In 2020, the NHS began paying for new roles like physiotherapists and social prescribers to work in general practice, but no one knows whether the way different GP networks spend this money actually improves patient care. This matters because the Additional Roles Reimbursement Scheme was a major policy response to a long-running workforce crisis, yet evidence is lacking on how decisions about skill-mix are made within Primary Care Networks (PCNs) or what the variability in staffing means for patients. Without this understanding, the funding could be used inefficiently. If this research succeeds, it will produce practical recommendations for PCN decision-makers on how to deploy these new roles most effectively. The findings could directly shape workforce planning across England, helping GP teams and service planners allocate staff in ways that benefit both patients and the people working in primary care. The project brings together national workforce data, performance measures, and in-depth case studies to build a clear picture of what works—and what does not.
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Background: The Additional Roles Reimbursement Scheme (ARRS) funding for new and extended roles in general practice introduced in 2020 was a policy response to a workforce crisis over many years. The ARRS funding is delivered through networks of general practices – Primary Care Networks (PCNs) - to provide a wider range of services (e.g. physiotherapy, paramedic, social prescribing) and integrated care to local populations (around 50,000 people in up to six practices per PCN). National data indicate that there are differences between PCNs in how the funding is used but evidence is lacking on what this means for patient care and how decisions about skill-mix are made within PCNs. Aim: To improve understanding of the variability in skill-mixes among PCNs in England, how this relates to performance, and how decisions are made regarding the deployment of the new and extended roles in England, to inform future planning and policy. Design: Pragmatic, multistage, mixed methods. Research plan: Four linked work packages (WPs) over 27 months WP1: Assessment of variability amongst PCNs in workforce skill mix. Data on staff employed by PCNs (n~1252) and general practices (n~6300) from NHS England openly available sources will be used to describe differences in staffing FTE (overall, and by role) controlling for population size. Proportions of total staff FTE provided by PCNs vs general practices will be compared. Regression modelling will explore associations between workforce costs per 1000 patients and PCN characteristics (e.g. size, demography, morbidity). WP2: Associations between PCN workforce and performance. Data on PCN outcome measures will be drawn from the Fingertips public health data collection. The primary outcome will be the proportion of total available QOF points achieved in a PCN on the Quality and Outcomes Framework (QOF) pay-for-performance measure; secondary outcomes will be selected from other QOF outcomes where a link to ARRS roles might be expected. Regression modelling will explore associations between ARRS skill-mix variables and outcomes, controlling for local characteristics. Cost impacts will be calculated where skill mix changes are associated with significant changes in outcome. WP3: Decision making in PCNs. Information will be sought from the Directors of PCNs in England about the process and influences on the hiring decisions of PCNs by means of an online survey. Survey responses will help select six varied (by region, size, demography, deprivation) case-study PCNs for in-depth analysis. Desk analysis will collate contextual information about each PCN (national and supplied locally). Semi-structured interviews with staff (6 from practices, 4 from the regional Integrated Care Board, per PCN) and consultations with patient representatives to explore factors affecting hiring decisions and operational implications for staff and patients will be analysed thematically. WP4: Expert consensus building. Recommendations for PCN decision makers regarding deployment of ARRS roles will be agreed through an online consensus event involving 50 stakeholders (patients, public, staff in primary care, service planners, policy makers). Dissemination and impact: Outputs will be produced in a relevant format for all audiences (public, service planners, general practice teams, policy makers, academics). Recommendations will inform workforce planning in PCNs to the benefit of service users and staff.
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