Evaluating Additional Roles in Primary Care: Expanding Capacity and Transforming Care Delivery

The Additional Roles Reimbursement Scheme (ARRS), introduced by NHS England in 2019, aimed to expand the workforce, promote multidisciplinary team-based care, and improve patient outcomes.

To examine changes in consultation rates and outcomes in relation to ARRS implementation, and compare outcomes across primary care roles.

Longitudinal cohort study using the Clinical Practice Research Datalink (CPRD) AURUM, analysing 12,170,079 consultations (2015-21) from 600,000 randomly sampled patients at 400 English practices.

Joinpoint regression modelled trends in age- and sex-standardised consultation rates, further consultations within 1-14 days, prescribing, and referrals. Multilevel regression compared outcomes between diagnostic-capable roles and general practitioners (GPs).

Most consultations remained GP- or nurse-led, but rates with direct patient care (DPC)-ARRS-eligible roles increased, particularly for pharmacists, physiotherapists, and nursing associates. For paramedics and mental health practitioners, growth preceded formal ARRS inclusion, suggesting the scheme accelerated rather than initiated expansion. Most DPC-ARRS-eligible roles were consulted more frequently in less deprived areas, except physiotherapists. Compared to GPs, most DPC-ARRS-eligible roles delivered more consultations face-to-face (except pharmacists), had lower prescribing (except advanced nurse practitioners) and referral rates, and higher further consultation rates with a diagnostic-capable clinician within 1-14 days. However, all DPC-ARRS-eligible roles had lower odds of a further consultation specifically with a GP.

ARRS has supported and accelerated the diversification of the primary care skill-mix. Patterns of consultation activity suggest an expansion of overall primary care capacity with some redistribution of workload across the multidisciplinary team, rather than a direct reduction in GP workload.