An umbrella review of systematic reviews and selective review of recent primary studies on additional healthcare worker roles in general practice.

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

5B.5

Presenter:

Jane Smith

Co-authors:

Ian Porter(1), Louise Cooper(1), Nada Khan(1), Alison Bethel(1), Imelda McDermott(2), Sharon Spooner(2), Maria Panagioti(2), Georgette Eaton(3), Chris Salisbury(4), Danielle Van Der Windt(5), Stavros Petrou(3)

Author institutions:

(1) University of Exeter Medical School, (2) University of Manchester, (3) University of Oxford, (4) University of Bristol, (5) University of Keele

Problem

To address growing workforce pressures and patient needs, policymakers have encouraged increased use of “additional healthcare workers” (AHWs) in general practice, such as through the Additional Roles Reimbursement Scheme (ARRS). Despite this, there is a lack of synthesised evidence about the impacts of employing existing practitioners (e.g. physiotherapists, paramedics, dieticians) or newer professionals (e.g. social prescribing link workers, care co-ordinators) in these roles. To address this, we conducted an “umbrella review” examining studies on AHWs in general practice.

Approach

In line with our protocol (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341281), we searched Cochrane, Medline, EMBASE, PsycInfo, CINAHL and Web of Science Core Collection, for systematic reviews reporting on AHWs working in or closely with general practices. For roles where reviews were lacking, we undertook supplementary searching for UK-focussed primary research. We extracted quantitative and qualitative data on: roles and responsibilities; training; models of integration; impacts on practices (e.g. team-working, culture), existing staff (e.g., workload, well-being, retention), care provision (e.g., services offered, access, quality), patients (e.g., satisfaction, health outcomes, safety) and costs. We synthesised findings taking account of the quality of included reviews assessed using the Risk of Bias in Systematic reviews (ROBIS) tool.

Findings

From 5104 records screened and 422 full texts assessed for eligibility, we included 29 reviews in the main synthesis of findings: 12 on paramedics; five on care co-ordinators; three each covering physician associates and social prescribing link workers; and two on each of physiotherapists, health and well-being coaches, and mental health workers. Findings from five identified umbrella reviews on pharmacists were summarised separately. We found only three primary studies on podiatrists, two on dieticians and none examining pharmacy technicians, occupational therapists or nursing associates. Although most reviews were rated as at low risk of bias, the quality of their included studies was mostly poor. There was some evidence describing the roles and responsibilities of AHWs, highlighting the importance of role definitions and boundaries. Training, supervision and good communication appeared key to facilitating integration of AHWs into general practices. Apart from for health and wellbeing coaches (where good-quality evidence from two reviews suggested positive effects on managing chronic diseases), there was limited conclusive and good-quality evidence for the impact of AHWs on patient outcomes, care provision, resource use and costs. There was little evidence for any roles relating to impacts on wellbeing and workload, amongst the AHWs themselves or existing general practice staff (e.g. only 2/12 reviews on paramedics covered impacts on staff).

Consequences

For most AHWs reflecting ARRS-funded roles, positive impacts on general practice are yet to be established, highlighting the need for high quality primary research evaluating impacts of the ARRS workforce, particularly on patient outcomes, staff workload and costs.

Submitted by:

Jane Smith

Funding acknowledgement:

This review forms part of the “Assessing the contributions of additional role practitioners to general practice in England” (CARPE) study led by the University of Oxford and funded by the National Institute for Health Research (NIHR) School for Primary Care Research, Grant Reference Number: 568. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.