In a paper looking at the performance of the additional roles reimbursement scheme (ARRS), health experts said new recruits ‘are not being implemented and integrated into primary care teams effectively’ and that ‘there is a risk [it could] fail to have the intended impact’.
The report - commissioned by the DHSC - noted that in many cases PCNs ‘lack a clear, shared overall purpose and strategy or a clear, shared vision and buy-in for the ARRS roles’.
Damning conclusions on the performance of the flagship recruitment scheme, which aims to employ 26,000 extra staff by 2024 comes just two weeks after GPonline reported it had failed to reach its halfway target last December.
Disagreement over whether the roles are primarily intended to deliver PCN contract work or to perform ‘core’ general practice activities has become a point of contention within networks, with clinical directors confused about how best to use staff, the report found.
Report authors said there had been a failure to carefully consider how the role of GPs leading networks, or the organisation of general practice, might need to change to accommodate working with new staff - adding its ‘huge scale of ambition’ requires ‘significant and complex change across general practice’.
They added that a ‘lack of adequate estate’ was becoming an issue in many areas, while uncertainty around funding for ARRS roles beyond 2023/24 was beginning to cause anxiety for those running networks.
The report said: ‘PCNs have swiftly recruited to these roles and the ARRS has undoubtedly accelerated the development of multidisciplinary teams within and across general practices. However, anecdotal data suggests that the roles are not being implemented and integrated into primary care teams effectively and there is a risk that the scheme will fail to have the intended impact.
'Given the importance of these roles in helping to tackle the increasing pressures in general practice and the long-term sustainability of services, successful implementation of the roles is crucial.’
The ARRS is worth more than £3.5bn over four years from 2020/21 to 2023/24 and forms a critical plank of the government’s manifesto promise to increase the number of annual appointments in general practice by 50m.
But the King’s Fund found that PCN leaders ‘did not have the time or headspace' to absorb the guidance and act on it. Meanwhile, they said clinical directors had not been offered proper training.
Access to supervision for new staff was often constrained by ‘a lack of capacity, incentives, funding or recognition of the work involved’, the report said. A lack of specific funding to cover supervision had left new recruits feeling isolated and lonely.
The report warned that the ARRS had changed the role of GPs. One clinical director said: ‘This has implications which fundamentally alter the nature of UK general practice. One consequence (intended or otherwise) of creating a multi-professional workforce is that the role of the GP is changing from personal practitioner responsible for a caseload, to consultant/supervisor at the head of a "junior" team.
‘How we feel about that as a profession might in turn determine how medical graduates would view a career in general practice.’
The King's Fund has recommended ‘a comprehensive package of support’ to implement the scheme properly, in addition to a ‘clearer, shared vision’ for multidisciplinary working. It recommends additional funding, an estates strategy and leadership and management training to be embedded into GP specialist training.
It said ARRS roles 'have the potential to make a significant contribution to the quality of patient care in general practice' and could help make general practice sustainable, but wanred that better support was critical.
Last month King’s Fund senior fellow Beccy Baird told GPonline that general practice and PCNs need more support to integrate additional roles staff into multidisciplinary teams - adding the roles may need to change to boost recruitment.
Prominent London GP Dr Farzana Hussain recently stepped down from her position as co-clinical director, telling GPonline that top-down management, endless meetings, and restrictive recruitment rules had clouded the initial vision of the initiative.