Primary Care Networks are accountable for a defined set of contractual obligations under the PCN DES each year, covering workforce planning, service delivery targets and population health requirements. Clinical pharmacists have become one of the most widely deployed roles within the ARRS workforceand their scope of practice maps closely onto several of these core requirements. For network managers and Clinical Directors, understanding exactly where clinical pharmacists contribute is the starting point for more effective workforce planning.
Key takeaways:
- Clinical pharmacists are one of the most widely adopted ARRS roles in England, with over 8,000 now working across general practice and PCNs.
- They have a defined role in delivering Structured Medication Reviews (SMRs), a core DES requirement.
- Pharmacists with prescribing rights can contribute directly to CVD prevention activity, a sustained priority within the Network Contract DES.
- Their medicines optimisation work addresses polypharmacy and high-risk prescribing, both areas of documented NHS cost and risk.
- Workforce plans submitted to ICBs should clearly map clinical pharmacist activity to specific DES obligations.
Clinical Pharmacists as an ARRS Workforce Asset
The DES requires networks to demonstrate that their workforce planning reflects local population health needs. Clinical pharmacists contribute directly to thisand the Additional Roles Reimbursement Scheme (ARRS) has significantly expanded this workforce across primary care.
By June 2025, pharmacists had become the largest single staff group working in PCNs, with over 8,000 across England, whether employed directly by a PCN or by an individual practice. Their inclusion in workforce plans should be tied to specific service gaps in medicines management, long-term condition reviews and high-risk prescribing, rather than simply filling an ARRS headcount.
Delivering Structured Medication Reviews
Structured Medication Reviews (SMRs) represent the most clearly defined area of DES delivery in which clinical pharmacists have an established role. An SMR is a comprehensive review of a patient’s full medicines list, typically conducted for those with polypharmacy, complex long-term conditions or known high-risk prescribing.
Over 3.1 million SMR appointments were recorded across England between April 2023 and March 2024, with the majority carried out by clinical pharmacists. The scope of an SMR extends well beyond repeat prescription management, covering therapeutic appropriateness, opportunities for deprescribing, medicines adherence and the identification of medicines-related risk.
Protected time for thorough SMR delivery is an important operational requirement for PCNs. Reviews that are rushed or treated as a tick-box exercise offer limited clinical value and are unlikely to withstand scrutiny at ICB level.
CVD Prevention as a Growing DES Priority
Cardiovascular disease (CVD) prevention has been a sustained priority within the Network Contract DES, reflected in Quality and Outcomes Framework (QOF) indicators. Clinical pharmacists with prescribing rights can contribute directly to this work, rather than operating in a purely supportive or advisory capacity.
Where Clinical Pharmacists Contribute
Clinical Pharmacists who hold an independent prescribing qualification can initiate and adjust treatments for conditions including hypertension, hyperlipidaemia and heart failure. They can lead systematic case-finding for patients with uncontrolled cardiovascular risk factors and coordinate follow-up within structured pathways. This reduces demand on GP appointment slots while ensuring review activity remains within a clinically qualified role.
Networks that integrate pharmacists into their CVD prevention pathways are better placed to meet DES targets in this area without placing additional pressure on their GP workforce.
Medicines Optimisation and Reducing Prescribing Risk
Adverse drug events are estimated to cost the NHS around £400 million a year, with polypharmacy and high-risk prescribing in primary care accounting for a significant share of that figure. Clinical pharmacists are specifically trained to identify and address these risks.
What This Looks Like in Practice
In practice, this includes reviewing patients on multiple medicines for interactions and duplication, monitoring high-risk drugs such as anticoagulants and immunosuppressants, supporting safe prescribing protocols and identifying where medicines can be stopped or simplified.
Research suggests clinical pharmacists can take on roughly 20% of a GP’s workload—specifically the medicines-related proportion. For practices under sustained appointment pressure, that represents a meaningful redistribution of clinical workload, and it allows GP time to be directed towards cases that fall outside the pharmacist’s scope.
Working Within Multidisciplinary Teams
The DES places ongoing emphasis on integrated, multidisciplinary working across PCN member practices. Clinical pharmacists are well positioned to operate across this structure, attending clinical meetings, contributing to care planning for patients with complex needs and liaising with secondary care, community pharmacy and social prescribing services.
This collaborative element is worth planning for deliberately. Pharmacists who are isolated within a single practice, or whose role drifts largely into administration, are not fulfilling their potential within the DES framework. Networks that embed pharmacists into their wider team structurewith clear lines of communication and defined clinical responsibilitiestend to see more consistent results from this part of their ARRS investment.
Planning Clinical Pharmacist Roles Around DES Delivery
The clinical pharmacist role is adaptable, but that adaptability requires clear direction. Networks that align pharmacist responsibilities to specific DES requirements consistently achieve better outcomes than those where the role lacks defined structure.
Workforce plans submitted to ICBs should reflect exactly how pharmacist capacity is being used against DES obligations. Whether that covers SMR delivery, CVD prevention activity, medicines safety work or MDT contributions, the rationale needs to be explicit and the activity needs to be evidenced.
Clinical pharmacists cannot address every DES requirement, but across medicines management, structured reviews and preventive care, their impact is both measurable and well-documented.
