Potential workforce ‘tensions’ have been highlighted by a study examining the impact of the Additional Roles Reimbursement Scheme (ARRS) on primary care – with concerns over registered nurses losing opportunities to use their specialist knowledge.
The ARRS was set up to recruit 26,000 additional staff into general practice by 2024 and the study – authored by Bethan Jones, Zoe Anchors, Sarah Voss and Nicola Walsh and published by The British Journal of General Practice – observes that the implementation has ‘not always been straightforward’.
The report – titled Challenges and enablers to implementation of the Additional Roles Reimbursement Scheme in primary care: a qualitative study – draws upon 91 interviews with ARRS healthcare professionals and key professional stakeholders involved in staff education or scheme implementation across three integrated care systems in England.
According to the study, some of the perspectives revealed the need for ‘a delicate balance’ when incorporating additional staff into primary care to guard against ‘demoralising or deprioritising’ existing staff.
On the introduction of ARRS staff, one integrated care systems (ICS) lead told the study: ‘[Nursing staff] saw some of these roles coming in and taking away their work.’
The ICS lead added: ‘They, therefore, felt demoralised, they felt that there was no value placed on the work that they had been doing for years… and it’s all been given to a clinical pharmacist to sort out.’
The study also found that the difference in terms and conditions between ARRS and non-ARRS staff was a cause of tension, along with broader disparities in primary care opportunities.
A primary care network (PCN) manager interviewed for the study said: ‘This is one of the problems as our team see it; the additional roles are paid much more than anyone else in primary care.’
As part of the scheme, PCNs can claim salary reimbursement for several roles, including nursing associates and advanced nurse practitioners.
This year the role of an ‘enhanced’ practice nurse – an experienced GPN with postgraduate qualifications – was added to the ARRS staff list.
The issues raised in the study seemingly echo the view that general practice nurses (GPNs) are being ‘put to one side’ while ARRS staff do the work they used to do – expressed recently by Dr Crystal Oldman, chief executive of the Queen’s Nursing Institute (QNI) at the Nursing in Practice London conference last month.
Also reflecting the study’s findings, a QNI report from earlier this year found that almost half of GPNs are being expected to provide education and supervision for ARRS staff despite, in many cases, being paid less and given fewer development opportunities.
The Royal College of Nursing has also warned that GPNs are seeing their roles substituted since the introduction of ARRS – in many cases with nursing associates and care coordinators.
The British Journal of General Practice report concludes that while most ARRS staff feel valued, the scheme has broadened expertise available in primary care rather than reducing GP burden, which was originally anticipated.
