Additional Roles Reimbursement Scheme (ARRS Roles)

Expanding our workforce

The needs of our communities, in particular in areas where there are health inequalities, are greater than ever before. Our population is being impacted more and more by complex, long term conditions. There is a growing concern about areas of longstanding unmet health need and the social determinants of health are playing a bigger role than ever before. These new challenges are increasing the pressure on the system to deliver for those in our communities and there is more that we can do to shift our focus from treating those who are unwell to preventing ill health and tackling health inequalities.

To support PCNs, the Additional Roles Reimbursement Scheme (ARRS) provides funding for 26,000 additional roles to create bespoke multi-disciplinary teams. Primary care networks assess the needs of their local population and, working with local community services, make support available to people where it is most needed. Find out more on each of the ARRS roles below.

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Care coordinators provide extra time, capacity, and expertise to support patients in preparing for clinical conversations or in following up discussions with primary care professionals. They work closely with the GPs and other primary care colleagues within the primary care network (PCN) to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers (if appropriate), and ensuring that their changing needs are addressed. They focus on the delivery of personalised care to reflect local PCN priorities, health inequalities or at risk groups of patients. They can also support PCNs in the delivery of Enhanced Health in Care Homes.
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Health and wellbeing coaches (HWBCs) will predominately use health coaching skills to support people to develop the knowledge, skills, and confidence to become active participants in their care so that they can reach their own health and wellbeing goals. They may also provide access to self-management education, peer support and social prescribing.

Health coaches will support people to self-identify existing issues and encourage proactive prevention of new and existing illnesses. This approach is based on using strong communication and negotiation skills and supports personal choice and positive risk taking.

They will work alongside people to coach and motivate them through multiple sessions, supporting them to identify their needs, set goals, and help them to implement their personalised health and care plan.

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Social Prescribers give people time over several sessions to offer a patient-centred conversation based around asking "what matters to you?". Covering the whole
population, Social Prescribers work with VCSE organisations, local authorities, and others, to offer referrals to community programmes such as local walks, cooking classes, and other activities. Sessions may be delivered one to one or in groups depending on the need and activity.

A number of specialities in social prescribing are currently emerging, including Children and Young People, mental health, and financial inclusion and advice.

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FCPs are physiotherapists with enhanced skills. They work with people with injuries and/or pain. As a First Contact role, they work alongside GPs, nurses and other staff to assess patients with musculoskeletal issues, providing diagnosis, advice on managing a problem or on-wards referral to a specialist e.g. surgeon if necessary.

Working as a first contact physiotherapist is both challenging and interesting, no two days are the same and the role requires continuous learning.

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Requirements: Undergraduate degree in physiotherapy, experience working at Level 7 capability in MSK, active registration with HCPC, Masters Level qualification or equivalent specialist knowledge, skills and experience. Occupational Therapists work with patients towards a specific outcome. Whilst a physiotherapist may work with a patient to walk with an aid, an occupational therapist will concentrate on an outcome such as getting to the shops.

Occupational Therapists work beyond diagnoses and limitations and look at the relationships between the activities of daily living alongside a patient's challenges and living environment to recommend adjustments that are practical, realistic, and personal. Occupational Therapists work with frail older adults, patients with mental health problems, and with working age adults requiring vocational rehabilitation.

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Podiatrists are experts in all aspects of the foot and lower limb. They are highly skilled health care professionals that are able to diagnose, treat, rehabilitate and prevent disease and complications of the feet.

Their work can delay deterioration due to chronic conditions such as diabetes and PAD, maintain and maximise mobility, reduce falls, and reduce hospital admissions and referrals.
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Dietitians are experts in diet and nutrition. They are able to help patients self-manage their care and provide preventative advice. Covering frailty, obesity, gastroenterology (including IBS and coeliac disease) and chronic conditions such as diabetes.

Dietitians are also able to help patients manage diet related medicines and ACBS products. Dietitians reduce demand on GP time and reduce referrals to secondary care and the need for hospitalisation.
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Community Paramedics work autonomously within the community at an advanced level of practice. They see undifferentiated, undiagnosed problems relating to minor injury and illness, abdominal pains, chest pain, tiredness and headaches. They are able to perform specialist health checks and reviews and provide clinical leadership within a practice team.

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Clinical Pharmacists are highly qualified experts in medicines. As part of a PCN, their role is typically managing patients with chronic disease and complex health needs. They carry out structured medication reviews and improve patient safety and outcomes
through a person-centred approach.
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Pharmacy Technicians complement the more clinical work of clinical pharmacists, completing tasks such as audits, discharge management, and issuing prescriptions.

Work is often under the direction of a clinical pharmacist within the PCN pharmacy team. The entry route to becoming a pharmacy technician is currently changing
but typically requires two years’ work-based experience and completion of a GPhC approved pharmacy technician training course.
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Advanced Practitioners are senior team members that have passed advanced clinical practice across the four pillars of clinical practice, leadership, evidence and research, and facilitating learning. Advanced Practitioners provide supervision to other members of the team, acting as team mentors and leaders. They are able to manage more complex cases, including management of undifferentiated conditions, identifying red flags and serious pathology, and undertake complex decision-making to inform diagnosis, investigation, and management of episodes of care within a broad scope of
practice.
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The nursing associate is a new support role that bridges the gap between healthcare support workers and registered nurses to deliver hands-on, person-centred care as part of the nursing team. The role was brought in to allow development opportunities for HCAs whilst also allow Practice Nurses to concentrate on more complex clinical work.

The role offers an established path of progression towards becoming a registered nurse. This involves two years training and working as a nurse associate, followed
by two years on the Registered Nursing Degree Apprenticeship Programme, at which point you can apply to registered as a Registered Nurse. Further information on the programme can be found on the Health Education England website.
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Physician Associates support doctors in the diagnosis and management of patients. As a physician associate you will work under the direct supervision of a GP. You will be trained to take medical histories, perform physical examinations, diagnose illnesses, review patients with long term chronic conditions, analyse test results,
provide health promotion and disease prevention advice and more.

To be a Physician Associate you will need to complete a two-year post-graduate training programme. You will typically need a bioscience related degree to enter, though it is also possible to enter the programme if you are already a registered healthcare professional such as a nurse AHP or midwife.