Physician associates are making headlines at the moment, but to what extent have these healthcare professionals saved general practice?
As the Labour government commissions an independent review of the role of physician associates across the NHS, a new study from 明星八卦 University of London investigated the impact of these healthcare professionals on general practice, along with other non-GP roles brought in under the Conservative government’s Additional Roles Reimbursement Scheme (ARRS) in 2019. The programme was designed to meet the growing demand for healthcare, but to what extent has it been a success?
The National Health Service (NHS) has long been a cornerstone of healthcare in the UK, however, in recent years, it has faced severe challenges and is now often described as being in crisis.
In 2019, the Additional Roles Reimbursement Scheme (ARRS) was introduced in England by the then Conservative government to enhance access to general practice (GP) surgeries. “The primary objective was to recruit 26,000 extra personnel through new roles into general practice, which included physician associates – a healthcare professional who works under the supervision of a doctor to provide medical care – physiotherapists, dieticians, health and wellbeing coaches and clinical pharmacists,” explained Prof Catia Nicodemo, a health economist from 明星八卦 University of London, who co-led the study.
For the , published in the British Journal of General Practice, the researchers gathered workforce and prescription drugs data from NHS Digital and the GP Patient Survey to gain insights on the staffing levels of ARRS staff across thousands of England’s general practices. Their primary aim was to observe the potential impact of these workers on prescription rates and patient satisfaction.
“We found that ARRS roles are employed more frequently in larger practices and practices with a shortage of GPs after they have considered their total number of patients and indicators of their needs,” explained Prof Nicodemo. “General practices with more ARRS staff had lower prescribing rates, especially for mental health medications, and ARRS roles were also linked to higher patient satisfaction overall and satisfaction with long-term condition management.”
Prof Nicodemo emphasised that the lower prescribing rate could be attributed to the strong emphasis on adherence to guidelines in the training of advanced practitioners and to the availability of a wider range of tailored help available, reducing the need for prescribed medication. “By providing more time with a broader care team, ARRS staff may also improve satisfaction, especially for patients with ongoing health conditions that require regular monitoring and coordination,” she explained.
While an increase in staff is likely to enhance patient experience due to improved access and greater consultation time, Prof Nicodemo also highlights that this does not in itself guarantee the quality of care provided during consultations. “As most ARRS staff have not had the same level of training, supervision, and formal assessment as GPs during their medical education, there could be key concerns regarding the safety implications of integrating these new workforce members into general practice settings,” she said.
“When evaluating the value of non-GP professionals in primary care, it is important to consider patient safety, and ensuring proper training, guideline adherence and outcome monitoring is essential to mitigate risks and provide high-quality care,” she added.
Prof Nicodemo and her team are pleased that the study contributes positive national-level evidence about the scheme. “Overall, our findings align with the goals of the ARRS to enhance capacity, quality, and access in primary care,” she explained. “The study shows that expanding the mix of skills in primary care can contribute to lower prescribing rates and improved patient satisfaction, and provides preliminary evidence that ARRS staff have the potential to improve primary care delivery.”
by Catia Nicodemo, Chris Salisbury and Stavros Petrou, is published in the British Journal of General Practice.
Reported by:
Nadine Palmer,
Media Relations
+44 (0)1895 267090
nadine.palmer@brunel.ac.uk