ARRS impact on workload and complexity ‘limited’

The Additional Roles Reimbursement Scheme (ARRS), launched in England in 2019 to expand the multidisciplinary primary care workforce, has had limited impact on general practice workload and complexity, according to a study in the BJGP.

The scheme was introduced against a background of persistent shortages of GPs and practice nurses alongside rising demand and more complex care needs in an ageing, multimorbid population.

Using routine records from 369 practices, the study found that direct patient care (DPC)-ARRS roles now deliver a substantially larger share of consultations and that a wider range of clinicians are more active in primary care.

‘Diagnostically capable’ ARRS roles were more likely than GPs to manage initial diabetes consultations and visits involving multiple routine or preventive tasks, but less likely to manage chronic pain, dementia, mental illness or learning disabilities. They were also less like to conduct consultations where three or more medicines were prescribed, two or more diagnoses were recorded, or those resulting in an emergency admission.

ARRS is intended to give GPs more time to focus on complex consultations and coordination-intensive care by delegating routine tasks. Typically, reception staff collect information at first contact, prioritise needs, and route patients to the most appropriate professional or service. However, there is evidence of unintended consequences; GPs and practice nurses report higher caseload complexity, fragmented care, and workload pressures.

Rising consultation complexity across all professional groups, rather than ARRS role expansion alone, appears to be shaping workload changes, highlighting the need for clearer role boundaries, stronger supervision, and effective demand management.

Hong J, et al. Br J Gen Pract 2026; DOI: https://doi.org/10.3399/BJGP.2025.0670