ARRS Roles: Recruitment and Retention  at West Leeds Primary Care Network

proposal

Proposal

The Additional Roles Reimbursement Scheme was introduced in England in 2019. Through the scheme, Primary Care Networks (PCNs) can claim reimbursement for the salaries (and some on-costs) of 17 new roles within a multidisciplinary team, selected to meet the needs of the local population. ARRS roles brings specialist skills directly into practices, along with general clinical knowledge and skills that can add capacity to practice and nursing teams, allowing GPs to focus on people with complex needs.

Situation

The West Leeds PCN team wanted to create a strong and stable environment where new ARRS roles could be recruited and retained within their organisation.  

Actions

  • The PCN looked at population health data to identify what the population needed and shaped the workforce and roles around those needs. An example of this was the introduction of social prescribers to meet the health and wellbeing needs of the population.
  • By identifying the needs of the population, they could ensure that the people coming into ARRS roles understood exactly what their role and delivery would look like.
  • They ensured that performance was monitored carefully by appropriate clinical/supervisory staff.
  • To support new employees, the PCN recruited two people into each role where possible to provide mutual support, held monthly MDT meetings and implemented staff engagement surveys every 6-12 months.
  • The induction period is a key part of starting any new role. Alongside the mandatory training offers, staff spent time working in and around other teams and practices to get a sense of the bigger picture of a PCN. It was also seen as an opportunity to feel part of the wider team, network with colleagues and identify opportunities for collaborative working.
  • All First Contact Practitioners (FCP) have to complete the FCP framework within the first 12 months of employment, supervised by an advanced practitioner who has completed the HEE accredited supervisor training. We offered this opportunity to staff within the PCN and 2 ACPS alongside 2 GPs completed the training. This ensured we had enough suitably qualified Health Care Professionals to support the ARRS staff, with the added benefit of further developing the skills of the supervisors themselves.

Clinical Outcomes

Over the lifetime of the ARRS funding to-date, West Leeds PCN has recruited to its numbers and achieved high retention. This meant that recurrent funding was secured for these roles. Only 76% of patients seen by a GP require GP intervention, so the introduction of ARRS roles reduced the amount of patients needing to see a GP. By working proactively with patients, they were able to reduce hospital admissions. For example, the biggest cohort of frailty patients are considered moderately frail, so support with diet and lifestyle can prevent them from becoming severely frail and therefore reduce hospital admissions. 

Financial Outcomes

The focus of the PCN is to support the practices, whilst gaining economies of scale by working across the whole population. The PCN staff support practices by undertaking NHS health checks, where the practice receives £20 per health check completed. They also supported the COVID and flu vaccination campaign which generates £10.06 per injection – the money going directly to practices. The Physician Associates have been trained to deliver Learning Disabilities health checks, which generate £140 per health check undertaken; again this funding goes directly to practices.

Longer Term Impact

In expanding general practice capacity, the scheme improves access for patients, supports the delivery of new services and widens the range of offers available in primary care.  Staff are encouraged to upskill, train and develop. The PCN currently has two team members doing the Advanced Clinical Practitioner (ACP) course and one team member doing the Trainee Nursing Associate (TNA) course. 

tips

Top Tips

Planning is imperative for bringing in a new role.

You need a strong team structure and organisation with the right people in the right positions.

Training and education is key – be supportive of training opportunities relevant to the roles. 

There must be buy in from the practice and it’s pivotal to ensure that a clinical lead is assigned to champion and support those in ARRS roles.

When recruiting, consider the existing team and whether the person being interviewed would be a good fit – don’t be afraid to employ a candidate who needs some development if they demonstrate the right aptitude and cultural fit.

“You can’t build a house on poor foundations, so take the time to get the right structure in place”

Practice Business Manager