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Consultation complexity and professionals consulted: a retrospective cohort study in English primary care
Hong Jialan, Edwards Peter Jonathan, Kashyap Mavin Nathan, McLeod Hugh, Salisbury Chris, Walsh Nicola, Bennett Ben, Ward Isobel L et al.. The British journal of general practice : the journal of the Royal College of General Practitioners, 2026-02-24
Topic: Risk, prevention and care in population studies
The Additional Roles Reimbursement Scheme (ARRS) launched in England in 2019 to expand the multidisciplinary primary care workforce, but its impact on workload since implementation is unclear. To examine changes in workload complexity associated with ARRS implementation. A longitudinal cohort study was conducted, which used the Clinical Practice Research Datalink (CPRD) Aurum. In total, 3 530 628 consultations were analysed involving GPs, nurses, or direct patient care (DPC)-ARRS roles for 420 986 patients from 369 English practices in 2018 and 2021. Multilevel logistic regression assessed associations between 17 patient and consultation complexity factors and being seen by a DPC-ARRS role, adjusting for year, age, sex, region, deprivation, and consultation mode. Complex consultations with DPC-ARRS-eligible roles increased from 15.8% in 2018 to 18.8% in 2021. Diagnostically capable ARRS roles were more likely than GPs to conduct the first consultation after diabetes diagnosis (odds ratio [OR] 1.4, 95% confidence interval [CI] = 1.3 to 1.5) and consultations with ≥2 preventive tasks (OR 5.6, 95% CI = 5.5 to 5.8), but less likely to manage chronic pain (OR 0.8, 95% CI = 0.7 to 0.9), dementia (OR 0.4, 95% CI = 0.3 to 0.4), mental illness (OR 0.4, 95% CI = 0.3 to 0.5), learning disabilities (OR 0.3, 95% CI = 0.3 to 0.4), consultations with ≥3 medicines prescribed (OR 0.6, 95% CI = 0.5 to 0.6), consultations resulted in emergency admission (OR 0.7, 95% CI = 0.6 to 0.8), and consultations with ≥2 diagnoses coded (OR 0.5, 95% CI = 0.5 to 0.5). Patients with interpreter needs (OR 1.2, 95% CI = 1.1 to 1.3), experiencing recent homelessness (OR 1.4, 95% CI = 1.1 to 1.7), or ≥3 long-term conditions (OR 1.1, 95% CI = 1.1 to 1.1) were more likely to be seen by diagnostic ARRS staff. Following ARRS implementation, primary care activity was delivered by a broader workforce managing increasingly complex care. Further research should assess the safety, quality, and system impacts of ARRS roles.
Key findings
- To examine changes in workload complexity associated with ARRS implementation.
Why it matters
This study examined workload in English primary care and found that ARRS roles were less likely than GPs to manage consultations for dementia. It provides no information on treating, curing, or preventing Alzheimer's disease.
Study details
- Study designcohort study
- Participants986
- Effect size15.8%; 18.8%; OR 5.6
- Evidence strengthModerate
How this study scored 48/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (The British journal of general practice : the journal of the Royal College of General Practitioners) |
| Journal's citation record | 1 / 4 | British Journal of General Practice: journal h-index 124 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 2 / 4 | 986 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-17) |
| Citations per year | 0 / 5 | 0.0 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Maria Theresa Redaniel: h-index 22 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Bristol: institution h-index 1,259 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41730680) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 48 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Jialan, H., Jonathan, E. P., Nathan, K. M., Hugh, M., Chris, S., Nicola, W., et al. (2026). Consultation complexity and professionals consulted: a retrospective cohort study in English primary care. The British journal of general practice : the journal of the Royal College of General Practitioners. https://doi.org/10.3399/bjgp.2025.0670
Vancouver
Jialan H, Jonathan EP, Nathan KM, Hugh M, Chris S, Nicola W, et al. Consultation complexity and professionals consulted: a retrospective cohort study in English primary care. The British journal of general practice : the journal of the Royal College of General Practitioners. 2026. doi:10.3399/bjgp.2025.0670. PMID: 41730680.
BibTeX
@article{jialan2026-41730680,
author = {Jialan, Hong and Jonathan, Edwards Peter and Nathan, Kashyap Mavin and Hugh, McLeod and Chris, Salisbury and Nicola, Walsh and Ben, Bennett and Ward Isobel, L. and others},
title = {{Consultation complexity and professionals consulted: a retrospective cohort study in English primary care}},
journal = {The British journal of general practice : the journal of the Royal College of General Practitioners},
year = {2026},
doi = {10.3399/bjgp.2025.0670},
pmid = {41730680},
url = {https://doi.org/10.3399/bjgp.2025.0670}
}