At PCC, we have been delivering workshops on the development of the additional roles reimbursement scheme (ARRS) with clinical directors, PCN managers and practice managers and listening to their different experiences of expanding their workforces under the scheme.
Funding for the ARRS has increased nationally from £430m (2020-21) to £746m max. (2021-22) with an allocation available for each primary care network (PCN) depending on the size of the population it covers. Clinical commissioning groups (CCGs) draw down the funds but only as new roles are recruited within PCNs. PCNs are therefore being strongly encouraged to make use of their ARRS allocation to ensure people in their neighbourhoods benefit from the funding available.
The need to utilise this additional resource has come at a time when there are competing priorities in primary care, not least the Covid-19 vaccination programme. When you are very busy it can be tempting to take a pragmatic approach to the question of what new roles you might need, starting with what you know is useful. General practice has embedded clinical pharmacists over the past few years and they have demonstrated their worth in a primary care setting, so PCN leaders are telling us that using ARRS funding to increase pharmacy staff across a PCN is a comfortable decision. Similarly, recruiting more social prescribing linkworkers to reach out into communities to tackle the health inequalities highlighted by the pandemic can seem like a sensible idea.
But how to make best use of the remaining funding allocated to each PCN? Primary care leaders know they do not need to recruit one of every new role, but how can population health data help them to make informed choices about what roles would add value in their neighbourhood?
Practice-level data available on NHS ViewPoint helps PCNs to understand the current physical health needs of patients together with key demographic information about the make up of the population in age, ethnicity and deprivation. They can use this information to hone recruitment of additional roles.
For instance, analysing data on diabetes could identify:
- people who are at high risk of developing type 2 diabetes
- people who have newly diagnosed type 2 diabetes
- people with ongoing management of type 2 diabetes
The PCN would then consider which of the clinical and non-clinical additional roles could enhance care for pre-diabetics and diabetics at different stages in their self-care and management of the condition (see fig.)
Incorporating public health and local authority data, and the knowledge of local people, groups and organisations can help PCNs gather even richer information to support recruitment to meet needs in their areas. In an affluent area with an older population, it may be useful to recruit a first contact physiotherapist, health and wellbeing coach and podiatrist to work together on increasing strength and stability for people as they age, with a goal of preventing the often devasting first fall. In a deprived area with a history of long-term unemployment, a PCN might see the value in an occupational therapist to help people on long-term sick leave gain the confidence to get back into work, a physiotherapist to help with rehabilitation, and a health and wellbeing coach to help people set and achieve personal goals.
The analysis of data allows PCNs to align services to needs and predict local health needs in the future, identifying demographic trends in their neighbourhoods and bringing in roles to support prevention and provide anticipatory care; enabling them to better engage people in their own health and wellbeing, and help them stay healthy for longer.
See PCC’s support on the ARRS and contact us https://www.pcc-cic.org.uk/expert-support-when-its-needed-2/