McDermott Imelda, Spooner Sharon, Checkland Kath
Centre for Primary Care and Health Services Research, University of Manchester, Manchester.
Br J Gen Pract. 2025 Feb 27;75(752):e153-e158. doi: 10.3399/BJGP.2024.0562. Print 2025 Mar.
The Additional Roles Reimbursement Scheme (ARRS) was introduced in England in 2019 to alleviate workforce pressures in general practice by funding additional staff such as clinical pharmacists, paramedics, first-contact physiotherapists, and from 1 October 2024 the scheme funds recently qualified GPs. However, the employment and deployment models of ARRS staff present ongoing complexities and challenges that require further exploration.
To explore the decision-making processes behind primary care networks (PCNs) and general practice staffing choices, and how these choices influence the operationalisation of ARRS.
This was a qualitative case study across four PCNs in England using a realist evaluation framework.
Data collection took place between September 2022 and November 2023. Semi-structured interviews were conducted with PCN clinical directors, GPs, practice managers, and ARRS staff ( = 42). Transcripts were analysed using a realist evaluation framework to identify the context-mechanism-outcome configurations.
Direct employment models fostered staff development and retention, contingent on established trust among practices. Subcontracting was favoured to mitigate employment risks but could lead to unintended consequences such as conflicting accountabilities and less integration with existing GP practice staff. The optimal deployment model involved rotations across a limited number of GP practices, ideally two, with one serving as a base, ensuring consistency in training and management.
This study provides novel insights into the complexities of different employment and deployment models of ARRS staff. These findings will be invaluable for creating a sustainable GP practice workforce and informing future workforce strategies as the scheme expands to include recently qualified GPs.
2019年，英国推出了额外角色报销计划（ARRS），通过为临床药师、护理人员、首诊物理治疗师等额外工作人员提供资金，以缓解全科医疗中的劳动力压力，自2024年10月1日起，该计划还为刚获得资格的全科医生提供资金。然而，ARRS工作人员的就业和部署模式仍存在持续的复杂性和挑战，需要进一步探索。
探讨初级保健网络（PCN）和全科医疗人员配置选择背后的决策过程，以及这些选择如何影响ARRS的实施。
这是一项采用现实主义评估框架，对英国四个PCN进行的定性案例研究。
数据收集于2022年9月至2023年11月期间进行。对PCN临床主任、全科医生、执业经理和ARRS工作人员（n = 42）进行了半结构化访谈。使用现实主义评估框架对访谈记录进行分析，以确定背景-机制-结果配置。
直接雇佣模式促进了员工的发展和留用，这取决于各医疗机构之间建立的信任。分包模式更受青睐，以减轻就业风险，但可能会导致意外后果，如责任冲突以及与现有全科医疗工作人员的融合度降低。最佳部署模式是在有限数量的全科医疗诊所（理想情况下为两个）之间轮岗，其中一个作为基地，以确保培训和管理的一致性。
本研究为ARRS工作人员不同就业和部署模式的复杂性提供了新的见解。随着该计划扩大到包括刚获得资格的全科医生，这些发现对于创建可持续的全科医疗劳动力队伍以及为未来的劳动力战略提供信息将具有重要价值。
