There are several key factors that you need to consider when embedding additional roles into your practice or Primary Care Network (PCN). Since the creation of primary care networks and the Additional Roles Reimbursement Scheme (ARRS) as part of the NHS Primary Care Long Term Plan in 2019, the question about how to maximise the benefits of these roles has been present. Although many of the first contact practitioner roles had been trialled for many years in general practice prior to 2019, some of the roles were very new and there was and remains a lack of consistent clarity around how to get the best impact from the additional roles for those patients and practices.
Clear and well-defined clinical support is essential for roles such as physiotherapists, pharmacists, paramedics, occupational therapists, and other first contact clinicians. This need is emphasised in the NHS England Roadmaps to Practice documents, which outline the governance and expectations associated with the GP contract. Daily debriefs on clinical matters, structured Continuing Professional Development (CPD) learning opportunities, and professional development initiatives—including quality improvement projects and service development—have been shown to significantly enhance job satisfaction and retention among professionals in these additional roles, particularly within first contact settings.
A key aspect of all the additional roles is the necessity of integrating these roles within both clinical and non-clinical teams. Many of the staff in these additional roles receive support from third-party providers, such as NHS trusts or community pathways, as well as independent organisations specialising in first contact roles or services related to social prescribing, health, well-being, pharmacy, and physiotherapy.
While these employing organisations are responsible for providing clinical support and training opportunities, it remains crucial for practices to engage directly with individual practitioners, whether clinical or non-clinical, within their teams. A sense of belonging in a practice team has been shown to enhance retention, improve staff well-being, and reduce absenteeism.
Encouraging your additional roles reimbursement team staff to participate in social and training events is an effective way to foster their sense of inclusion in the practice team, allowing them to perform their roles effectively. Additionally, it is important to maintain open communication with their employing organisations to ensure that any problems or concerns regarding individual staff members are addressed promptly, with the support of their employers.
In summary, regardless of how your additional roles are employed, their integration within the practices and PCNs is essential if you are to maximise the benefit of them for both patients and practices. Integrating additional staff into practice teams can take time. However, simple measures can help facilitate this process. For example, include new team members in social or training events, and offer them cups of tea and cakes during breaks, just as you would with existing staff. These approaches are sensible and effective ways to engage new members as part of your practice team. The result of this will be improved staff satisfaction, reduced absenteeism, and a general improvement of the work environment for all the members that work across your practice and PCN.
Phin Robinson BSc (Hons), MSc Advancing physiotherapy, PG Dip Orthopaedic Medicine.
After qualifying in 2001 Phin has worked as an MSK physiotherapist within the NHS and independent sector. He has been an injecting therapist since 2006 and spent 15 years working as an advanced practitioner in MSK between primary and secondary care settings. He heads up Pure Unity Health group and remains passionate about the physiotherapy profession and the positive impacts that can be gained from quality physio lead MSK care. Since 2020 Phin has taught on NHSE accredited FCP courses and works part time in an FCP and ARRS ambassador role.
