Additional Roles Reimbursement Scheme (ARRS)

The Additional Roles Reimbursement Scheme (ARRS) is designed to expand the primary care workforce. To find out more on these job roles, click on the links below

New Roles in Primary Care:

• Care Co-ordinator
• Chiropodists/Podiatrists
• Clinical Pharmacists
• Dietitians
• First Contact Physiotherapist
• Health and Wellbeing Coach
• Mental Health Practitioner
• Nursing Associate
• Occupational Therapists
• Paramedics - Advanced Paramedic Practitioner
• Pharmacy Technician
• Physician Associate
• Social Prescribing Link Worker

Care Co-ordinator

Care co-ordinators provide extra time, capacity, and expertise to support patients in preparing for or in following-up clinical conversations they have with primary care professionals. They will work closely with the GPs and other primary care professionals within the Primary Care Network (PCN) to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers and ensuring that their changing needs are addressed.

They focus delivery of the Comprehensive Model for Personalised Care to reflect local priorities, health inequalities or population health management risk stratification.

For more information on this role, visit the HEE website

Podiatrists

Podiatrists are healthcare professionals who have been trained to diagnose and treat foot and lower limb conditions. Podiatrists provide assessment, evaluation and foot care for a wide range of patients, which range from low risk to long-term acute conditions. Many patients fall into high risk categories such as those with diabetes, rheumatism, cerebral palsy, peripheral arterial disease and peripheral nerve damage.

For more information on this role, visit the HEE website

Clinical Pharmacists

Clinical pharmacists work in primary care as part of a multidisciplinary team in a patient facing role to clinically assess and treat patients using expert knowledge of medicines for specific disease areas. They will be prescribers, or if not, can complete an independent prescribing qualification following completion of the 18-month Centre for Pharmacy Postgraduate Education (CPPE) pathway. They work with and alongside the general practice team, taking responsibility for patients with chronic diseases and undertaking clinical medication reviews to proactively manage people with complex polypharmacy, especially for the elderly, people in care homes and those with multiple comorbidities.

For more information on this role, visit the HEE website

Dietitians

Dietitians are healthcare professionals that diagnose and treat diet and nutritional problems, both at an individual patient and wider public health level. Working in a variety of settings with patients of all ages, dietitians support changes to food intake to address diabetes, food allergies, coeliac disease, and metabolic diseases. Dietitians also translate public health and scientific research on food, health, and disease into practical guidance to enable people to make appropriate lifestyle and food choices.

For more information on this role, visit the HEE website

First Contact Physiotherapist

First Contact Practitioners (FCP) are qualified autonomous clinical practitioners who can assess, diagnose, treat, and manage musculoskeletal (MSK) problems and undifferentiated conditions – where appropriate – and discharge a person without a medical referral. FCPs working in this role can be accessed directly by self-referral or staff in GP practices can direct patients to them to establish a rapid and accurate diagnosis and management plan to streamline pathways of care.

For more information on this role, visit the HEE website

Health & Wellbeing Coach

Health and Wellbeing Coaches (HWBCs) will predominately use health coaching skills to support people with lower levels of patient activation to develop the knowledge, skills and confidence to become active participants in their care so that they can reach their self-identified health and wellbeing goals. Patient Activation refers to the spectrum of knowledge, skills and confidence in patients and the extent to which they feel engaged and confident in taking care of their condition. HWBCs may also provide access to self-management education, peer support and social prescribing.

HWBCs will use a non-judgemental approach that supports the person to self-identify existing issues and encourages proactive prevention of new and existing illnesses. This approach is based on using strong communication and negotiation skills, supports personal choice and positive risk-taking, addresses potential consequences, and ensures people understand the accountability of their own decisions based on what matters to the person.

They will work alongside people to coach and motivate them through multiple sessions, supporting them to self-identify their needs, set goals, and help them to implement their personalised health and care plan.

For more information on this role, visit the HEE website

Mental Health Practitioner

Further guidance on this role is currently being developed.

Nursing Associate/Trainee Nursing Associate 

This role was introduced to help build the capacity of the nursing workforce and the delivery of high-quality care. It provides career progression for health care support workers and is a progression route to registered nurse if required.

For more information on this role, visit the HEE website

Occupational Therapists

Occupational therapists are playing an increasing role in primary care. They enable people living with a range of health problems and chronic conditions to overcome the barriers so they can participate in everyday life, and improve their health and wellbeing.

They assess the needs of people to do what they need and want to do (occupations). They develop plans with patients, so they can re-engage in everyday life, despite their health and social difficulties.

Through intervening early and taking a collaborative approach occupational therapists are able to address what matters to people. This can minimise crisis situations, prevent further deterioration and promote independence and social inclusion.

Occupational therapists help GPs to support patients who: 

• are frail, with complex needs
• live with chronic physical or mental health conditions 
• manage anxiety or depression 
• require advice to return or remain in work 
• need rehabilitation so they can continue with previous occupations (activities of daily living).

For more information on this role, please visit the HEE website

Paramedics - Advanced Paramedic Practitioner

Advanced Paramedic Practitioners work autonomously, using their enhanced clinical assessment and treatment skills to provide first point of contact for patients presenting with undifferentiated, undiagnosed problems relating to minor illness or injury, abdominal pains, chest pains and headaches. They are Health Professional who practice at an advance level having capability to make sound judgements in the absence of full information and to manage varying degrees of risk when there are complex, competing or ambiguous information or uncertainty. They will support the delivery of Anticipatory care plans and lead certain community services (e.g. monitoring BP’s & Diabetes risk of elderly patients living in sheltered housing)

They will be able to:

• Perform Specialist health checks and reviews
• Perform and interpret ECG’s
• Perform investigatory procedures as required
• Undertake the collection of pathological specimens including intravenous blood samples, swabs etc
• Perform investigatory procedures needed by patients and those requested by the GP’s

Pharmacy Technician

Pharmacy technicians play an important role within general practice and complement the more clinical work of clinical pharmacist, through utilisation of their technical skillset. Their deployment within primary care settings allows the application of their acquired pharmaceutical knowledge in tasks such as audits, discharge management, prescription issuing, and where appropriate, informing patients and other members of Primary Care Network (PCN) workforce. Work is often under the direction of clinical pharmacists, and this benefit is realised through the creation of a PCN pharmacy team.

For more information on this role, visit the HEE website

Physician Associate

Physician Associates who work in primary care are dependent practitioners who remain under the supervision of a named GP.

They are specifically trained healthcare professionals who can deliver a valuable role in general practice, as part of the practice team, and can often effectively free up GP time. Depending upon their level of experience, a PA can manage a proportion of a GPs workload in a supportive and complementary way, rather than being viewed as a substitute. PAs will often commence in practice on a salary of between £30,000 - £35,000 per annum, which equates to an NHS Band 6/7 (Agenda for Change).

The Royal College of Physicians has a Faculty of Physician Associates that provides more information on the role.

Social Prescribing Link Worker

Social prescribing enables all primary care staff and local agencies to refer people to a link worker. Link workers give people time and focus on what matters to the person as identified through shared decision making or personalised care and support planning. They connect people to community groups and agencies for practical and emotional support. They work within multi-disciplinary teams and collaborate with local partners to support community groups to be accessible and sustainable and help people to start new groups. Social prescribing complements other approaches such as ‘active signposting’. Link workers typically support people on average over 6-12 contacts (including phone calls, meetings and home visits) with a typical caseload of 200-250 people per year, depending on the complexity of people’s needs and the maturity of the social prescribing scheme.

For more information on this role, visit the HEE website