GPNs ‘expected to train’ higher earning ARRS colleagues

General practice nurses (GPNs) are expected to train and supervise staff employed on the additional roles reimbursement scheme (ARRS), despite being on lower pay in some cases, a new report revealed.

Research by the Queen’s Nursing Institute’s (QNI) International Community Nursing Observatory (ICNO) has highlighted some of the challenges posed by ARRS and how it is impacting the workload of GPNs.

The ARRS was introduced into general practice in 2019 as part of the government’s manifesto commitment to improve access to general practice and support the recruitment of additional staff into the field.

“The introduction of ARRS has been problematic for the general practice nursing workforce”

Alison Leary

The scheme funds the salaries of 17 roles to expand the primary care workforce, including advanced nurse practitioners, nursing associates, physician associates, dieticians, podiatrists, parademics and occupational therapists. It does not include GPNs.

The new report, co-authored by director of the ICNO, Professor Alison Leary, and fellow nursing workforce researcher Dr Geoff Pushon, surveyed 531 GPNs on their experience with the ARRS scheme.

More than a third of GPNs (37%) said the introduction of ARRS roles had increased their workload, while 24% said their workload had decreased.

The report warned that due to many ARRS colleagues being new to their role, they often sought support from GPNs, which had increased the workload for nurses.

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Whether GPNs were expected to provide education and supervision for those in ARRS was split, with 49% saying they did and 42% saying they did not.

However, over half of respondents (51%) said ARRS colleagues were not able to practise independently in general practice without some help from GPNs.

Nurses cited specific issues around having to train colleagues without any additional time or resources, as well as work being duplicated due to ARRS colleagues’ lack of experience in primary care.

One respondent said: “Care is disjointed and there is duplication of work, misunderstanding of recall systems and ways of working causing patients to be asked to come in when there is no clinical requirement.”

Nurses did not report having more capacity to see complex patients, since the introduction of ARRS.

The report found that just 22% of respondents said they had more appointments available to see patients, while 72% said they had not.

In addition, only 26% of GPNs said they had been able to see more appropriate patients, while 63% said they have not.

Concerningly, the research showed that some GPNs were expected to support and supervise ARRS colleagues who earned more than them.

In addition, it found that GPNs had less access to developmental opportunities compared to their colleagues on the scheme.

One respondent said: “[Some] ARRS roles are paid more than GPNs and have less qualifications, little to no experience and require support from GPNs earning much less.

“It reinforces the message that nursing isn’t a valued profession.”

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Another said: “ARRS roles are allowed unlimited training time and get better terms and conditions compared to practice employed staff. This causes disruptions in the team.”

GPNs viewed those on the ARRS as being part of an “unplanned workforce with a poorly defined purpose”, warned the report.

One respondent said patients were also “confused” about the remit of some of the roles of those employed on ARRS.

GPNs reported little consultation prior to implementing the ARRS in general practice, particularly nursing associates and their trainees, for which they are responsible for supervising.

One respondent said: “ARRS seems to be a ‘sticking plaster’ over the issues that are currently being seen in general practice.

“Experienced GPNs are feeling pushed out and are underrepresented in implementation of these roles.”

Professor Alison Leary

Alison Leary

Report author and leading nursing workforce academic, Professor Leary, said: “The introduction of ARRS has been problematic for the general practice nursing workforce.

“Change in the workplace affects the workforce and major changes should be assessed for potential impact on the workforce.”

Professor Leary noted that ARRS had impacted the GPN workforce in several ways and said that the lack of consultation on the roles had led to “feelings of devaluation among the workforce”.

Meanwhile, the chief executive of the Queen’s Nursing Institute, Dr Crystal Oldman, said: “The survey shows that multiple assumptions were made about the primary care workforce and no real assessment of the impact that ARRS was likely to have.

“This has led to the GPN workforce feeling devalued.

Crystal Oldman

Crystal Oldman

“In some cases, GPNs have experienced significant disadvantage.”

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The report made a series of recommendations, based on the findings of the survey, including “full and meaningful” workforce engagement in any future changes that impact the nursing workforce.

It also called for any inequity in opportunity in pay or professional development to be addressed.

The report warned that the introduction of ARRS roles appeared to be based on availability rather than demand, and as such called for demand modelling to take place when implementing new roles.

Meanwhile, it called for clarity around all ARRS roles and scope of practice, as well as more supervision and support for new roles and those transitioning to a new area of practice.

In addition, the report argued for scrutiny at a regional and national level of how ARRS impacts the overall workforce strategy in primary care and the community healthcare workforce.

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