Bramwell Donna, Hammond Jonathan, Warwick-Giles Lynsey, Bailey Simon, Checkland Kath
Centre for Primary Care and Health Services Research, University of Manchester, Manchester.
Centre for Health Services Studies, University of Kent, Canterbury, Kent.
Br J Gen Pract. 2024 Apr 25;74(742):e323-e329. doi: 10.3399/BJGP.2023.0216. Print 2024 May.
The Additional Roles Reimbursement Scheme (ARRS) provides funding to Primary Care Networks (PCNs) in England to recruit additional staff into specified roles. The intention was to support general practice by recruiting an extra 26 000 staff by 2024, increasing access and easing workload pressures.
To explore the establishment of the ARRS as part of PCNs' development to understand their role in supporting general practice.
A longitudinal, qualitative case study involving seven geographically dispersed PCNs across England.
Data were collected from July 2020 to March 2022, including 91 semi-structured interviews and 87 h of meeting observations. Transcripts were analysed using the framework approach.
Implementation of the ARRS was variable across the study sites, but most shared similar experiences and concerns. The COVID-19 pandemic had a significant impact on the introduction of the new roles, and significant variability was found in modes of employment. Cross-cutting issues included: the need for additional space to accommodate new staff; the inflexibility of aspects of the scheme, including reinvestment of unspent funds; and the need for support and oversight of employed staff. Perceived benefits of the ARRS include improved patient care and the potential to save GP time.
The findings suggest the ARRS has potential to fulfil its objective of supporting and improving access to general practice. However, attention to operational requirements including appropriate funding, estates, and management of staff is important if this is to be realised, as is clarity for the scheme post-contract end in 2024.
额外角色报销计划（ARRS）为英格兰的初级医疗网络（PCNs）提供资金，以招聘额外人员担任特定角色。其目的是到2024年招聘额外的26000名员工来支持全科医疗，增加医疗服务可及性并减轻工作量压力。
探讨将ARRS作为初级医疗网络发展的一部分来建立，以了解其在支持全科医疗方面的作用。
一项纵向定性案例研究，涉及英格兰七个地理位置分散的初级医疗网络。
数据收集时间为2020年7月至2022年3月，包括91次半结构化访谈和87小时的会议观察。使用框架法对访谈记录进行分析。
ARRS在各研究地点的实施情况各不相同，但大多数有相似的经历和担忧。新冠疫情对新角色的引入产生了重大影响，并且在就业模式上存在显著差异。共同问题包括：需要额外空间来容纳新员工；该计划某些方面缺乏灵活性，包括未使用资金的再投资；以及需要对受雇员工提供支持和监督。ARRS的预期益处包括改善患者护理以及有可能节省全科医生的时间。
研究结果表明，ARRS有潜力实现其支持和改善全科医疗服务可及性的目标。然而，若要实现这一目标，关注运营要求（包括适当的资金、场地和人员管理）很重要，2024年合同结束后该计划的明确性也同样重要。
