Overcoming the challenges of integrating ARRS roles in general practice

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Primary Care

Overcoming the challenges of integrating ARRS roles in general practice

General practice in the United Kingdom is becoming more and more collaborative. With the declining number of GPs every year and the increased number of patients, multidisciplinary teams are more essential than ever to provide the core service expected of primary care services. 

GPs, pharmacists, nurses and many other healthcare professionals collaborate consistently to ensure patients receive the right care. The Kings Fund states that multidisciplinary teams are fundamental to the future of general practice, and we agree!

What is the Additional Roles Reimbursement Scheme?

NHS England’s Additional Roles Reimbursement Scheme (ARRS) was introduced in January 2019. 

The ambitious aim for ARRS roles was to bring in 26,000 new people into general practice by 2024 by providing the ability to hire non-GP reimbursable roles. As a result, there was hope that bringing more people into primary care would help reduce unavoidable health inequalities resulting from significant workforce shortages.

ARRS roles

ARRS roles are a mix of both clinical and non-clinical roles, that are integrated into general practice teams to provide support and services to patients, with the aim of improving patient care, enhancing access to services and reducing the burden on GPs. 

ARRS roles provide roles outside of GPs and include many different roles outlined below:

Breakdown of reimbursable ARRS roles

Many PCNs across England were extremely quick to hire people into these roles. However, there has been some difficulty in implementing and integrating different ARRS roles into existing teams. 

Making these teams function efficiently and effectively is complex and can be a challenging thing to do.

Sign up for our webinar to learn more about maximising the efficiency of ARRS roles from the people themselves.

The challenges faced by PCNs with ARRS roles

According to Pulse, around £64m out of £1.02bn has been forecast to go unspent, and this year's underspend will be lost from primary care and given back to the Treasury.

ARRS underspend bids approved by Integrated Care Board (ICB) area


It's now more important than ever to address the challenges many PCNs have had regarding ARRS roles. 

But what are these challenges? 

PCNs were set up in 2019, which is still relatively new in terms of the NHS. As a result, there often isn’t a clear and shared strategy around ARRS roles. 

As The Kings Fund points out, 'the complexities of 'sovereignty' between practices and the PCN cause issues for those employed in ARRS roles.' We often see that the practices that make up a PCN don’t have a shared team identity, strategy or work culture. This can make more centralised roles, like ARRS roles, challenging to manage and implement successfully across every practice. 

Without a clear strategy, managing a multidisciplinary team can become difficult. There are different views on how to integrate ARRS roles successfully, along with managing people from diverse work backgrounds with varying expectations of their positions.

ARRS roles often involve close collaboration with GPs, nurses, and other healthcare professionals, necessitating effective communication and coordination. Ensuring smooth integration of ARRS roles into the existing team and workflow can be complex, requiring clearly defined roles and responsibilities, streamlined communication channels, and coordinated task allocation. In the fast-paced and dynamic healthcare environment, where priorities and workloads may vary among team members, this can pose significant challenges.

There's a lack of clarity around the purpose and intention of ARRS roles for many people within general practice. For many people, it's unclear whether ARRS roles are there to deliver the PCN DES requirements or the core work within a practice.

In the King's Fund research on ARRS roles, they found a lack of understanding around what working as a multidisciplinary team actually entailed and how this would impact the day-to-day running of a practice and clinical working practices.

It seems that how ARRS roles can contribute to solving the problems within general practice isn't universally understood, and how practices, GPs, practice staff and general practice as a whole might need to adapt as a by-product.

Many ARRS roles need a level of clinical or peer supervision and support, which is key for members of staff to be integrated into teams and perform their roles successfully. However, with staffing shortages, lack of funding and workforce pressures, this level of support is often difficult for many practices and PCNs to provide.

Strategies for overcoming ARRS challenges

The integration and use of ARRS roles can be confusing, but there are ways to overcome these challenges.

Some of the strategies for overcoming these challenges could include:

  • Defining which ARRS roles you need and why
    For ARRS roles to be successful within PCNs and practices, practice staff must have a clear understanding of what ARRS roles are needed, why this is the case and precisely what they're responsible for. 
  • Fostering a positive team environment
    Working in a multidisciplinary team can be challenging, especially if it's new to people. Fostering an environment with good communication and teamwork is essential for people in an ARRS role to feel like part of the team and for general practice staff to understand their value.
  • Creating clear clinical supervision arrangements
    For ARRS roles that require clinical supervision, this should be clearly set out for both the member of staff and the people providing this supervision. Included in these arrangements, there should be clear policies and procedures and how ARRS staff can access education and training in their roles.

Like all new roles, embedding and understanding how ARRS roles can improve primary care can take some time. However, creating a sense of stability and consistency for staff members is really important to ensure ARRS roles in your PCN are as effective and efficient as possible. 

Sign up for our webinar, where we'll speak to people in ARRS roles about how you can maximise the efficiency of ARRS roles within primary care.

If you’re interested in working with Suvera in future to meet your objectives and manage your patients with long-term conditions, please get in touch.