Primary care in the UK continues to face significant pressures. GP workloads remain high, patient demand is increasing, and recruiting staff presents ongoing challenges. Clinical pharmacists have become established members of the healthcare team in many practices and PCNs, offering specialist medicines expertise that supports how care is delivered.
Clinical pharmacists work directly within general practice settings alongside GPs to manage patient medication needs. Their role centres on medication management and optimisation, providing clinical services that can address several of the challenges facing primary care.
Reducing GP Workload Through Medication Management
Clinical pharmacists can manage medication-related consultations independently, which helps practices redistribute workload more effectively. GPs spend considerable time on prescription queries, medication reviews, and drug-related problems – tasks that clinical pharmacists are trained to handle.
By managing repeat prescribing, medication reconciliation following hospital discharge, and responding to patient queries about medicines, clinical pharmacists take on work that would otherwise fall to GPs. This allows GPs to focus more time on diagnosis and managing acute presentations.
What Clinical Pharmacists Typically Handle
● Repeat prescription queries and routine medication changes
● Post-discharge medication reconciliation
● Drug interaction checks and monitoring for adverse effects
● Prescribing for certain conditions within their scope of practice
● Patient education about medications
Practices with clinical pharmacists report improvements in how medication-related work is managed. The pharmacists conduct structured medication reviews, identify patients who may benefit from medication optimisation, and address polypharmacy concerns systematically.
Structured Medication Reviews and Medicines Optimisation
Structured Medication Reviews (SMRs) are a key part of clinical pharmacy work in primary care. These reviews assess whether patients are receiving appropriate, effective, and safe medications for their conditions.
Clinical pharmacists typically conduct SMRs for patients with multiple long-term conditions, those taking numerous medications, and individuals at higher risk of medication-related problems. During reviews, they check whether each medication remains clinically appropriate, look for potential drug interactions, and monitor for adverse effects.
Medicines optimisation work helps practices improve prescribing quality, address inappropriate polypharmacy where it exists, and support patients in understanding their treatment. This approach can contribute to better medication adherence and health outcomes, though results vary depending on individual patient circumstances.
Supporting PCN Development and ARRS Funding
The Additional Roles Reimbursement Scheme (ARRS) provides funding for PCNs to expand their workforce, with clinical pharmacists among the roles commonly recruited. Making effective use of this funding whilst ensuring good service delivery requires planning and ongoing management.
Clinical pharmacists funded through ARRS can work across multiple practices within a PCN, providing pharmaceutical care throughout the network. This arrangement allows smaller practices to access specialist pharmacy expertise they might struggle to fund independently.
Using ARRS Effectively
Clinical pharmacists help PCNs meet requirements within the PCN Directed Enhanced Service (DES), particularly those related to medicines optimisation and structured medication reviews. Deploying clinical pharmacists strategically across the network can make good use of available reimbursement funding.
Many PCNs find that the practical challenge lies in recruiting, managing, and retaining qualified clinical pharmacists rather than in accessing the funding itself. Some opt for managed pharmacy services to address these operational issues.
Enhanced Prescribing Safety and Clinical Governance
Clinical pharmacists contribute to prescribing safety through their specialist knowledge of medicines. They conduct prescribing audits, identify prescribing patterns that may warrant review, and help implement systems to reduce medication errors.
Their training in pharmacology, drug interactions, and adverse effects provides additional expertise that supports patient safety and clinical governance. This is particularly valuable for practices looking to strengthen their governance frameworks around medication management.
Clinical pharmacists also monitor high-risk medications, ensuring that appropriate monitoring happens and that patients receive necessary blood tests and health checks. This helps identify potential problems before they develop into complications.
Managing Complex Patients and Long-Term Conditions
Patients with multiple long-term conditions require careful medication management. Clinical pharmacists are trained to work with these complex cases, balancing treatment effectiveness against the risks that come with taking multiple medications.
They regularly work with patients who have diabetes, cardiovascular disease, respiratory conditions, and mental health problems – often several conditions simultaneously. Through medication reviews and ongoing monitoring, clinical pharmacists work to optimise treatment regimens and ensure patients understand their therapy.
Multimorbidity is increasingly common, particularly among older patients. Clinical pharmacists can dedicate the time needed to manage these patients properly, with consultations often lasting 30 minutes or longer – time that is difficult for busy GPs to consistently provide.
Deprescribing and Polypharmacy Management
Where appropriate, clinical pharmacists apply deprescribing approaches to safely reduce medication burden for patients taking multiple drugs. This requires detailed knowledge of drug interactions, potential withdrawal effects, and clear communication with patients – areas where clinical pharmacists have specific training.
Flexible Service Delivery Models
Clinical pharmacy services can be delivered in different ways: on-site presence, remote consultations, or a combination of both. This means practices and PCNs can choose arrangements that work for their specific situation and available space.
Remote clinical pharmacy services have become more common. Pharmacists can access practice clinical systems remotely, review patient records, and conduct telephone or video consultations without needing desk space in the practice. This model can be deployed across multiple sites relatively easily.
For practices with limited space or those in rural areas, remote delivery removes some practical barriers whilst maintaining clinical pharmacy support. It avoids the space requirements and associated costs of accommodating additional on-site staff.
Improving Patient Access
Clinical pharmacists provide patients with an additional contact point for medication-related concerns. Patients can book appointments directly with the pharmacist for prescription queries, medication reviews, or advice about managing their medicines. This helps reduce pressure on GP appointment availability and ensures patients can access timely advice from someone with specialist medicines knowledge. Patients often value having longer consultations focused specifically on their medications, with time to ask questions and discuss concerns.
Feedback from practices indicates that patients generally respond well to clinical pharmacist consultations, particularly appreciating the detailed explanations and time given to discuss their treatment.
Conclusion
Clinical pharmacists are now well-established in many primary care settings across the UK. They help manage GP workload related to medicines, contribute to prescribing safety, deliver structured medication reviews, and support patient care. For practices and PCNs managing workforce pressures and patient demand, clinical pharmacy services offer practical benefits. The extent of these benefits will depend on how services are implemented and integrated within existing teams, but the evidence base for clinical pharmacy in primary care continues to grow.
