Additional Roles Reimbursement Scheme uptake, patient satisfaction, and QOF achievement: an ecological study from 2020-2023.

Background: The Additional Roles Reimbursement Scheme (ARRS) was introduced by NHS England in 2019 alongside primary care networks (PCNs), with the aims of increasing the workforce and improving patient outcomes.

Aim: To describe the uptake of direct patient care (DPC)-ARRS roles and its impact on patients' experiences.

Design and setting: An ecological study using 2020-2023 PCN and practice workforce data, registered patient characteristics, the General Practice Patient Survey, and the Quality and Outcomes Framework (QOF).

Method: Descriptive statistics with associations were examined using quantile and linear regression.

Results: By March 2023, 17 588 full-time equivalent (FTE) DPC-ARRS roles were commissioned by 1223 PCNs. PCNs with fewer constituent practices had more DPC-ARRS roles per population (P<0.001), as did PCNs with more FTE GPs per population (P = 0.005). DPC-ARRS commissioning did not vary with age, sex, or deprivation characteristics of practice populations. DPC-ARRS roles were associated with small increases in patient satisfaction (0.8 percentage points increase in patients satisfied per one DPC-ARRS FTE) and perceptions of access (0.7 percentage points increase in patients reporting 'good' experience of making an appointment per one DPC-ARRS FTE), but not with overall QOF achievement.

Conclusion: The commissioning of DPC-ARRS roles was associated with small increases in patient satisfaction and perceptions of access, but not with QOF achievement. DPC-ARRS roles were employed in areas with more GPs rather than compensating for a shortage of doctors. Single-practice PCNs commissioned more roles per registered population, which may be advantageous to single-practice PCNs. Further evaluation of the scheme is warranted.