The Additional Roles Reimbursement Scheme (ARRS) entitles PCNs to access funding to support recruitment across reimbursable roles.
PCN reimbursement claims must only be for staff additional to the PCN baseline.
Each PCN’s Additional Roles Reimbursement Sum is based upon the PCN’s weighted population share. The basis for weighting is the same as for global sum (i.e. Carr-Hill Formula).
Care coordinators provide extra time, capacity, and expertise to support patients in preparing for clinical conversations or in following up discussions with primary care professionals. They work closely with the GPs and other primary care colleagues within the primary care network (PCN) to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers (if appropriate), and ensuring that their changing needs are addressed. They focus on the delivery of personalised care to reflect local PCN priorities, health inequalities or at risk groups of patients. They can also support PCNs in the delivery of Enhanced Health in Care Homes.
Clinical pharmacists work in primary care as part of a multidisciplinary team in a patient facing role to clinically assess and treat patients using expert knowledge of medicines for specific disease areas. They work with and alongside the general practice team, taking responsibility for patients with chronic diseases and undertaking clinical medication reviews to proactively manage people with complex medication use, especially for the elderly, people in care homes and those with multiple conditions.
A paramedic in primary care can recognise and manage the deteriorating patient and can manage patients with long term conditions, minor injuries, and minor illness. They can also support patients who require wound care, have fallen, have MSK problems, and have urinary tract or respiratory infections. Paramedics can supply a range of medicines through PGDs, including antibiotics and analgesics.
Paramedics can support PCNs in responding to on the day demand by offering Hear and Treat telephone triage or undertaking home visiting. They can also support PCNs to improve access to care by seeing minor ailments and injuries in surgery. Paramedics can support PCNs with the delivery of Enhanced Health in Care Homes and overall their intervention should reduce the need for admission to hospital.
Dietitians are healthcare professionals that diagnose and treat diet and nutritional problems, both at an individual patient and wider public health level. Working in a variety of settings, including primary care, with patients of all ages, dietitians support changes to food intake to address diabetes, food allergies, coeliac disease, and metabolic diseases. Dietitians also translate public health and scientific research on food, health, and disease into practical guidance to enable people to make appropriate lifestyle and food choices.
First Contact Physiotherapists (FCP) are qualified independent clinical practitioners who can assess, diagnose, treat, and manage musculoskeletal (MSK) problems and undifferentiated conditions and, where appropriate, discharge a person without a medical referral. FCPs working in this role can be accessed directly by patients, or staff in GP practices can refer patients to them to establish a rapid and accurate diagnosis and management plan to streamline pathways of care.
As part of the wider team in general practice, General Practice Assistants provide a support role, carrying out administrative tasks, combined in some areas with basic clinical duties. They focus on supporting General Practitioners in their day-to-day management of patients, specifically aimed at reducing the administrative burden, making the best use of consultation time and supporting those particularly vulnerable to isolation who are regular attenders at the practice.
Development of the role depends on a range of factors – patient needs, existing skills mix, culture and having the staff, time and financial resource to invest in work-based learning, mentorship and supervision.
Funding
A national programme was set up by HEE in April 2019 to support wider spread of the role. This is led by a Primary Care Training Hub in each region to host and coordinate the introduction of 40 learners across each regional footprint, with further expansion planned in 2020/21.
The aim is to provide a consistent approach to developing the role, underpinned by a defined job description and competency framework to support work-based learning.
Training/Development
- A work-based learning programme has been developed that typically takes 6-9 months to complete. Learning takes place in the practice, led, and assessed by a GP mentor
- Learners are usually existing staff with some experience of general practice (such as HCAs or receptionists) who are upskilling to the GPA role
- Learners are expected to have 1 day per week of protected time to learn their new skills. This includes time to work with their GP mentor, for teaching and ‘hands on’ experience (half a day) and time to upload their evidence of competence to the online platform (half a day).
- A GPA certificate is awarded on successful completion of the competency-based portfolio.
Health and wellbeing coaches (HWBCs) will predominately use health coaching skills to support people to develop the knowledge, skills, and confidence to become active participants in their care so that they can reach their own health and wellbeing goals. They may also provide access to self-management education, peer support and social prescribing.
Health coaches will support people to self-identify existing issues and encourage proactive prevention of new and existing illnesses. This approach is based on using strong communication and negotiation skills and supports personal choice and positive risk taking.
They will work alongside people to coach and motivate them through multiple sessions, supporting them to identify their needs, set goals, and help them to implement their personalised health and care plan.
Mental Health Practitioners – including Improving Access to Psychological Therapy (IAPT) – to be included in the scheme from April 2021 – Awaiting further advice and guidance.
The nursing associate is a new support role in England that bridges the gap between healthcare support workers and registered nurses to deliver hands-on, person-centred care. Nursing associates work with people of all ages in a variety of settings in health and social care, including general practice.
Occupational therapists (OTs) support people of all ages with problems resulting from physical, mental, social, or development difficulties. OTs provide interventions that help people find ways to continue with everyday activities that are important to them. This could involve learning new ways to do things or making changes to their environment to make things easier. As patients’ needs are so varied, OTs help GPs to support patients who are frail, with complex needs, live with chronic physical or mental health conditions, manage anxiety or depression, require advice to return or remain in work and need rehabilitation so they can continue with daily activities.
Physician associates are healthcare professionals with a generalist medical education, who work alongside doctors providing medical care as an integral part of the multidisciplinary team. Physician associates are dependent practitioners who work under the supervision of a fully trained and experienced doctor. They bring new talent and add to the skill mix within teams, providing a stable, generalist section of the workforce which can help ease the workforce pressures that primary care currently faces.
Pharmacy technicians play an important role within general practice and complement the more clinical work of clinical pharmacists, through utilisation of their technical skillset. Working within primary care settings allows the pharmacy technician to apply their acquired pharmaceutical knowledge in tasks such as audits, discharge management, prescription issuing, and where appropriate, informing patients and other members of the primary care network (PCN) workforce. Work is often under the direction of clinical pharmacists as part of the PCN pharmacy team.
Podiatrists are healthcare professionals that have been trained to diagnose and treat foot and lower limb conditions. Podiatrists provide assessment, evaluation, and foot care for a wide range of patients, which range from low risk to long-term acute conditions. Many patients fall into high risk categories such as those with diabetes, rheumatism, cerebral palsy, peripheral arterial disease, and peripheral nerve damage.
Social Prescribing Link Workers give people time and focus on what matters to the person as identified in their care and support plan. They connect people to community groups and agencies for practical and emotional support and offer a holistic approach to health and wellbeing, hence the name ‘social prescribing’.
Social prescribing enables patients referred by general practice, pharmacies, multi-disciplinary teams, hospital discharge teams, allied health professionals, fire service, police, job centres, social care services, housing associations and voluntary, community and social enterprise (VCSE) organisations get the right care for them.
Link workers typically work with people over 6-12 contacts (including phone calls and face to face meetings) over a three-month period with a typical caseload of up to 250 people, depending on the complexity of people’s needs.
Advanced Practitioners are an integral part of the 21st century NHS workforce as new models of care are transforming the way patients are treated. Advanced Practitioners work at level 7 across the four pillars of advanced practice – clinical, management & leadership, research & education, and offer multiple benefits to the health service and the population. They bring more holistic care to patients, support continuity of care and extend the scope of practice across traditional boundaries. This leads in turn to a greater focus on prevention, more personalised care, a more efficient team, a faster response to patient needs and better outcomes.
They are instrumental in supervising the multi-professional team in primary care, they attract and lead research and audits, and manage highly complex high-risk patients. They have a leadership role in the ICS around pathways and population health.
Health Education England is establishing the Centre for Advancing Practice to support education and training for Advanced Practitioners in England through:
- development of agreed national training standards for advanced practice education
- delivery of a programme accreditation process (kitemarking) for training courses for advanced level practice.
Training/Development
The HEE multi-professional training framework can be found here: https://www.hee.nhs.uk/sites/default/files/documents/Multi-professional%20framework%20for%20advanced%20clinical%20practice%20in%20England.pdf
Further Information: