Integrating additional roles into primary care networks
- Collection:
- Health Policy and Services Research
- Author(s):
- Baird, Beccy, author Lamming, Laura, author Bhatt, Ree'Thee, author Beech, Jake, author Dale, Veronica, author
- Contributor(s):
- King's Fund (London, England), issuing body.
- Publication:
- London : The King's Fund, February 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Delivery of Health Care, Integrated -- organization & administration Patient Care Team Primary Health Care -- organization & administration United Kingdom
- Genre(s):
- Technical Report
- Abstract:
- Key messages. (1) In January 2019 the Additional Roles Reimbursement Scheme (ARRS) was introduced in England, which would eventually support the recruitment of 26,000 additional staff working in general practice by 2023/24. This scheme formed a critical plank of the government’s manifesto commitment to increase the number of annual appointments in general practice by 50 million. (2) The ARRS represents a huge scale of ambition and requires the implementation of significant and complex change across general practice. While primary care networks (PCNs) have swiftly recruited to these roles, they are not being implemented and integrated into primary care teams effectively. (3) We found that PCNs are in their early stages of development and in many cases lack a clear, shared overall purpose and strategy or a clear, shared vision and buy-in for the ARRS roles. Many PCNs do not share a team identity, and this makes deploying network-wide staff in a supported way very complex when there are different strategies, different cultures and different identities to be managed. (4) The confusion around strategy is also linked to a lack of agreement about whether the roles are primarily intended to deliver the requirements of the PCN contract or to undertake what might be considered the ‘core’ work of general practice. (5) The potential contribution of additional roles to general practice is not universally understood, despite large amounts of written guidance, job descriptions and roadmaps, all of which may even have added to the confusion. (6) We found ambiguity among some GPs about what multidisciplinary working would mean for them and their working practices, both clinically and in the way in which their practices are run. While the national direction of travel appears to be that multidisciplinary working in general practice is a key part of the future vision, there has not been enough consideration about how GP roles, or the organisation of general practice itself, might need to change as a result. (7) The cultural change required by the introduction of additional roles, and new approaches to teamworking, requires extensive organisational development, leadership and service redesign expertise and this has not been adequately available to PCNs, nor is it present in many individual practices. All of this has been compounded by the impact of the Covid-19 pandemic on general practice. (8) This lack of effective and supported implementation means that the core needs of individuals working in ARRS roles--autonomy, belonging and contribution--are not being met in many cases. (9) A variety of support – including clinical supervision and managerial, human resources (HR) and peer support – is critical to the effective integration of ARRS roles within general practice and yet there is inadequate additional funding to provide PCNs with the capacity to provide this support well. (10) Centralised or subcontracted employment models have the potential to provide some of this support more easily but have the downside of ARRS staff feeling even more distanced from the teams they are working alongside. (11) A lack of an adequate estate is fast becoming an issue in many areas. The solutions will require expertise in the design and use of space to support multidisciplinary teamworking, and it is not clear how PCNs will access such expertise. (12) The uncertainty around the future of funding for the ARRS roles after 2023/24 has started to generate concern. Expectations of the impact that these roles will have are high, but like all new roles, it will take time before they are fully understood. Creating stability and certainty will play an important role in this. (13) We found examples of good practice and positive stories of implementation, but to ensure successful implementation of the roles we make recommendations including: (i) a clearer, shared vision for a multidisciplinary model of care; (ii) a comprehensive package of support for implementation of the scheme; (iii) a focus on future sustainability, including funding, estates strategy and career progression; (iv) leadership and management skills development embedded in GP specialist training.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (i, 47 pages, 1 unnumbered page))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918521284806676 (See catalog record)
- ISBN:
- 9781915303011
- Permanent Link:
- http://resource.nlm.nih.gov/9918521284806676