Related Experiment Video
Updated: Feb 25, 2026
E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Consultation complexity and professionals consulted: a retrospective cohort study in English primary care
Jialan Hong1,2, Peter Jonathan Edwards2, Mavin Nathan Kashyap2
1National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK jialan.hong@bristol.ac.uk.
Background:
The Additional Roles Reimbursement Scheme (ARRS) launched in England in 2019 to expand the multidisciplinary primary care workforce, but its impact on workload since implementation is unclear.
Aim:
To examine changes in workload complexity associated with ARRS implementation.
Design And Setting:
A longitudinal cohort study was conducted, which used the Clinical Practice Research Datalink (CPRD) Aurum. In total, 3 530 628 consultations were analysed involving GPs, nurses, or direct patient care (DPC)-ARRS roles for 420 986 patients from 369 English practices in 2018 and 2021.
Method:
Multilevel logistic regression assessed associations between 17 patient and consultation complexity factors and being seen by a DPC-ARRS role, adjusting for year, age, sex, region, deprivation, and consultation mode.
Results:
Complex consultations with DPC-ARRS-eligible roles increased from 15.8% in 2018 to 18.8% in 2021. Diagnostically capable ARRS roles were more likely than GPs to conduct the first consultation after diabetes diagnosis (odds ratio [OR] 1.4, 95% confidence interval [CI] = 1.3 to 1.5) and consultations with ≥2 preventive tasks (OR 5.6, 95% CI = 5.5 to 5.8), but less likely to manage chronic pain (OR 0.8, 95% CI = 0.7 to 0.9), dementia (OR 0.4, 95% CI = 0.3 to 0.4), mental illness (OR 0.4, 95% CI = 0.3 to 0.5), learning disabilities (OR 0.3, 95% CI = 0.3 to 0.4), consultations with ≥3 medicines prescribed (OR 0.6, 95% CI = 0.5 to 0.6), consultations resulted in emergency admission (OR 0.7, 95% CI = 0.6 to 0.8), and consultations with ≥2 diagnoses coded (OR 0.5, 95% CI = 0.5 to 0.5). Patients with interpreter needs (OR 1.2, 95% CI = 1.1 to 1.3), experiencing recent homelessness (OR 1.4, 95% CI = 1.1 to 1.7), or ≥3 long-term conditions (OR 1.1, 95% CI = 1.1 to 1.1) were more likely to be seen by diagnostic ARRS staff.
Conclusion:
Following ARRS implementation, primary care activity was delivered by a broader workforce managing increasingly complex care. Further research should assess the safety, quality, and system impacts of ARRS roles.
More Related Videos
07:31Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
Published on: May 15, 2020
14:43A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
Published on: January 12, 2018
Related Concept Videos
01:26Introduction to Epidemiology
01:11Observational Studies
There are three types of observational studies – Prospective, retrospective, and cross-sectional.
Prospective Study
Prospective studies, also known as longitudinal or cohort studies, are carried out by collecting future data from groups sharing similar characteristics. One...
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
02:20Longitudinal Research
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:20Study Designs in Epidemiology
Observational studies are those where the researcher does not intervene but rather observes natural variations. They include cross-sectional, cohort, and...