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. Aim Describe the uptake of direct-patient care (DPC)-ARRS roles and its impact on patients' experiences. Design and Setting 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, 17,588 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=0.005). 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.

The authors have declared no competing interest.

This research was funded by the NHS Insights Prioritisation Programme and supported by the National Institute for Health Research (NIHR) Applied Research Collaboration West (NIHR ARC West). PJE was funded by a NIHR In-Practice Fellowship (NIHR302692). MK is an NIHR Academic Clinical Fellow in Primary Care. CS is supported as an NIHR Senior Investigator (NIHR 201314). The views expressed in this article are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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The study used only publicly available data originally located at: NHS Digital. Primary Care Network Workforce [Internet]. 2023 [cited 2023 Dec 1]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/primary-care-network-workforce NHS Digital. General Practice Workforce [Internet]. [cited 2023 Dec 1]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services NHS England, IPSOS MORI. GP patient survey [Internet]. 2022. Available from: https://www.gp-patient.co.uk/ NHS Digital. QOF 2022-23 [Internet]. 2023 [cited 2023 Dec 1]. Available from: https://qof.digital.nhs.uk/ NHS Digital. NHS Digital. [cited 2023 Feb 15]. Patients Registered at a GP Practice. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice Ministry of Housing, Communities and Local Government. The English Indices of Deprivation 2019. London; 2019 Sep.

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