ActivePublic Health & HealthcareEducation & Skills
New and Extended Practice Roles in NHS Primary and Community Health and Social Care: A Scoping Review and Meta-review of Realist Reviews and Evaluations with integrated Knowledge Mobilisation
Since 2019, NHS England has hired 17 new types of staff—such as paramedics, physiotherapists, and social prescribers—into GP surgeries and community teams under a scheme that has already exceeded its recruitment targets. The problem is that no one has systematically worked out which of these roles actually improve patient care, in which settings, and why. The NHS has spent heavily on the Additional Roles Reimbursement Scheme, but the evidence base for how to integrate these staff effectively remains patchy. This project will fill that gap by synthesising existing research and stakeholder knowledge. If successful, the research will produce practical decision-support tools for NHS managers and policymakers. These tools could help primary care teams deploy new staff more effectively, reducing pressure on GPs and improving patient access to the right professional at the right time. The project will also advance the methodology for synthesising complex evidence, which could benefit future workforce evaluations.
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Background: The NHS faces critical workforce shortages that are projected to rise significantly. These shortages are acutely felt in primary and community health settings. In response, NHS England introduced the Additional Roles Reimbursement Scheme (ARRS) in 2019, introducing 17 new or expanded roles ('Additional Roles') to enhance access to primary care. Despite substantial investment and the scheme's success in surpassing initial targets, knowledge gaps persist regarding these roles' integration, impact, and scalability in varied health and social care contexts. Research Question: What underlying mechanisms contribute to the integration and impacts of Additional Roles in different contexts? What works, for whom, and why? Aims and Objectives: Our research will generate actionable evidence to support sustainable implementation of Additional Roles. We will meet this aim through the following objectives: 1) Use integrated knowledge translation techniques to triangulate evidence, theory, and stakeholder insights, ensuring relevant, impactful, and sustainable findings (WP1); 2) Identify, review, and map evidence and knowledge gaps on Additional Roles in NHS primary and community care, focusing on their integration, impact, and research methods (WP2); 3) Conduct a Meta-review of Realist Reviews and Evaluations (MoRRE) to synthesise programme theories, highlighting both generic and role-specific mechanisms (WP3); 4) Develop new programme theories to support the effective implementation and integration of Additional Roles, providing robust decision-support tools for stakeholders (WP3). Methods: We have designed an innovative research programme grounded in the NIHR principle of 'needs-led, science-added'. In doing so, we draw on several different methods across our three WPs. In WP1, we will engage stakeholders in various ways, including advisory groups and a World Café approach, to ensure our work remains relevant, impactful, and sustainable. In WP2, we will systematically scope and map the evidence on Additional Roles, focusing on data related to their integration, impact, and research study methods. In WP3, we will conduct a new type of synthesis called a Meta-review of Realist Reviews and Evaluations (MoRRE) to synthesise and refine programme theories from existing realist research, building on existing understanding of realist methods and standards. We will document and share learning through a Study Within A Review (SWAR). The synthesis will highlight role-specific and generic mechanisms to guide the successful integration and impact of ARRS roles, offering decision-support tools for policymakers and practitioners. Duration: 30 months Impact and Dissemination: We will ensure actionable insights throughout the research lifecycle by embedding and integrating knowledge mobilisation methods throughout our work. Dissemination strategies include stakeholder events, open-access resources, and tailored guidance for policy and practice. Anticipated impacts will include: 1) Evidence that enhances the integration of Additional Roles into healthcare teams 2) Relationship and capacity building between a variety of stakeholders in this field 3) Contributions to the advancement of realist research methodologies
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