ARRS

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Additional Roles Reimbursement Scheme (ARRS)

The Additional Roles Reimbursement Scheme (ARRS), was introduced to alleviate workload pressures, improve patient experience and cut waiting times, by funding new multidisciplinary roles into primary care. 

It has enabled practices and PCN’s to really shape the future of primary care through the integration of a flexible workforce, that are adaptable and skilled, to deliver care which improves health outcomes for patients.

We have created quick reference guides to help you understand how some of these roles can be embedded and how they can benefit already established primary care teams.

Please click here for further information about ARRS from NHSE

Clinical Pharmacists

Benefits of the Clinical Pharmacist role

Having a clinical pharmacist in general practice can increase access to healthcare for patients, reduce waiting times for appointments, improve screenings and diagnosis of chronic and common ailments. Clinical Pharmacists provide safety checks on medications for patients, reducing patient harm due to potential adverse effects of medications and reduce the wastage and overuse of medicines.

The clinical pharmacist will consult in the practice like any other clinician and will have time for appointments as well as time to manage non-clinical activities within the practice.

Role duties

The scope of work of a Clinical pharmacist depends on the qualifications, competence, and skills, which is often driven by the setting in which they trained, i.e. community pharmacy, Hospital pharmacy, General Practice.

  • Managing and prescribing for long-term conditions (with complementary skills to the nursing and health care assistant teams)
  • Reviewing patients on complex medicine regimens, such as: likely to cause addiction or dependence medications, high risk medicines
  • Assessing the appropriateness of treatments that require regular follow ups
  • Blood test filing and triaging
  • Taking referrals from other members of the team
  • Stratification of Long-term condition reviews, focusing on high-risk patients
  • Clinical leadership and mentorship
  • Some Clinical pharmacists will develop an expertise in minor ailments or acute presentations, a Clinical pharmacist can also become an Advanced Clinical

Prescription management (often supported by Pharmacy technicians)

  • Dealing with medication for patients recently discharged from
  • Helping the practice deliver QOF or other incentive schemes
  • Delivering repeat prescription
  • Being the point of contact for all medicine-related queries
  • Overseeing the practice’s repeat prescription
  • Audit and support for prescribing teams in the practice
  • In dispensing practices, pharmacists can take responsibility for the business management of the dispensary

Qualification Requirements

Pharmacy professionals must be registered with the GPhC to practice in the UK. To be able to register as a pharmacist, you need to complete a 4-year Master’s degree in pharmacy, followed by 1 Foundation year in which trainees are placed on a competence based programme to enable safe practice under a Pharmacist Supervisor before sitting the final registration exam.

Post graduate qualifications such as a Clinical Diploma or Independent prescribing course are often undertaken as part of the progression in the clinical role of a pharmacist.

Pharmacist independent prescribers must have completed a GPhC accredited training programme. Pharmacist independent prescribers can prescribe any medicine for any medical condition and must work within their own level of professional competence and expertise

Pharmacy professional that are new to General Practice undertake an 18 month (Pharmacists) or 15 Month (Pharmacy Technicians) training pathway. This pathway is designed as a 'learning whilst doing the job' approach, and it is fully funded by NHSE for Pharmacy professionals enrolled on the Additional Reimbursement role scheme that are employed by the Primary Care Networks. This training consists in study days (online or face2face), learning set and supervision meetings.

Currently to enable conversion from professionals from other fields of pharmacy, and as part of the Additional roles attached to the practices, there is a National education Pharmacist programme provided by CPPE which is essential to assure the quality and the consistency of the new Clinical Pharmacists working in General practice.

Support and Supervision

Pharmacy professionals must be registered with the GPhC to practice in the UK. To be able to register as a pharmacist, you need to complete a 4-year Master’s degree in pharmacy, followed by 1 Foundation year in which trainees are placed on a competence based programme to enable safe practice under a Pharmacist Supervisor before sitting the final registration exam.

Post graduate qualifications such as a Clinical Diploma or Independent prescribing course are often undertaken as part of the progression in the clinical role of a pharmacist.

Pharmacist independent prescribers must have completed a GPhC accredited training programme. Pharmacist independent prescribers can prescribe any medicine for any medical condition and must work within their own level of professional competence and expertise

Pharmacy professional that are new to General Practice undertake an 18 month (Pharmacists) or 15 Month (Pharmacy Technicians) training pathway. This pathway is designed as a 'learning whilst doing the job' approach, and it is fully funded by NHSE for Pharmacy professionals enrolled on the Additional Reimbursement role scheme that are employed by the Primary Care Networks. This training consists in study days (online or face2face), learning set and supervision meetings.

Currently to enable conversion from professionals from other fields of pharmacy, and as part of the Additional roles attached to the practices, there is a National education Pharmacist programme provided by CPPE which is essential to assure the quality and the consistency of the new Clinical Pharmacists working in General practice.

Join the Midlands Pharmacy Network consisting of 11 integrated care systems and 42 trusts. The NHS Futures workspace is regularly updated with the lates news, training offers, faculty groups and a Foundation Year Training DPP Support Workspace packed full of articles, discussion forums, FTPP resources and Independent Prescribing university course information - Midlands Practice Pharmacy Network | Clinical Pharmacists & Technicians | England

Useful links

Registering as a pharmacist | General Pharmaceutical Council (pharmacyregulation.org)

Standards for pharmacy professionals | General Pharmaceutical Council (pharmacyregulation.org)

Revalidation for pharmacists and pharmacy technicians | General Pharmaceutical Council (pharmacyregulation.org)

Health and Wellbeing Coach

Benefits of the Health and Wellbeing Coach role

Health and Wellbeing Coaches work with people with Long Term Conditions to support lifestyle change in order to better improve their health, or management of their condition. The priority of the role is not to advise but to find the service users intrinsic motivation for behaviour change.

A Health Coach will use coaching conversation tools and motivational interviewing techniques to build the service users’ knowledge, skills and confidence, empowering them to take a more leading role when it comes to their health. This will lead to the service user requiring fewer appointments with their GP/nurse as they manage their condition better, and in some cases may even reverse the long-term condition entirely.

Qualification requirements

Every Health and Wellbeing Coach that starts in this role should be offered a 4 day training accredited by the Personalised Care Institute as standard. There is then an expectation that the coach should have regular ongoing supervision with a qualified Health Coach Supervisor. This is something that can be accessed regionally.

There are many avenues into a Health Coach role, the main priority being an ability to be a skilled, empathic listener with a background knowledge in healthy lifestyle behaviours.

Role duties

A Health Coach's appointments will be a suitable length of time to offer the service user the space to discuss “What matters to you.” This may vary depending on the individual and the practice, but 45-60 minutes would be a reasonable time for a first appointment. The service is patient-centred and should therefore offer some flexibility in terms of length and frequency of appointments. Over several weeks, the appointments should become more infrequent in order to build the individuals confidence until they feel able to continue without the support of the Health Coach.

A Health and Wellbeing Coach will not see anybody under the age of 18, nor somebody who is acutely unwell or in a mental health crisis. However, they can work with people whom, if they were to make lifestyle changes it would improve their health outcomes. For example, people who fall into the unhealthy weight category, people with high blood pressure, high cholesterol, poorly managed diabetes and low-level mental health problems.

Musculoskeletal First Contact Practitioner – MSK FCP

Benefits of an MSK FCP

An MSK FCP service is provided by highly trained physiotherapists who are the first point of contact for patients, usually based in GP surgeries. They provide new expertise and increased capacity to general practice and provide patients with faster access to the right care. MSK FCPs have extensive experience in the assessment and management of musculoskeletal conditions and can see MSK patients without the need for a GP appointment.

They are qualified autonomous clinical practitioners who are able to assess, diagnose, treat and discharge a person without a medical referral – where appropriate. If appropriately trained they can refer for investigations when indicated, including blood tests, x-rays and scans. They can also refer patients onto specialist services if required. With additional training MSK FCP’s can prescribe medications and perform steroid injections.

MSK FCP services will relieve pressure in primary care by managing a significant proportion of the MSK workload and brings physiotherapy expertise to the front end of the MSK pathway.

Patients can book to see the MSK FCP in the same way that they would access a GP appointment. Reception staff can access guidance to support them in promoting the role of MSK FCP’s and in ensuring this is the appropriate appointment for the patient. First contact physiotherapy GP resources | The Chartered Society of Physiotherapy (csp.org.uk)

If a patient requires physiotherapy rehabilitation they will be referred to the physiotherapy service for ongoing care. MSK FCP does not provide ongoing rehabilitation or physiotherapy treatment.

Qualification requirements

An MSK FCP must hold a BSc Hons in Physiotherapy and be registered as a physiotherapist, they must have a minimum of five years post registration training and a minimum of three years postgraduate learning and experience in MSK specifically. However, a broad range of experience is considered ideal for FCP role development. MSK FCP’s must complete the MSK FCP roadmap to practice. This can be completed by a portfolio route or on taught routes at higher education institutes.

First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal) A Roadmap to PracticeFirst Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal) A Roadmap to Practice (hee.nhs.uk)

The roadmap to practice comprises of two parts, part one should be completed prior to entering primary care as an FCP and stage two within 6 -10 months of starting the role (based on FTE hours).

This details the knowledge, skills and attributes required for stage 1 and the capabilities in primary care required for stage 2. 

FCP’s will require a roadmap supervisor – this can be a fellow physiotherapist or GP who has completed the roadmap supervisor training.

Roadmap supervision courses | Health Education England (hee.nhs.uk)

Due to recent changes to FCP training, please follow this link for more information - First Contact Practice FAQs | NHS England | Workforce, training and education (hee.nhs.uk)

Roadmap supervision courses | NHS England | Workforce, training and education

Paramedics

Benefits of an Paramedic role

Paramedics working in primary care reduces the burden on the GP in the assessment and management of patients presenting with acute clinical conditions. Utilising FCPs and ACPs (advanced, specialist paramedics) to undertake the acute assessments, allows the GP to concentrate on the patient with chronic or more complicated presentations and conditions. Paramedics are ideally based to undertake home visits within the community and assessments within care homes.

Increasing the workforce with FCPs and ACPs for acute presentations increases the number of on the day consultations, whether this is face to face, or telephone consultations, that the patients can access on a daily basis.

Role duties

  • Patient Home Visits
  • Assess and manage patients presenting with on the day acute illness
  • Assess and manage patients presenting with chronic illness
  • Telephone triage and consultations
  • Take part in multidisciplinary case reviews
  • Respond to medical emergencies within the practice
  • Address medicines concordance with patients/carers
  • Interpret and manage the results of blood tests and imaging
  • Undertake clinical audit
  • Signpost and refer patients to appropriate services

Qualification requirements

A paramedic will have a degree level qualification to be registered with the Health and Care Professions Council (HCPC).

Enhanced level practice paramedic (3-5 years post qualification): Should be part of a rotational model between PCN and ambulance trust. The clinician requires access to robust daily clinical supervision from an appropriately qualified and experienced clinician such as a multi-professional AP, paramedic FCP/AP or GP. The role is not currently eligible for reimbursement under the ARRS. The paramedic can also begin working towards master’s level practice and/or over three years to build a portfolio of evidence to complete stage 1 of the FCP roadmap.

FCP (5+ years post qualification): To work within Primary Care a Paramedic MUST undertake additional training at a level 7 (master’s level of study).

An FCP will have, or be studying towards a Post Graduate Diploma, which could be in the form of the First Contact Paramedic qualification. An Advanced Clinical Practitioner will be working towards or have achieved a master’s in advanced practice.

Useful links

First Contact Practitioner and Advanced Practitioner in Primary Care: (Paramedic) – A roadmap to practice.

https://www.hee.nhs.uk/sites/default/files/documents/Paramedics-FINAL%20(002).pdf

Health and Care Professions Council (HCPC) Paramedic Standards of Proficiency.

https://www.hcpc-uk.org/standards/standards-of-proficiency/paramedics/

Paramedics in General Practice

https://www.england.nhs.uk/wp-content/uploads/2022/11/B1847-Paramedics-in-general-practice-1.pdf

Pharmacy Technician

Benefits of an Pharmacy Technician role

The role of a Pharmacy Technician is broad, and duties can vary depending on where you work. A Pharmacy Technician working in General Practice will have a positive effect on the management of medicines for both the patients and the practice, they can significantly reduce day-to-day workload for GPs.

Pharmacy Technicians effectively support GPs and other clinicians with prescribing, following local and national guidelines, clinical reviews, safety alerts and medication queries. They empower patients to be more involved with their medication management, and ensure that they are taking the right medication, in the right way, and that they’re up to date with health reviews and important blood monitoring. They contribute to processes that help to maximise benefit and minimise risk to patients from their medicines and ensure the smooth transition.

Role duties

  • Repeat Prescription management
  • Medicines Reconciliation
  • Compliance reviews
  • Counselling patients about their medication
  • Medication switching
  • Respond to Medicines & Healthcare products Regulatory Agency (MHRA) safety alerts
  • Medication queries
  • Drug monitoring
  • Simple medication reviews
  • Vaccination programmes

Qualification Requirements

To become a Pharmacy Technician, you must be working in a pharmacy environment for 2 years whilst completing a General Pharmaceutical Council (GPhC) recognised course. This is available as a BTEC Level 3 apprenticeship. Once qualified, you will register with the GPhC to practice as a Pharmacy Technician.

In general practice there are very subtle differences between Pharmacy Technicians and Pharmacists but essentially a Pharmacy Technician cannot become an independent prescriber and as such cannot undertake Structured Medication Reviews (SMRs).

Much of what a Pharmacy Technician can do will depend on their own competencies and experience. Many practices have specific protocols in place for certain reviews that a Pharmacy Technician can undertake. For example, contraception/pill reviews, hypothyroidism reviews and other long term condition medication reviews. Some Pharmacy Technicians are trained similarly to Health care assistants so that they can do basic observations; Blood pressure, Respiratory rate, Oxygen saturations and pulse rate and perform phlebotomy This can enable them to run warfarin clinics and monitor post discharge and high-risk medications.

It is a requirement for all ARRs funded Pharmacy roles to undertake additional training which is currently provided by the Centre for Pharmacy Postgraduate Education (CPPE). The Primary Care Pharmacy Education Pathway (PCPEP) runs for 15 months for Pharmacy Technicians and provides the necessary knowledge, skills, and experience to work in various patient-facing roles in primary care networks as part of a multidisciplinary tea