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Home > About us > Document library > 24/21 Impact of new or extended roles in primary and community health and social care - commissioning brief

24/21 Impact of new or extended roles in primary and community health and social care - commissioning brief

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Published: 13 February 2024

Version: 1.0- February 2024

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Scope

The Health and Social Care Delivery Research (HSDR) Programme is inviting applicants to undertake research to investigate the impact of any new and extended clinical and non-clinical roles on the delivery of primary care, community health, and social care services. The HSDR Programme is particularly interested in funding studies that aim to produce evidence about the quality of care, access to care, organisation and delivery of services. Research proposals should focus on one or more roles which are new to primary care and/or community health and/or social care settings, or are of an extended scope, where roles have additional skills or work across professional boundaries. Research on voluntary and contracted third sector roles are considered out of scope for this opportunity. GPs and doctors working in other specialties should not be the primary research focus, but may be studied to understand how utilising staff working in new and extended roles affects their role and workload.

Background

To meet changing health and care needs, including caring for an ageing population, care that was previously delivered in secondary care settings is now often provided in primary and community care settings. This shift in care setting, coupled with workforce shortfalls, has placed additional pressure on services delivered in primary and community care. The NHS Long Term Workforce Plan commits to train, retain, and reform the workforce and work practices. To improve access to primary care, the NHS Long Term Workforce Plan builds on the Additional Roles Reimbursement Scheme (ARRS), which was introduced in England in 2019 to provide primary care networks with salary support for additional roles to address the workforce shortage. This scheme has helped recruit 29,000 additional staff (currently across 17 roles) in primary care. Many of the multidisciplinary team roles funded by ARRS are new roles in primary care settings, or are extended roles in which practitioners have additional skills such as non-medical prescribing. Allied health professionals are an important group of practitioners, who may be working in new or extended roles and have the potential to deliver, efficiently, quality integrated services in various health and social care settings. Furthermore, through supporting social care staff to provide appropriate referrals, allied health professionals may help to reduce the burden on primary care services. The enhanced health in care homes framework recommends developing and testing new roles in care homes, including care co-ordinators, to improve continuity of care.

Identified research need

While existing research exploring new or extended clinical and non-clinical roles has predominantly concentrated on primary care, it is also important to evaluate these roles in community health and social care settings. Moreover, while there is a greater diversity of roles used in primary and community care settings, there is not yet equity in understanding how these roles may improve service delivery. Research is needed to address inequities in evidence across roles – particularly for non-clinical roles such as receptionists or digital and transformation leads – to inform effective deployment. A King’s Fund report identified cultural, organisational, and leadership factors that are key to implementing additional roles. Future work should investigate how these implementation factors apply to less researched new or extended roles, and how to leverage these when designing services.

There is complexity and variation in the choice of service delivery models using new or extended roles and how these are put into practice. There is also a need to understand potential service benefits, including the impact on service access. Much of this variation is due to appropriate localised practices, which work well for communities and for these roles. To scale up models of care using new or extended roles to meet future care demands, it is important to understand how more standardised national models can retain adaptability to optimise local service provision.

To maximise service delivery and organisation to improve outcomes, there is a need to better understand which roles are suited to which tasks, considering specific expertise and competencies. For example, using clinical pharmacists in primary care is associated with improved prescribing quality and lower prescribing volume. To clarify the potential benefits of additional training needed for some extended roles, it is important to determine the right level of training and upskilling for different roles by examining: quality of care, value for money, impact on GP workload and professional development for those working in extended roles, and how these are affected over time. Moreover, research is needed to understand staff turnover and workplace changes following additional training.

It is important to understand the experience of new and extended roles from the perspectives of patients, carers, families, other health and care professionals, and from those working in these roles. Currently, there is a lack of shared vision and understanding regarding the potential contributions of staff in these roles at a primary care network level, and patients are often unaware of the purpose of some newer roles. The evidence around patient satisfaction with new or extended roles is mixed. There is a need to understand this complexity, and for evidence to guide improvements in clarity of communication to patients to ensure that they understand the skills and scope of staff working in new or extended roles. It is also important to explore if staff working in new or extended roles feel appreciated and supported in the care team, as well as to better understand career paths and opportunities for professional progression, and to develop approaches for staff to retain their professional identities. For studies in primary care, research should consider how GPs view new or extended roles, focusing on supervision, service redesign, satisfaction with service delivery and impact on GP workload.

Areas of interest

The HSDR Programme is interested in funding high quality research that should generate national learning around the use of any new or extended clinical and non-clinical roles in primary care and/or community health and/or social care settings. Research design and methods should be appropriate for the proposed study. Research proposals should engage with all relevant stakeholder groups, including staff employed in new and extended roles, staff whose role is impacted by new and extended roles, patients and their support networks.

The following areas are of particular interest to the HSDR Programme, though other areas, posing relevant research questions, may be studied with appropriate justification:

  • Understanding how health and care services choose to employ specific roles, how they design suitable skill mixes to deliver new service models, and how they promote workforce retention. How can service models be scaled up and what is the optimal longer term workforce composition? What are the key metrics to determine if these roles are improving service quality and delivery, and how can metrics be evaluated?
  • Understanding and evaluating new or extended roles as a factor in improving the delivery of integrated care, examining horizontal and vertical integration.
  • Examining the impact of new or extended roles on patients, other health and care professionals, service access and organisation. What is the effect on continuity of care? What is the impact of a multidisciplinary culture on care quality and experience? Are there any unintended consequences of workforce redistribution?
  • Understanding how changes in service delivery models including remote or hybrid consultations impact the quality and experience of services delivered by new or extended roles.
  • Assessing service productivity and care pathway efficiency: Do new or extended roles provide timely and appropriate care? Investigating the frequency and reasons behind duplicate appointments with another care professional.
  • Understanding and evaluating the effectiveness and efficiency of clinical audit processes when applied to staff working in new or extended roles.
  • Exploring the role and impact of new or extended roles in improving population health and addressing inequalities, including promoting equal access and outcomes.
  • Understanding patient, staff, and carer experiences of services that utilise new and extended roles, including what is working and understanding aspirations for future service design. Using this learning to improve the quality, accessibility, organisation and overall experience of health and social care services.

Additional information

Applicants should take note of the NIHR portfolio to ensure that research proposals do not directly overlap with, but build upon, ongoing and completed studies. This is particularly important for research proposals that look at pharmacists, link workers, paramedics, physician associates/assistants, physiotherapists, and peer support workers. Ongoing and completed studies of interest in the NIHR portfolio include:

Research inclusion

The NIHR is committed to creating a diverse and inclusive culture, as outlined in our Equality, Diversity and Inclusion strategy 2022-2027. We, therefore, encourage applications from people from all backgrounds and communities. We are committed to having leadership and teams that contain diverse skills and experiences.

All NIHR research proposals need to demonstrate that they have met the requirements of the Equality Act (2010). Researchers should consider being diverse and inclusive in the design, planning, conduct, impact, and dissemination of their research study.

NIHR also welcomes partnerships between research active and other less active institutions and those located in geographical areas of deprivation. Applicants are also expected to pay attention to populations that have been underserved, to conduct research in locations where the need is greatest.

General guidance

The HSDR Programme supports applied research with the aim of improving both health and social care services across the nation and is open to any appropriate methodological approaches to answer the proposed research question(s); the approach must be fully explained and justified. To enhance the success of a research proposal, a clear theory of change and pathway to impact, with links into the NHS and social care services delivery, is suggested. It is useful to consider in the research study design how outcomes could be scaled up to maximise impact and value for money across the NHS and social care services – the focus is on applied research with tangible impacts that improve the quality and organisation of health and social care services. This includes stakeholder engagement and the development of processes, tools, and guidelines to strengthen workforce capacity. Further general information is available on the HSDR Programme.

Research proposals should be co-produced with national organisations, professional bodies, health and social care service professionals, and service users. Links with health and social care planners and professional bodies are required to ensure impact and scaling up of research findings to benefit the wider health and social care system.

The COVID-19 pandemic is having a significant impact across the health and social care system. As this research may be conducted during the COVID-19 response and recovery period, applicants should consider how the impact of the COVID-19 response and recovery may affect the deliverability of their research.