Independent, not-for-profit, social enterprise PCC has been delivering workshops on the development of the additional roles reimbursement scheme (ARRS) with clinical directors, PCN managers and practice managers, and listening to their different experiences of expanding their workforces under the scheme
Funding for the ARRS has increased nationally from £430m in 2020-21, to £746m max in 2021-22, with an allocation available for each primary care network (PCN) depending on the size of the population it covers. Clinical commissioning groups (CCGs) draw down the funds – but only as new roles are recruited within PCNs. PCNs are, therefore, being strongly encouraged to make use of their ARRS allocation to ensure people in their neighbourhoods benefit from the funding available.
The need to utilise this additional resource has come at a time when there are competing priorities in primary care – not least the COVID-19 vaccination programme. When you are very busy it can be tempting to take a pragmatic approach to the question of what new roles you might need, starting with what you know is useful.
General practice has embedded clinical pharmacists over the past few years, and they have demonstrated their worth in a primary care setting, so PCN leaders are telling us that using ARRS funding to increase pharmacy staff across a PCN is a comfortable decision. Similarly, recruiting more social prescribing link workers to reach out into communities to tackle the health inequalities highlighted by the pandemic can also seem like a sensible idea.
But how to make best use of the remaining funding allocated to each PCN? Primary care leaders know they do not need to recruit one of every new role, but how can population health data help them to make informed choices about what roles would add value in their neighbourhood?
Practice-level data available on NHS ViewPoint helps PCNs to understand the current physical health needs of patients, together with key demographic information about the make up of the population in age, ethnicity and deprivation. They can use this information to hone the recruitment of additional roles.
For instance, analysing data on diabetes could identify:
people with ongoing management of type 2 diabetes.
The PCN would then consider which of the clinical and non-clinical additional roles shown in the diagram below,could enhance care for pre-diabetics and diabetics at different stages in their self-care and management of the condition.
Incorporating public health and local authority data – as well as the knowledge of local people, groups and organisations – can help PCNs gather even richer information to support recruitment to meet needs in their areas.
For example, in an affluent area with an older population, it may be useful to recruit a first contact physiotherapist, health and wellbeing coach and podiatrist to work together on increasing strength and stability in people as they age, with a goal of preventing the, often devasting, first fall – while in a deprived area with a history of long-term unemployment, a PCN might see the value in an occupational therapist to help people on long-term sick leave gain the confidence to get back into work, a physiotherapist to help with rehabilitation, and a health and wellbeing coach to help people set and achieve personal goals.
The analysis of data allows PCNs to align services to needs and predict local health requirements in the future, identifying demographic trends in their neighbourhoods and bringing in roles to support prevention and provide anticipatory care. This enables them to better engage people in thinking about their own health and wellbeing, helping them stay healthy for longer.
However you finally decide to recruit, embedding the new roles into PCN and practice teams is crucial to their success. We have found that an induction programme which includes primary care and the general practice culture, work with the existing practice staff to understand the new role, and developing champions in the practice to help embed the new ways of working, helps the new roles to make a significant impact most quickly. We have supported PCN leaders to decide on skill mix, develop practice champions and provide induction programmes.
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