8 | Nursing in Practice | Spring 2023
Nurses ’ views on ARRS : concerns and solutions
A summary of points and suggestions raised by general practice nurses
Concerns
• ARRS could dilute the GPN role
• Mentoring and teaching ARRS practitioners is an additional demand on GPNs ’ time
• GPNs are being asked to supervise practitioners in ARRS-funded roles who are often on better pay , terms and conditions
• From a patient perspective , ARRS roles can be confusing and can disrupt continuity of care
• Practitioners in ARRS roles may focus on a medical model to deliver care , rather than a holistic approach . This can lead to additional work and patient appointments for GPNs
Solutions
• ARRS roles need to be embedded across PCNs
• More training and supervision is needed , such as regular joint training sessions with practice and PCN teams
• PCNs need to communicate effectively with GPNs and their teams about how additional roles will work , and should involve them in any key meetings
• Having senior nurses at PCN level can help to ensure that GPNs have a voice
• GPNs need to be proactive in raising any issues or concerns about how additional roles are working , and what could be improved
• GPNs can share information with ARRS practitioners about how they work , and ask how they can help them . Giving feedback is essential
* Source : elearning for healthcare and Health Education England : New Roles in Primary Care . bit . ly / 3JL7V1v
increasing ‘ now practices understand their potential benefit ’. However , ‘ they do need to spend time out of the surgery to do training , and they do need supervision ’. ( See our My Day profile of a nurse associate , on page 24 ).
Another ARRS role with a positive impact is the social prescriber link worker . These professionals help patients with issues such as housing and employment .
‘ Social prescribers are proving invaluable ,’ says Ms Aston . ‘ They are really helpful in dealing with aspects of patient care that are non-medical , such as housing .’
The potential of collaboration Increasingly , some services , such as vaccinations , are being offered at a PCN level rather than at individual practice level , a development that GPNs report as having a positive impact .
Nursing in Practice heard that the Covid and flu vaccination rollouts have worked particularly well . ‘ At our PCN , care coordinators , nursing associates and pharmacists all undertook training to give these vaccinations at Covid clinics and care homes , and were also doing home visits ,’ says Ms Mann .
‘ This allowed practice nursing teams to carry out vaccinations for those coming into practice clinics , and gave us extra capacity to offer more vaccinations .’
For Ms Bradley , her PCN ’ s drive to deliver Covid and flu vaccinations ‘ was a really positive experience in that it allowed practice teams to get to know and work with people within the organisation ’.
The successful rollout of Covid and flu vaccinations , with general practice nurses and those in additional roles working together , demonstrates how much can be achieved by proper collaboration across primary care .
ARRS roles * The following job roles are covered under the ARRS scheme :
• Care coordinator
• Clinical pharmacist
• Pharmacy technician
• Dietitian
• First contact physiotherapist
• General practice assistant
• Health and wellbeing coach
• Mental health practitioner
• Nursing associate
• Occupational therapist
• Community paramedic ( currently under review )
• Podiatrist
• Social prescribing link worker
• Physician associate
• Advanced practitioner
Nurses ’ feedback is essential , and it ’ s important to talk to those in ARRS roles about how you work Naomi Berry
Find out more
• The King ’ s Fund ( 2022 ) Integrating additional roles into primary care networks . bit . ly / 3mQ1f99
• NHS England . Expanding our workforce . bit . ly / 3TbRWwg
Where this is happening , nurses say they welcome more roles in the practice and different people to collaborate with as a team . ‘ We ’ ve got good working relationships , and PCN staff have worked hard to embed themselves and be visible across practices ,’ says Ms Mann .
Ms Yeadally Khan agrees , saying she is ‘ very much in favour ’ of additional roles . ‘ For example , if I need information on medication , I can now ask a pharmacist .’
Additional roles can also benefit student nurses . ‘ It ’ s so valuable for them to spend time with a pharmacist or paramedic ,’ says Ms Bradley .
Making the most of additional roles Care needs to be taken , therefore , to ensure the new roles are properly embedded across PCNs , with ARRS staff working closely with GPNs to the benefit of patients .
‘ My vision is about embedding the PCN team , having them enhance the services we can deliver across the practices , and for everyone to really embrace these new roles and skills ,’ says Ms Mann .
Training and supervision are also crucial . Ms Mann ’ s PCN , for example , has introduced regular joint training sessions with practice and PCN teams .
PCNs also need to communicate effectively with GPNs and their teams about how additional roles will work , and should involve them in any key meetings , says Ms Bradley . She suggests having senior nurses at PCN level can ensure GPNs have a voice in this respect .
Practice nurses need to be proactive in raising any issues or concerns they might have about how additional roles are working , and what could be improved . ‘ Giving feedback is essential ,’ says Ms Berry , ‘ and it ’ s also important to take time to talk to those doing additional roles about how you work , and ask if there is anything you can do to help them . Because , if we embrace these roles they can have a really positive impact .’
Future concerns Funding is always a background worry in primary care . Looking to the future of the ARRS model , Ms Bostock says : ‘ While we are assured the funding model will increase slightly each year , we are aware government policies could bring cuts . This would completely destabilise general practice , which is already struggling .’
Meanwhile , there remains a fear that if coordination at PCN level slips and ARRS roles are seen to take away the responsibilities that attract people to practice nursing in the first place , the diminishing GPN workforce may reduce still further – or disappear altogether .
‘ If ARRS roles take all the specialist areas , and manage long-term conditions , and nursing associates take over the day-to-day work of practice nurses , where does the GPN fit in ?’ asks Ms Hall .
And with ARRS roles highlighting that practice nurses remain outside Agenda for Change pay and conditions , Ms Randle says : ‘ We need to value the role of the practice nurse and make sure it isn ’ t diluted so that we don ’ t lose that skill set in general practice .’
Ms Eveleigh concludes : ‘ It ’ s sad to hear that anxiety and threats to GPN roles are circulating in some PCNs ; I ’ d encourage GPN leaders to step forward and advocate for better communication and transition of services , using successful models employed elsewhere .’
There are further opportunities , she says : ‘ With other clinicians sharing the load , this is a fantastic opportunity for PCNs to raise the status of nurses working in residential homes . GPNs are ideally placed to integrate them more closely into the primary care family and help develop their skills .’