Abstract：
BACKGROUND: The Additional Roles Reimbursement Scheme (ARRS) was introduced by NHS England in 2020 alongside Primary Care Networks (PCNs) with aims of increasing the workforce and improving patient outcomes.
OBJECTIVE: Describe the uptake of direct-patient care (DPC)-ARRS roles and its impact on patients\' experiences.
METHODS: Ecological study using 2020-2023 PCN and Practice workforce data, registered patient characteristics, the General Practice Patient Survey, and the Quality and Outcomes Framework (QOF).
METHODS: Descriptive statistics with associations examined using quantile and linear regression.
RESULTS: By March 2023, 17,714 FTE DPC-ARRS roles were commissioned by 1,223 PCNs. PCNs with fewer constituent practices had more DPC-ARRS roles per population (p<0.001) as did PCNs with more FTE GPs per population (p=0.012). DPC-ARRS commissioning did not vary with age, proportion female or deprivation of practice populations. DPC-ARRS roles were associated with small increases in patient satisfaction (0.8 percentage points increase in patients satisfied per one DPC-ARRS FTE) and perceptions of access (0.7 percentage points increase in patients reporting \'good\' experience of making an appointment per one DPC-ARRS FTE), but not with overall QOF achievement.
CONCLUSIONS: The commissioning of DPC-ARRS roles was associated with small increases in patient satisfaction and perceptions of access, but not with QOF achievement. DPC-ARRS roles were employed in areas with more GPs rather than compensating for a shortage of doctors. Single practice PCNs commissioned more roles per registered population, which may be advantageous to single practice PCNs. Further evaluation of the scheme is warranted.
OBJECTIVE: Describe the uptake of direct-patient care (DPC)-ARRS roles and its impact on patients\' experiences.
METHODS: Ecological study using 2020-2023 PCN and Practice workforce data, registered patient characteristics, the General Practice Patient Survey, and the Quality and Outcomes Framework (QOF).
METHODS: Descriptive statistics with associations examined using quantile and linear regression.
RESULTS: By March 2023, 17,714 FTE DPC-ARRS roles were commissioned by 1,223 PCNs. PCNs with fewer constituent practices had more DPC-ARRS roles per population (p<0.001) as did PCNs with more FTE GPs per population (p=0.012). DPC-ARRS commissioning did not vary with age, proportion female or deprivation of practice populations. DPC-ARRS roles were associated with small increases in patient satisfaction (0.8 percentage points increase in patients satisfied per one DPC-ARRS FTE) and perceptions of access (0.7 percentage points increase in patients reporting \'good\' experience of making an appointment per one DPC-ARRS FTE), but not with overall QOF achievement.
CONCLUSIONS: The commissioning of DPC-ARRS roles was associated with small increases in patient satisfaction and perceptions of access, but not with QOF achievement. DPC-ARRS roles were employed in areas with more GPs rather than compensating for a shortage of doctors. Single practice PCNs commissioned more roles per registered population, which may be advantageous to single practice PCNs. Further evaluation of the scheme is warranted.
摘要：
背景：NHSEngland于2020年与初级保健网络（PCN）一起引入了附加角色报销计划（ARRS），旨在增加劳动力并改善患者预后。
目的：描述直接患者护理（DPC）-ARRS的作用及其对患者体验的影响。
方法：使用2020-2023年PCN和实践劳动力数据进行的生态研究，注册患者特征，全科医生患者调查，以及质量和成果框架(QOF)。
方法：使用分位数和线性回归检查相关性的描述性统计。
结果：到2023年3月，1,223个PCN委托了17,714个FTEDPC-ARRS角色。组成实践较少的PCN在每个人群中具有更多的DPC-ARRS作用（p<0.001），而在每个人群中具有更多FTEGPs的PCN（p=0.012）。DPC-ARRS调试不随年龄而变化，女性或剥夺实践人群的比例。DPC-ARRS角色与患者满意度(每一次DPC-ARRSFTE满意的患者增加0.8个百分点)和获得感(报告每一次DPC-ARRSFTE预约体验良好的患者增加0.7个百分点)相关,但总体QOF成就不佳。
结论：DPC-ARRS角色的启用与患者满意度和访问感知的小幅增加有关，但不是QOF成就。DPC-ARRS角色在全科医生较多的地区使用，而不是弥补医生的短缺。单一实践PCN在每个登记人口中委托更多角色，这可能有利于单一实践PCN。有必要对该计划进行进一步评估。
目的：描述直接患者护理（DPC）-ARRS的作用及其对患者体验的影响。
方法：使用2020-2023年PCN和实践劳动力数据进行的生态研究，注册患者特征，全科医生患者调查，以及质量和成果框架(QOF)。
方法：使用分位数和线性回归检查相关性的描述性统计。
结果：到2023年3月，1,223个PCN委托了17,714个FTEDPC-ARRS角色。组成实践较少的PCN在每个人群中具有更多的DPC-ARRS作用（p<0.001），而在每个人群中具有更多FTEGPs的PCN（p=0.012）。DPC-ARRS调试不随年龄而变化，女性或剥夺实践人群的比例。DPC-ARRS角色与患者满意度(每一次DPC-ARRSFTE满意的患者增加0.8个百分点)和获得感(报告每一次DPC-ARRSFTE预约体验良好的患者增加0.7个百分点)相关,但总体QOF成就不佳。
结论：DPC-ARRS角色的启用与患者满意度和访问感知的小幅增加有关，但不是QOF成就。DPC-ARRS角色在全科医生较多的地区使用，而不是弥补医生的短缺。单一实践PCN在每个登记人口中委托更多角色，这可能有利于单一实践PCN。有必要对该计划进行进一步评估。
