Why isn’t the Additional Role Reimbursement Scheme relieving workload stresses?

I’m hearing a fair bit of criticism at the moment about the Additional Roles Reimbursement Scheme, which is part of the Primary Care Network DES (Direct Enhanced Service). The whole idea behind the scheme is to grow additional capacity through new roles, and by doing so, help to solve some of the workforce shortage in general practice.

Sounds straightforward enough. But this isn’t working out. Roles that have been brought in are often not alleviating workload pressure as intended. I was in a session just a few days ago with GPs who were quite vociferous in saying they didn’t feel this was a scheme that was delivering for them.

So, what’s the answer here? What happens when we gently challenge this thinking?

Revisit the original plan

Right from the start, the Additional Roles Reimbursement Scheme has had an element of flexibility to it. Every Primary Care Network gets a budget against which it can recruit the roles it wants to recruit. There’s a list of roles that can be accommodated.

New roles have been added since the scheme was introduced in July 2019 and continue to be added to try to help the Primary Care Networks recruit roles they can more realistically fill because there simply aren’t enough GPs and nurses in training.

But if it’s not working as envisaged, what is the plan here?

  • Go back to the job description, what did you recruit for?
  • What was the workplan that was developed against that job description?
  • How close to that are you in terms of delivery?

What I often find is that the new roles are delivering what was envisaged at the time in the job description and the job plan. So, what isn’t working here?

What workload did the new recruit actually take on?

If this sounds a familiar conundrum faced by your Primary Care Network (or practice), you may want to take a look at what else has changed in general practice to adapt since the new role came around.

You may have put in place a pharmacist or a physician associate or a social prescriber or a health and wellbeing link worker. But if your GPs, nurses and others in the healthcare professional team haven’t adequately adjusted their own way of working in response, it will feel like it isn’t working.

If a particular piece of frustrating workload isn’t identified and taken away from a GP or nurse as a result of the new role coming in, the perception will be that is has failed because nothing will feel like it has really changed. You have to properly plan for it.

How to make the Additional Roles Reimbursement Scheme work effectively

So for those who genuinely feel their Additional Roles Reimbursement Scheme isn’t working, my advice is to go back, regroup as a Primary Care Network, sit down, look at the job description, look at the roles you’ve recruited and then ask yourselves:

  • What do you want this role to do?
  • How do you want them to do it?
  • Who in the network or in the practice is responsible? (that could be the person you’ve recruited, a practice manager, the network business manager or the clinical lead) And for what?
  • Who is responsible for supporting the role and making sure you get the best out of it?
  • What outcomes do you expect from the role?
  • And how are you going to measure and evaluate the role on a weekly and monthly basis?

That last point means that if there is a shortfall you can act on it instead of letting it drift on to increasing levels of dissatisfaction with people muttering and grumbling about how it’s not working.

Can you afford not to make this work?

A lot of the complaints I receive about the scheme come around from having a lack of a crystal clear plan covering what they envisage from the roles. It’s the old adage – if you fail to plan then plan to fail because, without that planning, bringing new roles in is not going to work.

Recruitment is tougher than ever right now and with 1,307 Primary Care Networks across England all trying to recruit there is a real danger that you could lose valuable members of the team to other networks if they become dissatisfied in their role.

So suddenly that pharmacist you recruited has resigned and is heading to that other network up the road who has promised them a really clear job plan, a well-defined role and a well-supported induction.

The over-arching message is – if you are going to recruit through the scheme, get a robust plan in place that your whole team buys into and understands. It’s very simple to do, it doesn’t take an awful lot of time but it will pay back massively and make sure you’re able to get the most out of the Additional Roles Reimbursement Scheme.

Scott McKenzie helps GPs, PCNs and GP federations build sustainable and resilient practices and organisations that thrive and supports pharmaceutical, medical technology and device firms to increase revenue by getting their products and services in front of the right NHS decision makers. If you want to know how to double your revenue,