Background The Additional Roles Reimbursement Scheme (ARRS), commissioned by Primary Care Networks (PCNs), began in 2020 to expand the non-medical practitioner workforce in primary care. It is expected to improve primary care delivery by expediting patient access, mitigating rising demand, and providing an advanced career pathway for non-GP practitioners. 14 direct patient care roles are currently eligible to be commissioned through the scheme. Integration of roles into PCNs has occurred rapidly, with around 12,000 full time equivalent staff in ARRS roles (September 2022). However, the scheme has undergone limited evaluation.

Our aims were to:

1. Describe the commissioning of ARRS roles in England

2. Explore associations between ARRS roles and patients’ experiences of primary care services

Methods We used an ecological study design where outcomes and exposures were measured at the General Practice and PCN level.

We used PCN workforce matched with General Practice workforce and General Practice Patient Survey (GPPS) data 2020–2022. We described PCN-level commissioning of roles and associations between Practice-level FTE in ARRS roles and GPPS outcomes (perceived access to care and satisfaction), adjusted for characteristics of the Practices (workforce, number of patients) and patients (age, gender, deprivation, clinical need). Analyses included descriptive statistics and adjusted linear regression models.

Results By September 2022, 11,865 FTE in ARRS roles had been commissioned by 1,089 PCNs. These were predominantly pharmacists and pharmacy technicians (3,400 and 1,048 FTE), social prescribing link workers (2,047 FTE), care coordinators (1,895 FTE), and physiotherapists (972 FTE). The median PCN-level FTE ARRS roles was 1.9 per 10,000 registered patients (25%, 75%: 1.3, 2.5). PCNs from more deprived compared with less deprived areas commissioned slightly fewer ARRS FTE (median FTE/10 k=1.7 versus 2.0 most versus least deprived PCNs respectively).

An increase of one FTE in ARRS roles was associated with a roughly one percentage point increase in the proportion of patients satisfied with their care (beta=1.1, 95% CI: 0.81, 1.4) and able to make an appointment (beta=1.3, 95% CI: 0.91, 1.6).

Discussion The commissioning of ARRS roles has occurred rapidly and is associated with a small positive increase in perceptions of the accessibility of and satisfaction with primary care. Residual confounding and assumptions of how the PCN workforce is distributed across Practices necessitate a cautious interpretation. Recording of the PCN workforce is less complete than for GP workforce. Further research is needed into whether roles are commissioned according to clinical need and whether these roles are extending or filling gaps in the primary care workforce.