Enhancing ARRS Retention in Primary Care: Miad’s Approach to Supervision and Training
Author
Dr Karthik Bhat
FY2 Doctor & Associate at Miad Healthcare
Introduction
Over the past five years, the primary care landscape has undergone a significant transformation, gravitating towards collaborative efforts and working at a broader scale. GP practices have come together to establish primary care
networks (PCNs). These PCNs are a means to deliver more individualised care to the local population while optimising resource utilisation to better address population health needs.
In support of this vision, primary care is evolving to encompass a more extensive array of services for patients. This expansion necessitates the engagement of a diverse range of staff roles, distributed across the PCN, aimed at enhancing the workforce and cultivating additional capacity to meet the evolving demands of healthcare delivery. 1
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What is ARRS?
ARRS is the Additional Roles Reimbursement Scheme and allocates a pot of money towards hiring professionals that will add value and better manage the workload across a PCN. 2
Examples of ARRS professionals includes the following:
– Clinical pharmacists
– Social prescribing link workers
– Physician associates
– First contact physiotherapists
– Nursing associates
– Mental health practitioners
The role of ARRS in primary care
ARRS promises improved access to primary care and a broader range of services for patients, ultimately reducing wait times. Given the heavy workloads of current primary care staff, particularly GPs, ARRS offers a solution to alleviate the burden while addressing evolving local health needs. Additionally, it aids practices in supporting QOF, enhanced access, and local enhanced services. 2
Challenges for implementation
The feedback from the implementation of ARRS shows clear benefits in terms of service delivery within Primary Care. Part of the premise of the scheme is to facilitate working at scale, however this is exactly where ARRS faces its most troublesome challenges.
Lack of a shared identity is an ongoing challenge faced by several PCNs and this barrier extends its challenges to ARRS. With the additional roles being shared across all GP practices within a PCN, a lack of shared identity leads to inconsistency and unsettlement for ARRS staff. Having to switch between individual organisations with different goals, visions, culture can also lead to a lack of belonging resulting in dissociation from the role. 3
Different professionals across PCNs have highlighted availability of physical space as an important restriction to ARRS success. A survey of PCN clinical directors from NHS confederation showed more than 90% agreement that lack of estates infrastructure hindered the progress of ARRS in Primary Care. 3
While remote working has often been raised as a solution, the counterpoints to this are:
- Several ARRS roles, such as First Contact Physiotherapists, require their own consulting room to ensure safe and adequate patient care.
- Staff feeling isolated and un-supported working from home. 3
Another very pertinent challenge relates to professional development and supervision for ARRS staff. Currently ARRS funding does not cover supervision and training for the new staff. PCNs are currently drawing on other sources of funds such as core funding and IIF in order to overcome this. Understandably there is question as to whether this is a sustainable solution and ultimately without an allotted fund, there will be little way to maintain supervision and training. Supervision is crucial to bringing out the best of the team within a PCN and also helps practices uphold CQC requirements. 3, 4
The importance of supervision for staff retention
An article from Pulse from early 2023 reiterated the retention issues caused by lack of professional development, with many ARRS staff highlighting the lack of long term prospects and professional growth obtainable working for PCNs. 5
The Management in Practice Journal also records accounts of clinical pharmacists hired through ARRS who talk about the tough realities of life as ARRS staff feeling isolated and detached from their work environment. Exit interviews for these staff revealed this could have been significantly avoided if managers and senior staff held early conversations about achieving success by laying out clear goals and expectations. Holding such conversations early and regularly would help to ‘prevent later frustrations’ and establish belonging. 6
These issues were further unpacked and explored in a report from the Kings Fund where the views of 48 professionals, including a mix of different ARRS roles as well as primary care stakeholders, were analysed. 3
The report uncovers some key points about ARRS supervision and training:
- Due to the late arrival of their professional roadmaps – ARRS staff had to back-pedal on their supervision which led to extra work for both the staff and the supervisors in question.
- The importance of peer support from those within the same profession but also those from similar professions (e.g., GPs). This helps to navigate through change especially at the outset.
- There are clear benefits for ARRS staff when supervisors have a vision themselves for ARRS roles. This gives role clarity and a sense of belonging. Currently some supervisors are unsure themselves as to what is expected from these new roles.
- Practice managers are important allies for ARRS staff, and on many occasions will be more knowledgeable about ARRS requirements compared to other professionals working in the practice. They play a key role in supervision and ensuring ARRS staff are utilised properly.
Miad’s work with ARRS supervision
It’s evident that the challenges surrounding ARRS retention are multifactorial and touch on different aspects of the PCN. Challenges involving estates and shared identity/organisational culture are complex, deep rooted and, aside from obvious solutions such as an increase in funding, require extensive work with PCNs on a larger scale.
The supervision and training issues have been targeted by Miad based on specific feedback received from ARRS staff and PCN clinical directors from various Northeast London PCNs. This has been highlighted as a short-term realistic target to drive change in workforce retention. While there is work to be done from organisational bodies surrounding role clarity, there is scope to work with individual PCNs and practices to deliver the necessary training to aid the development of GPs and other senior professionals as ARRS supervisors.
The role of supervisor is not a pair of easy boots to fill and requires a specific know-how to fulfil the role successfully and to have the most impact for those being supervised. However, PCNs have fed back to Miad that in some cases GPs and other senior colleagues have understandably found it challenging to carry out this role as there is currently little guidance and training offered by existing organisational bodies.
Miad aims to tackle this face-on by holding training sessions to help senior colleagues flourish as supervisors and to help reiterate how providing good supervision will help to retain ARRS staff in the long haul.
Within their training sessions Miad touches on some key learning points:
- Understanding the role of supervisor for ARRS staff
- The benefits of good supervision
- The different types of supervision
- How to adapt supervision and mentorship styles for different types of workers
By tackling these key areas, Miad with its group of experienced facilitators/trainers, aims to help practices provide a productive and secure work environment for ARRS staff, where they can continually develop themselves under structured supervision. Furthermore, the in-depth training makes the supervisor role more seamless which should maintain the consistency and quality of supervision in the years to come.
In its infancy, the course has already achieved significant success with 100% of participants saying that they would benefit from completing the course in full.
The long-term challenges
While the initial feedback validates the utility of the course, there is an appreciation that a likely long-term challenge is the limited time and capacity within PCNs to facilitate supervision for ARRS. The King’s Fund has highlighted concerns among clinical directors who recognise the struggles faced by some GPs in providing supervision due to their overwhelming workloads and the ongoing pressures in service provision. 3
NHS England, in its supervision guidance document, identifies a variety of professionals who can step up as supervisors, including GPs, advanced practitioners, senior nurses, and senior paramedics, among others. 7 However, in many PCNs, the primary responsibility often falls on GPs. This situation appears unsustainable, given the demands placed on GPs, and it could potentially have a detrimental impact on the quality of supervision in the long run. Dr. Ruth Rankine, Director of Primary Care for the NHS Confederation, has been a strong advocate for sharing the responsibility of supervision. 8 To address this issue, Miad has taken proactive steps by promoting the course to a diverse range of primary care professionals. Furthermore, sessions will emphasise effective time and workload management techniques to ensure that everyone involved can contribute effectively and sustainably.
In the dynamic landscape of primary care, Miad recognises the necessity for these courses to remain flexible and responsive to the evolving needs of primary care professionals. The pursuit of the most effective approach to deliver supervision training is an ongoing journey, but one that propels Primary Care Networks (PCNs) toward enhancing ARRS retention.
References used in this article
[2] Additional roles reimbursement scheme – NHS england (2019). Available at: https://www.england.nhs.uk/wp-content/uploads/2019/12/network-contract-des-additional-roles-reimbursement-scheme-guidance-december2019.pdf
[3] Baird , B. et al. – Integrating additional roles into primary care networks e. rep. Kings Fund. (2022) Available at:https://www.kingsfund.org.uk/sites/default/files/2022-02/Integrating%20additional%20roles%20in%20general%20practice%20report%28web%29.pdf
[4] Jones , N. Strengthening and mobilising arrs roles to unlock capability and potential. (2022) Available at:
http://www.primarycaresheffield.org.uk/wp-content/uploads/2022/10/ARRS-Report-PCS-Final-Version-September-2022-PDF.pdf
https://www.pulsetoday.co.uk/analysis/pulse-pcn/arrs-about-face-how-well-is-the-additional-roles-scheme-working/
[6] Gault, B. (2022) Lack of clinical support and isolation driving retention issues among ARRS staff, Management In
Practice. Available at: https://managementinpractice.com/news/lack-of-clinical-support-and-isolation-driving-retention-issues-among-arrs-staff/
https://www.england.nhs.uk/long-read/supervision-guidance-for-primary-care-network-multidisciplinary-teams/
[8] Lantum (2021) Unlocking the value of ARRS for your primary care network, Lantum Blog. Available at:
https://blog.lantum.com/unlocking-arrs-value-arrs-primary-care-networks