Penfold Chris, Hong Jialan, Edwards Peter J, Kashyap Mavin, Salisbury Chris, Bennett Ben, Macleod John, Redaniel Maria Theresa
National Institute for Health and Care Research Applied Research Collaboration (NIHR ARC) West, University Hospitals Bristol and Weston NHS Foundation Trust; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol.
Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol.
Br J Gen Pract. 2024 Dec 26;75(750):e35-e42. doi: 10.3399/BJGP.2024.0083. Print 2025 Jan.
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.
To describe the uptake of direct patient care (DPC)-ARRS roles and its impact on patients' experiences.
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).
Descriptive statistics with associations were examined using quantile and linear regression.
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 (<0.001), as did PCNs with more FTE GPs per population ( = 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.
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.
2019年，英国国家医疗服务体系（NHS）英格兰地区在推出初级医疗网络（PCN）的同时引入了额外角色报销计划（ARRS），旨在增加医疗劳动力并改善患者治疗效果。
描述直接患者护理（DPC）-ARRS角色的采用情况及其对患者体验的影响。
一项生态研究，使用2020 - 2023年PCN及医疗机构劳动力数据、注册患者特征、全科医疗患者调查以及质量与结果框架（QOF）。
使用分位数和线性回归对具有关联性的描述性统计数据进行分析。
截至2023年3月，1223个PCN委托设立了17588个全职等效（FTE）的DPC-ARRS角色。组成医疗机构较少的PCN每人口拥有的DPC-ARRS角色更多（<0.001），每人口拥有更多FTE全科医生的PCN也是如此（=0.005）。DPC-ARRS委托设立情况与医疗机构人群的年龄、性别或贫困特征无关。DPC-ARRS角色与患者满意度的小幅提高（每一个DPC-ARRS FTE使满意患者增加0.8个百分点）以及就医便利性感知（每一个DPC-ARRS FTE使报告预约体验“良好”的患者增加0.7个百分点）相关，但与整体QOF达标情况无关。
DPC-ARRS角色的委托设立与患者满意度及就医便利性感知的小幅提高相关，但与QOF达标情况无关。DPC-ARRS角色在全科医生较多的地区使用，而非用于弥补医生短缺。单医疗机构PCN每注册人口委托设立的角色更多，这可能对单医疗机构PCN有利。该计划值得进一步评估。
