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The use of additional roles reimbursement scheme (ARRS) in primary care networks (PCNs) is linked to lower prescribing rates and higher patient satisfaction in GP practices, a study has found.
The study, published in the British Journal of General Practice on 10 December 2024, looked at data from more than 6,000 general practices in England, including prescribing data and the NHS GP Patient Survey, between January 2018 and December 2021.
The links between ARRS staff and patient satisfaction (β=3.2, P<0.001) and lower prescribing (β=−0.52, P<0.001) remained even after controlling for patient and practice characteristics.
In particular, lower prescribing for mental health medications, as well as greater patient satisfaction with long-term condition management, was seen in general practices with more ARRS staff.
The paper said: “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 forms of help, which may reduce the need for prescribed medication.
“This is particularly consistent with the employment of a high number of clinical pharmacists,” it added.
The ARRS scheme began in England in 2019 and enables PCNs to claim salary costs for additional general practice staff to support the needs of their local population. As well as clinical pharmacists, ARRS roles include pharmacy technicians, podiatrists and dieticians.
Primary care workforce data, published by NHS Digital in February 2024, showed that the number of pharmacists working in primary care had increased by 24.5% in a year, from 6,874 full-time equivalents in December 2023 and from 5,522 full-time equivalents at the same time in 2022.
Commenting on the paper, Graham Stretch, president of the Primary Care Pharmacy Association, said: “I am pleased further evidence of the value of ARRS staff has been published, specifically for pharmacists in reducing overprescribing and the demonstration of increased patient satisfaction with the management of their long-term conditions — a key role where pharmacists can demonstrate their expertise, improving safety.
“These quality aspects of healthcare delivery, proactive review and avoidance of harms are a win-win-win for all. Patients, as seen here, understand their medications better and have improved satisfaction with their care. Pharmacists are able to deliver deprescribing, structured medication reviews and medication optimisation improving outcomes and reducing harms,” he added.
Danny Bartlett, clinical lead at Kent, Surrey and Sussex Primary Care School and a member of the Royal Pharmaceutical Society’s English Pharmacy Board, said the study was a “great indication that ARRS staff are making positive impacts in primary care”.
“The prescribing figures, I believe, are inherently linked to pharmacists having impacts and roles, which allow them to question why patients are prescribed inappropriate medications and deprescribe them where possible. This is something which obviously was not happening enough before the ARRS roles were in place, due to GP capacity, and is a welcome change,” he added.
In May 2024, concerns were expressed that some pharmacist jobs at PCNs could be at risk, following a change to regulations that meant PCNs could not redistribute unspent ARRS funds between them.
Also in May 2024, speaking at the Clinical Pharmacy Congress, held at ExCeL London, Liz Fidler, senior adviser on pharmacy technicians at NHS England, said that there were plans to fund designated prescribing practitioners (DPPs) under the ARRS scheme.
