Additional Roles Reimbursement Scheme (ARRS)

The Additional Roles Reimbursement Scheme (ARRS) was introduced in 2019 to improve access to general practice. Through the scheme Primary Care Networks (PCNs) can claim reimbursement for salaries of 17 new roles within the Primary Care multidisciplinary team to meet the needs of the local population. In introducing these new roles primary care can expand the range of services and offers to improve access for patients.

Training Hubs support future workforce planning as one of their core functions. Training Hubs are designed to meet the educational needs of the multidisciplinary primary care team and bring together NHS organisations, community providers and local authorities. This resource will allow Training Hubs to work with their PCNs and support workforce planning, providing a valuable resource for systems developing their primary care workforce.

ARRS Roles

An overview of the current ARRS roles can be found below, for the most up to date information visit NHS England E-Learning for Healthcare

Overview of the role

  • AfC Band 4
  • Max reimbursable amount over 12 months (with on cost) – £29,135

Care Coordinators play an important role within a PCN to proactively identify and work with people, including the frail/elderly and those with long-term conditions, to provide coordination and navigation of care and support across health and care services.

Care Coordinators could potentially provide extra time, capacity, and expertise to support patients in preparing for or in following-up clinical conversations they have with primary care professionals. They will work closely with the GPs and other primary care professionals within the PCN to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers, and ensuring that their changing needs are addressed. This is achieved by bringing together all the information about a person’s identified care and support needs and exploring options to meet these within a single personalised care and support plan, based on what matters to the person.

Funding

From April 2020, this role will be reimbursed at 100% of actual salary plus defined on-costs, up to the maximum reimbursable amount of £29,135 over 12 months.

Training/Development

Care Coordinators require a strong foundation in enabling and communication skills as set out in the core Curriculum for Personalised Care. These can be achieved via a two day health coaching skills course as set out here. In addition, training to build on this will be available via the from 15th September 2020.

Care coordinators should also access statuary and mandatory training, including but not limited to:

  • Principles of information governance, accountability and clinical governance
  • Maintenance of accurate and relevant records of agreed care and support needs
  • Identify when it is appropriate to share information with carers and do so
  • The professional and legal aspects of consent, capacity, and safeguarding

Care Coordinators should be familiar with the six components of the universal model for personalised care with a specific focus on:

  • Support for self-management
  • Personalised care and support planning
  • Shared decision making
  • Social prescribing
  • Personal Health Budgets

Overview of the role

  • AfC Band 7/8a
  • Max reimbursable amount over 12 months (with on cost) – £55,670

Clinical pharmacists work in primary care as part of a multidisciplinary team in a patient facing role to clinically assess and treat patients using expert knowledge of medicines for specific disease areas. They will be prescribers, or if not, can complete an independent prescribing qualification following completion of the 18-month Centre for Pharmacy Postgraduate Education (CPPE) pathway. They work with and alongside the general practice team, taking responsibility for patients with chronic diseases and undertaking clinical medication reviews to proactively manage people with complex polypharmacy, especially for the elderly, people in care homes and those with multiple comorbidities.

Funding

From April 2020, this role will be reimbursed at 100% of actual salary plus defined on costs, up to the maximum reimbursable amount of £55,670 over 12 months.

Training/Development

  • Clinical Pharmacists employed through the Network Contract DES will either be enrolled in, or been granted exemption from, the 18-month Primary Care Pharmacy Education Pathway (PCPEP). This pathway equips the pharmacist to be able to practice and prescribe safely and effectively in a primary care setting.
  • All Clinical Pharmacists will be part of a professional clinical network and will always be clinically supervised by a senior Clinical Pharmacist and GP clinical supervisor.
  • Independent prescribing is in addition to the training pathway and will be completed following completion of the PCPEP.

Pre-requisites

  • Pharmacy degree and registration as a pharmacist with the General Pharmaceutical Council or the equivalent regulatory authority in your home country

Length of course

  • 18-month pathway, including 28 days dedicated study days
  • Learner receives a statement of assessment & progression on completion of the pathway
  • No placement is required as the Clinical Pharmacist will be employed within primary care whilst completing the PCPEP.

Overview of the role

  • AfC Band 5
  • Max reimbursable amount over 12 months (with on cost) – £35,389

Pharmacy Technicians play an important role within General Practice and complement the work of Clinical Pharmacists through utilisation of their technical skillset. Their deployment within primary care settings allows the application of their acquired pharmaceutical knowledge in tasks such as audits, discharge management, prescription issuing, and where appropriate, informing patients and other members of the PCN workforce. Work is often under the direction of Clinical Pharmacists, and this benefit is realised through the creation of a PCN pharmacy team.

Funding

From April 2020, this role will be reimbursed at 100% of actual salary plus defined on costs, up to the maximum reimbursable amount of £35,389 over 12 months.

Training/Development

  • Pharmacy technicians undergo a vocational workplace-based two-year education and training programme before they can register with the General Pharmaceutical Council (GPhC)
  • The new initial education and training standards for pre-registration trainee pharmacy technicians is being tested with placements in General Practice, through the Pharmacy Integration Fund (PhIF)

Pre-requisites

  • Registered with the GPhC

Overview of the role

  • AfC Band 7
  • Max reimbursable amount over 12 months (with on cost) – £53,724

Dietitians are healthcare professionals that diagnose and treat diet and nutritional problems, both at an individual patient and wider public health level. Working in a variety of settings with patients of all ages, dietitians support changes to food intake to address diabetes, food allergies, coeliac disease and metabolic diseases. Dietitians also translate public health and scientific research on food, health and disease into practical guidance to enable people to make appropriate lifestyle and food choices.

Funding

100% of actual salary plus defined on costs, up to the maximum reimbursable amount of £53,724 over 12 months.

Training/Development

To practice, dietitians must be registered with the Health and Care Professions Council (HCPC). To register with the HCPC, completion of an approved degree in dietetics is required. This is usually a BSc (Hons) degree, although there are shortened postgraduate programmes available. A degree apprenticeship standard in dietetics has also been approved

  • HEE Primary care FCP training must be completed as the minimum threshold for entry to primary care and be supported by appropriate governance and indemnity.
  • HEE primary care FCP training can begin 3-5 years postgraduate

Overview of the role

  • AfC Band 7/8a
  • Max reimbursable amount over 12 months (with on cost) – £55,670

First Contact Physiotherapists (FCPs) are qualified autonomous clinical practitioners who can assess, diagnose, treat and manage musculoskeletal (MSK) problems and undifferentiated conditions and – where appropriate – discharge a person without a medical referral. FCPs working in this role can be accessed directly by self-referral or by staff in GP practices who can direct patients to them to establish a rapid and accurate diagnosis and management plan to streamline pathways of care.

Funding

100% of actual salary plus defined on costs, up to the maximum reimbursable amount of £55670 over 12 months.

Training/Development

  • A physiotherapy degree (BSc) is required to work as a physiotherapist in any setting.
  • For band 7 roles HEE Primary care FCP capability training must be completed as the minimum threshold for entry to primary care and be supported by appropriate governance and indemnity.
  • HEE primary care FCP training can begin 3-5 years postgraduate
  • For band 8a roles the HEE FC primary care training must be completed, and they must be working at an advanced level of practice i.e. at master’s level (level 7) across all four pillars of advanced practice.

Job Description

The first draft of the FCP MSK job description can be found here. This is yet to go through the Gateway process of approval.

Overview of the role

  • AfC Band 3 / 4 dependent on experience
  • Reimbursement not available for this role

As part of the wider team in general practice, General Practice Assistants provide a support role, carrying out administrative tasks, combined in some areas with basic clinical duties. They focus on supporting General Practitioners in their day-to-day management of patients, specifically aimed at reducing the administrative burden, making the best use of consultation time and supporting those particularly vulnerable to isolation who are regular attenders at the practice.

Development of the role depends on a range of factors – patient needs, existing skills mix, culture and having the staff, time and financial resource to invest in work-based learning, mentorship and supervision.

Funding

A national programme was set up by HEE in April 2019 to support wider spread of the role.  This is led by a Primary Care Training Hub in each region to host and coordinate the introduction of 40 learners across each regional footprint, with further expansion planned in 2020/21.

The aim is to provide a consistent approach to developing the role, underpinned by a defined job description and competency framework to support work-based learning.

Training/Development

  • A work-based learning programme has been developed that typically takes 6-9 months to complete. Learning takes place in the practice, led, and assessed by a GP mentor
  • Learners are usually existing staff with some experience of general practice (such as HCAs or receptionists) who are upskilling to the GPA role
  • Learners are expected to have 1 day per week of protected time to learn their new skills.  This includes time to work with their GP mentor, for teaching and ‘hands on’ experience (half a day) and time to upload their evidence of competence to the online platform (half a day).
  • A GPA certificate is awarded on successful completion of the competency-based portfolio.

Overview of the role

  • AfC up to 5
  • Max reimbursable amount over 12 months (with on cost) – £35,389

Health and Wellbeing Coaches (HWBCs) will predominately use health coaching skills to support people with lower levels of patient activation to develop the knowledge, skills, and confidence to become active participants in their care so that they can reach their self-identified health and wellbeing goals. They may also provide access to self-management education, peer support and social prescribing.

HWBCs will use a non-judgemental approach that supports the person to self-identify existing issues and encourages proactive prevention of new and existing illnesses. This approach is based on using strong communication and negotiation skills, supports personal choice and positive risk-taking, addresses potential consequences, and ensures people understand the accountability of their own decisions based on what matters to the person.

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

Funding

From April 2020, this role will be reimbursed at 100% of actual salary plus defined on-costs, up to the maximum reimbursable amount of £35,389 over 12 months.

Training/Development

  • The Personalised Care Institute will set out what training is available and expected for HWBCs. Further information will be provided when published. HWBCs will be required to be trained in health coaching in line with the NHSE/I Implementation and quality summary guide
  • Training will include understanding the basics of social prescribing, plus an accredited health coaching skills programme (minimum of 4 days) and documented practice hours, along with opportunities for reflection and follow up activities
  • Ongoing regular supervision from a health coaching mentor is required. Any health coaching provider will have to be accredited by the Personalised Care Institute (PCI).

Overview of the role

  • AfC TBC 2021/22
  • TBC 2021/22

Mental Health Practitioners – including Improving Access to Psychological Therapy (IAPT) – to be included in the scheme from April 2021 – Awaiting further advice and guidance.

Overview of the role

The Nursing Associate is a new support role in England that bridges the gap between healthcare support workers and registered nurses to deliver hands-on, person-centred care as part of the nursing team. Nursing Associates work with people of all ages in a variety of settings in health and social care.

The role was introduced in response to the Shape of Caring Review (2015), to help build the capacity of the nursing workforce and the delivery of high-quality care. It will be a vital part of the wider health and care team and aims to:

  • support the career progression of healthcare assistants
  • enable nurses to focus on more complex clinical work
  • increase the supply of nurses by providing a progression route into graduate-level nursing.

Funding

Refer to additional resources.

Refer to your HEE Nursing Associate regional contact for further information.

Training/Development

Refer to additional resources.

Further Information:

Select here to find out more about the role, including job descriptions, case studies and more: Nursing Associates

Overview of the role

  • AfC 7
  • Max reimbursable amount over 12 months (with on cost) – £53,724

Occupational therapists (OTs) support people of all ages with problems resulting from physical, mental, social, or development difficulties. OTs provide interventions that help people find ways to continue with everyday activities that are important to them. This could involve learning new ways to do things or making changes to their environment to make things easier. As patients’ needs are so varied, OTs help GPs to support patients who are frail, with complex needs, live with chronic physical or mental health conditions, manage anxiety or depression, require advice to return or remain in work and need rehabilitation so they can continue with previous occupations (activities of daily living).

Funding

From April 2020, this role will be reimbursed at 100% of actual salary plus defined on costs, up to the maximum reimbursable amount of £53,724 over 12 months.

Training/Development

  • A BSc degree in occupational therapy is required to work as an occupational therapist in any setting.
  • HEE Primary care FCP training must be completed as the minimum threshold for entry to primary care and be supported by appropriate governance and indemnity.
  • HEE primary care FCP training can begin 3-5 years after the completion of the postgraduate degree

Further Information:

Select here to find out more about the role, including job descriptions, case studies and more: Occupational Therapist

Overview of the role

  • Indictive Salary AfC 7
  • Reimbursement available from 2021

A qualified HCPC registered Paramedic has at least 3 years postgraduate experience.

There needs to be a narrative that highlights their paramedic skills around trauma, emergency and urgent care and their ability to improve conveyance rates.

Funding

Reimbursement available from 2021/22.

Training/Development

Awaiting further guidance – this is currently being reviewed by the DES contracting team.

  • HEE Primary care FCP training must be completed as the minimum threshold for entry to primary care and be supported by appropriate governance and indemnity.
  • HEE primary care FCP training can begin 3-5 years after the completion of the postgraduate degree

Further Information:

Select here to find out more about the role, including job descriptions, case studies and more: Community Paramedic

Overview of the role

  • Indictive Salary AfC 7
  • Max reimbursable amount over 12 months (with on cost) – £53,724

Podiatrists are healthcare professionals who have been trained to diagnose and treat foot and lower limb conditions. Podiatrists provide assessment, evaluation and foot care for a wide range of patients, which range from low risk to long-term acute conditions. Many patients fall into high risk categories such as those with diabetes, rheumatism, cerebral palsy, peripheral arterial disease and peripheral nerve damage.

Funding

From April 2020, this role will be reimbursed at 100% of actual salary plus defined on costs, up to the maximum reimbursable amount of £53,724 over 12 months.

Training/Development

Awaiting further guidance.

Must have a BSc to work as a podiatrist in all settings.

  • HEE Primary care FCP training must be completed as the minimum threshold for entry to primary care and be supported by appropriate governance and indemnity.
  • HEE primary care FCP training can begin 3-5 years after the completion of a postgraduate degree

Further Information:

Select here to find out more about the role, including job descriptions, case studies and more: Podiatrists and Chiropodist

Overview of the role

  • Indictive Salary AfC 5
  • Max reimbursable amount over 12 months (with on cost) – £35,389

Social prescribing enables all primary care staff and local agencies to refer people to a link worker. Link workers give people time and focus on what matters to the person as identified through shared decision making or personalised care and support planning. They connect people to community groups and agencies for practical and emotional support. They work within multidisciplinary teams and collaborate with local partners to support community groups to be accessible and sustainable and help people to start new groups. Social prescribing complements other approaches such as ‘active signposting’. Link workers typically support people on average over 6-12 contacts (including phone calls, meetings and home visits) with a typical caseload of 200-250 people per year, depending on the complexity of people’s needs and the maturity of the social prescribing scheme.

Funding

From April 2020, this role will be reimbursed at 100% of actual salary plus defined on-costs, up to the maximum reimbursable amount of £35,389 over 12 months. For social prescribing services sub-contracted by a PCN to another provider, the PCN may claim a contribution towards additional costs charged by the sub-contracted provider of up to £200 per month (£2,400 per year) for each WTE that the sub-contracted provider has apportioned to the PCN related activity. The overall contribution claimed cannot exceed £200 per month and the total amount claimed must not exceed the maximum reimbursable amount for a social prescribing link worker.

Training/Development

PCNs are required to ensure that social prescribing link workers complete the following training:

  • Completion of the NHSE/I online learning programme: https://www.e-lfh.org.uk/programmes/social-prescribing/
  • Enrolled in or qualified in appropriate training as set out by the Personalised Care Institute
  • Attendance of peer support networks coordinated by NHSE/I at ICS and/or STP level

PCNs must provide social prescribing link workers with:

  • Regular access to clinical supervision provided by a GP
  • Access to GP IT systems to enable them to record referrals using SNOMED codes

Overview of the role

  • Indictive Salary AfC 7 AfC PA Preceptorship 6
  • Max reimbursable amount over 12 months (with on cost) – £53,724

Physician Associates (PAs) are healthcare professionals with a generalist medical education who work alongside doctors providing medical care as an integral part of the multidisciplinary team. Physician Associates are dependent practitioners who work under the supervision of a fully trained and experienced doctor. They bring new talent and add to the skill mix within teams, providing a stable, generalist section of the workforce which can help ease the workforce pressures that the NHS currently faces.

Funding

From April 2020, this role will be reimbursed at 100% of actual salary plus defined on costs, up to the maximum reimbursable amount of £53724 over 12 months via Primary Care Networks.

Training/Development

Physician Associate students already have an undergraduate degree in a life science and/or a significant background in healthcare. To become a Physician Associate, students take a 2-year, full-time, intensive postgraduate course at Diploma or Masters level in Physician Associate studies. A list of courses can be found here: https://www.fparcp.co.uk/becoming-a-pa.

It includes over 1,400 hours of clinical placement experience in both acute and community settings. A new route via a 4-year Undergraduate Masters programme will run subject to approval. Once qualified, physician associates must maintain 50 hours of CPD per year and sit a recertification examination every 6 years.

Overview

  • Indictive Salary AfC 8a

Advanced Practitioners are an integral part of the 21st century NHS workforce as new models of care are transforming the way patients are treated. Advanced Practitioners work at level 7 across the four pillars of advanced practice – clinical, management & leadership, research & education, and offer multiple benefits to the health service and the population. They bring more holistic care to patients, support continuity of care and extend the scope of practice across traditional boundaries. This leads in turn to a greater focus on prevention, more personalised care, a more efficient team, a faster response to patient needs and better outcomes.

They are instrumental in supervising the multi-professional team in primary care, they attract and lead research and audits, and manage highly complex high-risk patients. They have a leadership role in the ICS around pathways and population health.

Health Education England is establishing the Centre for Advancing Practice to support education and training for Advanced Practitioners in England through:

  • development of agreed national training standards for advanced practice education
  • delivery of a programme accreditation process (kitemarking) for training courses for advanced level practice.

Training/Development

The HEE multi-professional training framework can be found here: https://www.hee.nhs.uk/sites/default/files/documents/Multi-professional%20framework%20for%20advanced%20clinical%20practice%20in%20England.pdf


Useful Links:
CPPE Primary Care Pharmacy Education Pathway for Clinical Pharmacists
HEE First Contact and Advanced Practitioners Roadmaps
NHSE Social Prescribing Link Worker Framework
NHSE Care Co-Ordinator Framework
NHSE Health & Wellbeing Coach Framework

Contacts

Support for the ARRS roles within the NW London training hub is being provided by Jon Ord – [email protected] – Jon is a point of contact who may be able to help with training queries and signposting to resources available to support these posts.

Please note that the Training Hub is not linked into the ARRS workforce approvals or payment system or financial allocations. Please contact the NW London Workforce team as a point of contact for those – [email protected]

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