What does this research mean for the field?

Following the implementation of the Additional Roles Reimbursement Scheme (ARRS), the proportion of complex consultations in primary care increased from 15.8% in 2018 to 18.8% in 2021. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To explore how the Additional Roles Reimbursement Scheme (ARRS) has affected workload complexity in primary care since its implementation.

February 25, 2026

Consultation complexity and professionals consulted: retrospective cohort in English primary care

JHJialan Hong PEPeter J EdwardsAt Bristol MKMavin Nathan KashyapUniversity of Bristol

Key Points

To explore how the Additional Roles Reimbursement Scheme (ARRS) has affected workload complexity in primary care since its implementation.
Conducted a longitudinal cohort study using Clinical Practice Research Datalink (CPRD) AURUM data.
Analyzed data from over 3.5 million consultations involving various healthcare roles.
Used multilevel logistic regression to assess associations between patient factors and consultation complexity.
Complex consultations with DPC-ARRS roles increased from 15.8% in 2018 to 18.8% in 2021.
ARRS roles showed higher likelihood than GPs to initiate consultations after diabetes diagnosis (OR=1.4).
Higher likelihood (OR=5.7) for ARRS roles to conduct consultations with ≥2 preventive tasks, but lower likelihood for managing chronic pain, dementia, mental illness, and more.

Abstract

Background The Additional Roles Reimbursement Scheme (ARRS) launched in England in 2019 to expand the multidisciplinary primary care workforce, but its impact on workload since implementation is unclear. Aim To examine changes in workload complexity associated with ARRS implementation. Design and Setting Longitudinal cohort study used the Clinical Practice Research Datalink (CPRD) AURUM. We analysed 3,530,628 consultations involving General Practitioners (GPs), nurses, or direct patient care (DPC)-ARRS roles for 420,986 patients from 369 English practices in 2018 and 2021. Methods Multilevel logistic regression assessed associations between 17 patient and consultation complexity factors and being seen by a DPC-ARRS role, adjusting for year, age, sex, region, deprivation, and consultation mode. Results Complex consultations with DPC-ARRS-eligible roles increased from 15.8% in 2018 to 18.8% in 2021. Diagnostically capable ARRS roles were more likely than GPs to conduct the first consultation after diabetes diagnosis (OR=1.4, 95%CI=1.3-1.6) and consultations with ≥2 preventive tasks (OR=5.7, 95%CI=5.5-5.8), but less likely to manage chronic pain (OR=0.9, 95%CI=0.8-1.0), dementia (OR=0.4, 95%CI=0.3-0.4), mental illness (OR=0.4, 95%CI=0.3-0.4), learning disabilities (OR=0.3, 95%CI=0.3-0.4), consultations with ≥3 medicines prescribed (OR=0.6, 95%CI=0.5-0.6), consultations resulted in emergency admission (OR=0.7, 95%CI=0.6-0.9), and consultations with ≥2 diagnoses coded (OR=0.5, 95%CI=0.5-0.5). Patients with interpreter needs (OR=1.2, 95%CI=1.1-1.3), recent homelessness (OR=1.4, 95%CI =1.1-1.7) or ≥3 long-term conditions (OR=1.1, 95%CI=1.1-1.1) were more likely to be seen by diagnostic ARRS staff. Conclusions Following ARRS implementation, primary care activity was delivered by a broader workforce managing increasingly complex care. Further research should assess the safety, quality, and system impacts of ARRS roles.

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