Additional Roles Reimbursement Scheme uptake, patient satisfaction, and QOF achievement: an ecological study from 2020-2023

Chris Penfold; Jialan Hong; Peter J Edwards; Mavin Kashyap; Chris Salisbury; Ben Bennett; John Macleod; Maria Theresa Redaniel

doi:10.3399/BJGP.2024.0083

Additional Roles Reimbursement Scheme uptake, patient satisfaction, and QOF achievement: an ecological study from 2020-2023

Br J Gen Pract. 2024 Dec 26;75(750):e35-e42. doi: 10.3399/BJGP.2024.0083. Print 2025 Jan.

Authors

Chris Penfold¹, Jialan Hong¹, Peter J Edwards², Mavin Kashyap², Chris Salisbury², Ben Bennett³, John Macleod⁴, Maria Theresa Redaniel¹

Affiliations

¹ National Institute for Health and Care Research Applied Research Collaboration (NIHR ARC) West, University Hospitals Bristol and Weston NHS Foundation Trust; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol.
² Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol.
³ Health Innovation West of England, Bristol.
⁴ NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol; Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol.

Abstract

Background: The Additional Roles Reimbursement Scheme (ARRS) was introduced by NHS England in 2019 alongside primary care networks (PCNs), with the aims of increasing the workforce and improving patient outcomes.

Aim: To describe the uptake of direct patient care (DPC)-ARRS roles and its impact on patients' experiences.

Design and setting: An ecological study using 2020-2023 PCN and practice workforce data, registered patient characteristics, the General Practice Patient Survey, and the Quality and Outcomes Framework (QOF).

Method: Descriptive statistics with associations were examined using quantile and linear regression.

Results: By March 2023, 17 588 full-time equivalent (FTE) DPC-ARRS roles were commissioned by 1223 PCNs. PCNs with fewer constituent practices had more DPC-ARRS roles per population (P<0.001), as did PCNs with more FTE GPs per population (P = 0.005). DPC-ARRS commissioning did not vary with age, sex, or deprivation characteristics of practice populations. DPC-ARRS roles were associated with small increases in patient satisfaction (0.8 percentage points increase in patients satisfied per one DPC-ARRS FTE) and perceptions of access (0.7 percentage points increase in patients reporting 'good' experience of making an appointment per one DPC-ARRS FTE), but not with overall QOF achievement.

Conclusion: The commissioning of DPC-ARRS roles was associated with small increases in patient satisfaction and perceptions of access, but not with QOF achievement. DPC-ARRS roles were employed in areas with more GPs rather than compensating for a shortage of doctors. Single-practice PCNs commissioned more roles per registered population, which may be advantageous to single-practice PCNs. Further evaluation of the scheme is warranted.

Keywords: general practice; patient satisfaction; primary health care; workforce.

MeSH terms

Adult
Aged
England
Female
General Practice
Humans
Male
Middle Aged
Patient Satisfaction*
Primary Health Care*
Quality of Health Care
Reimbursement Mechanisms
State Medicine*

Grants and funding

This research was funded by the NHS Insights Prioritisation Programme and supported by the National Institute for Health and Care Research Applied Research Collaboration (NIHR ARC) West. Peter J Edwards was funded by an NIHR in-practice fellowship (reference: NIHR302692). Mavin Kashyap is an NIHR academic clinical fellow in primary care. Chris Salisbury is supported as an NIHR senior investigator (reference: NIHR201314). The views expressed in this article are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.