriented, disjointed care’.
Report author and professor of healthcare and workforce modelling, Professor Alison Leary, commented that the introduction of ARRS had been ‘problematic’ for the GPN workforce.
‘ARRS appears to have impacted the workforce in several ways. This ranges from a lack of resources to support those new to primary care, expectations by others of GPNs filling a gap, and a lack of consultation regarding a major workforce change, leading to feelings of devaluation,’ she added.
Chief executive of the QNI, Dr Crystal Oldman, added: ‘The survey shows that multiple assumptions were made about the primary care workforce and no real assessment of the impact that ARRS was likely to have.’
The BMA recently revealed that its GP Committee in England is arguing for the inclusion of GPs in the ARRS as it could be an ‘obvious solution’ to practices’ workforce and financial issues.
Over 10,000 people have signed a petition calling for ARRS funding to be used to employ GPs and GPNs.
A GP practice in Surrey is making three GPs redundant due to ‘new ways of working’, including the use of ARRS – but Pulse recently revealed that the partners at this practice have been unable to take drawings during the last year.
Entirely predictable and tragic
Tragic, and resulting from the assumption that an idea (whether tested or not) will work everywhere!
Some ARRS-funded staff are well-fitted to the practice and role they are in, and provide excellent services to patients within their core skills, and save time for other staff types.
Unfortunately, none are skilled to work entirely unsupervised in seeing ALL unfiltered presentations and doing ALL doctoring jobs such as diagnosis and management with respect to full bio-psycho-social wholistic and longitudinal model, like GPs are, but many are being misused to plug gaps because of lack of appropriate funding, but excess of wrongly-directed funding, to NHS practices to choose which sorts of staff they need more of.
Could I add that, once again, what works well in the Professorial Hospital Unit, does not necessarily work well in ALL, especially distant, rural, small, GP practices.
And one wonders why they expect it to?
>31,000 ARRS staff in the UK – up from 0 before 2019
128,000 Hospital medical staff – up 64% from 2004
53,000 Hospital Consultants in the UK – up 89% from 2004
37,068 (27,487 WTE) GPs in the UK – a drop of around 2000 WTE GPs since 2016
I seem to recall the days when a G.P. was expected to accompany a trainee on a house call——what happened?
What do bear do in the woods again .Roll on April
I said a while ago ARRS will do nothing to reduce work load . Supervising them , takes much more time than sorting the patients problem yourself. I personally think same applies to a good number of triage calls..
Surprising that!
Maybe next HMG can co-opt the ancient but respectable profession of grandmothers into the ARRS scheme to give their pennyworth as well. Should reduce GP workload…
‘respectable profession of grandmothers into the ARRS scheme’
Brilliant idea!
no excrement sherlock. We could have a told you this without this expensive bit of research.
It’s the assumption that General Practice is easy and you don’t need huge amounts of training to do it.
This new pharmacy scheme is just more of the same and we will probably be having similar conversations about this in a year or so time.
The acronym appears eerily apt Just need an e on the end ?:)
In my experience these Proctors have increased workload
Fact is GP Principals on ICBs and PCNs have persuaded cajoled or forced coal face GPs to engage with ARRs and multiple other initiatives which have all undermined or undervalued the role of the coal face GP. The same Clinical Directors are now embracing private practice while NHS Primary Care collapses.
The extremely wealthy (for whom the country is currently run) don’t use NHS general practice. When they get ill they pay and see a ‘real’ Dr. They really dont care what anyone here thinks and they don’t read PULSE. You guys out there with your middle incomes and your middle income lives who came to assume, over many decades that what you think matters…dont (matter). Look around you. Who actually ‘matters’ these days? Where is all the wealth in our country sitting? Not with people who use the NHS and not with people like you
If the PCN Clinical Directors decided to refuse to accept the government financial inducements which allow this travesty to continue then none of this would be possible.
NHSE /HMG have relied on the fact that there will always be a small group of individuals wanting to circulate in these highly paid admin board roles who will accept monetary reward and an office job as opposed to clinical responsibility and for other various reasons known to themselves even if damage to colleagues and the wider NHS ensues.
PCN Clinical Directors rethinking their approach to their colleagues and the devastation caused to General Practice and colleagues by PCNs especially younger colleagues at all stages of their careers need to be reconsidered.
All other GPs should refuse the temptation of Clinical Director roles no matter the amount of the enticements from HMG/NHSE and however alluring these economic may seem.
There is a role for ARRs but not to replace GPs and it is PCN CDs who have enabled this catastrophe in my view.
I urge the BMA to advise PCN CDs to bank their gains and do the right thing and resign from these positions and others to decline these positions and not to be entrapped by enticements and thoughts of any personal financial gain.