How ARRS-Funded Pharmacy Roles Support Medicines Optimisation in Primary Care

Medicines optimisation places a substantial clinical burden on GP time. It requires consistent review of whether patients are on appropriate treatments, systematic identification of those at risk from polypharmacy and close management of repeat prescribing. ARRS support gives PCNs a direct way to meet this demand through dedicated clinical pharmacy roles and the evidence base for doing so is well established.

Key takeaways:

• Clinical pharmacists conduct Structured Medication Reviews (SMRs), manage complex repeat prescribing and lead deprescribing interventions within PCNs.
• A 2025 BJGP study found that practices employing clinical pharmacists achieved statistically significant reductions in opioid prescribing, anxiolytic use and total medicine costs per 1,000 patients.
• Pharmacy technicians reduce medication errors through consistent medicines reconciliation after hospital discharge and manage repeat prescribing workflows.
• Pharmacist-led SMRs can generate direct medicines cost savings of £13,100 per 100 reviews, rising to £168,800 when avoided healthcare resource use is included.

Medicines Optimisation and Polypharmacy

NICE defines medicines optimisation as a person-centred approach to safe and effective medicines use, with the goal of achieving the best possible outcomes for patients. This encompasses ensuring treatments are clinically appropriate, minimising prescribing-related harm, supporting adherence and identifying where deprescribing is warranted.

The Polypharmacy Challenge

Patients taking five or more medicines regularly face a greater risk of adverse drug reactions, drug-drug interactions and avoidable hospital admissions. As the population ages and multimorbidity increases, polypharmacy has become a persistent clinical challenge across general practice in England. Long-term conditions such as type 2 diabetes, chronic heart failure, COPD and atrial fibrillation frequently co-exist, and managing a medicines regimen across several conditions simultaneously demands careful, ongoing clinical oversight.

Deprescribing is a core component of that oversight. It involves the planned reduction or discontinuation of medicines that are no longer clinically indicated or are causing net harm. Done properly, it requires a thorough review of the patient’s full medicines history, a careful weighing of risk and benefit and shared decision-making with the patient. It is also time-consuming work that routine GP appointments rarely accommodate.

What Clinical Pharmacists Deliver Under ARRS

Clinical pharmacists train specifically in pharmacology, therapeutics and medicines management. Under ARRS, they conduct SMRs, support long-term condition management, manage complex repeat prescribing, advise on therapeutic switching and lead deprescribing interventions.

Structured Medication Reviews

During an SMR, the pharmacist reviews all of a patient’s medicines against their current health status, full clinical record and personal priorities, then documents agreed changes and follows them up. The clinical output is considerably greater than a brief medicines check during a GP appointment, particularly in terms of prescribing safety and medicines appropriateness.

Evidence of Impact

The evidence base is now well established. A longitudinal cohort study published in the British Journal of General Practice in February 2025 found that practices employing clinical pharmacists recorded statistically significant reductions in total medicine costs per 1,000 patients, opioid prescriptions per 1,000 patients and average daily anxiolytic use. A December 2024 study analysing data from over 6,000 general practices found that practices with more ARRS staff recorded lower overall prescribing rates and higher patient satisfaction scores, with the strongest effect seen in long-term condition management.

According to NHS England workforce data from early 2026, over 5,600 full-time equivalent clinical pharmacists now work across PCNs in England, with consistent growth over the preceding twelve months.

What Pharmacy Technicians Contribute

Pharmacy technicians are responsible for the operational elements of medicines management. Under ARRS, they carry out medicines reconciliation after hospital discharge, manage repeat prescribing workflows, support formulary compliance, run medicines-related audits and contribute to QOF data collection.

Medicines Reconciliation

Patients often leave hospital on a different regimen to the one they were admitted on and unresolved discrepancies between pre-admission and discharge medicines are a recognised cause of avoidable post-discharge harm. A pharmacy technician managing this process consistently across the network reduces medication errors at key care transition points.

Deploying clinical pharmacists and pharmacy technicians as a coordinated team consistently produces better outcomes than relying on either role alone. When technicians take on procedural tasks, clinical pharmacists can direct more of their time to SMRs, prescribing safety reviews and complex long-term condition management. Pharmacy technician numbers across PCNs grew by 8% year on year between January 2025 and January 2026, suggesting more networks are moving in this direction.

Outcomes and Cost Savings

NHS England’s national medicines optimisation guidance draws on research showing that pharmacist-led, person-centred SMRs delivered through a multidisciplinary framework can generate direct medicines cost savings of £13,100 per 100 reviews. When avoided healthcare resource use is factored in, that figure rises to £168,800 per 100 reviews. Patients in those studies also reported a better understanding of their medicines, improved adherence and reduced treatment-related harm.

Over a full financial year, regular review activity supports QOF achievement and reduces the volume of medication-related queries reaching GP appointment lists. Across a PCN with a large or complex patient population, that has a material effect on day-to-day clinical workload.

Deployment Considerations for Clinical Directors

Achieving these outcomes depends on how clinical pharmacy roles are structured within the network. A clinical pharmacist whose time is regularly occupied with tasks below their level of training will not deliver the prescribing quality improvements the evidence supports.

Clinical pharmacists need a clearly defined clinical scope and protected time for SMRs and long-term condition management. Pharmacy technicians need access to clinical systems such as EMIS or SystmOne, clear escalation pathways and responsibilities that complement rather than duplicate those of other team members.

For Clinical Directors seeking to maximise their ARRS allocation, working with an experienced provider ensures pharmacy roles are set up within a properly governed clinical framework, with the supervision and reporting arrangements needed to demonstrate outcomes to the wider integrated care system.