This independent report was commissioned by the Department of Health and Social Care. This report was funded by the National Institute for Health Research (NIHR) Policy Research Programme (grant number NIHR200702) as part of the partnership for responsive policy analysis and research (PREPARE) programme, a collaboration between the University of York and the King’s Fund for fast-response analysis and review to inform the Department of Health and Social Care’s policy development.

The Additional Roles Reimbursement Scheme (ARRS) was introduced in England in 2019 as a key part of the government’s manifesto commitment to improve access to general practice. The aim of the scheme is to support the recruitment of 26,000 additional staff into general practice. This represents a huge scale of ambition and requires the implementation of significant and complex change across general practice. While primary care networks (PCNs) have swiftly recruited to these roles, they are not being implemented and integrated into primary care teams effectively. Our research focused on four roles — social prescribing link workers; first contact physiotherapists; paramedics and pharmacists — to examine the issues related to the implementation of these roles, looking at the experiences of working in these roles and of the people managing them. We found a lack of shared understanding about the purpose or potential contribution of the roles, combined with an overall ambiguity about what multidisciplinary working would mean for GPs. Successful implementation of the scheme requires extensive cultural, organisational and leadership development skills that are not easily accessible to PCNs.