Pharmacists in general practice: A system shift we all need to understand

Over the past few years, we’ve seen more pharmacists moving into general practice. What’s driving this shift?

It’s true — over the past five to seven years, pharmacists have moved into general practice at an unprecedented scale. For many hospital pharmacists, this has felt rapid, and sometimes even a bit unclear.

But it’s important to understand that this wasn’t just about relieving GP workload. While the Additional Roles Reimbursement Scheme (ARRS) provided the mechanism, the real drivers were much deeper: rising multimorbidity, increasing polypharmacy, medicines-related harm, and the need for advanced prescribing embedded within neighbourhood teams.

This isn’t simply a sector shift — it’s a system redesign.

Can you tell us a bit about your background and perspective on this evolution?

My career has spanned community pharmacy, health authorities, CCGs, NICE implementation, national medicines policy, PCNs, and workforce transformation. I’ve worked at the interface of these systems for many years.

As one of the first pharmacist prescribers in the country, I’ve been able to support pharmacists transitioning into general practice while staying grounded in the governance, rigour, and specialist standards we value across all settings.

What are the main pressures that led to pharmacists being embedded in general practice?

There are three core drivers:

1. Medicines complexity
We’re seeing ageing populations with increasing multimorbidity. Many patients — especially those over 65 — are taking 10–15 medicines. Optimising that safely requires time, expertise, and prescribing authority.

2. Workforce sustainability
General practice has been under significant pressure. Embedding pharmacists allows medicines expertise to sit within the clinical team and contribute meaningfully to multidisciplinary decision-making for complex patients.

3. Policy direction
The NHS Long Term Plan and neighbourhood care model emphasise prevention, proactive care, and multidisciplinary working. Pharmacists are uniquely positioned to support all of this.

Of course, the Additional Roles Reimbursement Scheme (ARRS) provided the financial mechanism — but the clinical rationale has always been about medicines safety and optimisation at scale.

What does the role of a pharmacist in general practice actually look like day-to-day?

There really isn’t a typical day. The day often starts around 7:30am reviewing pathology results, discharge summaries, and urgent medicines queries. You might encounter:

• Acute kidney injury alerts in patients on ACE inhibitors or diuretics
• DOAC dosing and renal function reviews
• Methotrexate or lithium monitoring
• Opioid safety concerns
• Frequent fallers
• Queries from community pharmacy
• Immediate prescribing decisions requested by GPs

As a prescriber, the pace is fast and the accountability is real. Clinical reasoning needs to be both rapid and robust.

And what about patient-facing work?

Morning clinics often run for around three hours, with 10–15 minute appointments. These include:

• Polypharmacy reviews in frailty
• Heart failure optimisation
• Diabetes intensification
• Asthma reviews and inhaler technique
• Deprescribing in advanced multimorbidity
• Anticoagulation management
• Mental health medication reviews

These aren’t administrative tasks — they require diagnostic reasoning, risk stratification, shared decision-making, and independent prescribing.

Patients often present with evolving symptoms, so it’s about assessment as much as optimisation. Knowing the wider system and services — who can support the patient, how and when (according to what matters most to the patient) — is essential.

How does multidisciplinary working fit into the role?

A couple of hours in the middle of the day is often dedicated to MDT and PCN work, which might include:

• Multidisciplinary team meetings
• Care home reviews
• Safeguarding discussions
• Complex case planning
• Partnership strategy meetings
• Population health reviews using prescribing data

This is where pharmacists influence system-level decisions — shaping protocols, identifying unwarranted variation, and supporting prevention strategies.

There’s been a lot of discussion about the discharge interface. How has that changed?

This is one of the most significant developments. Pharmacists in general practice are now:

• Reconciling and clinically reviewing discharge summaries
• Clarifying specialist intent
• Titrating therapies post-discharge
• Initiating monitoring plans
• Using Advice & Guidance to liaise with secondary care

Discharges are no longer passive — they’re actively managed. For hospital colleagues, this changes the dynamic. There’s now a real opportunity for more collaborative and clinically sophisticated interface working — if we make the most of it.

What does the afternoon typically involve?

Afternoon clinics tend to allow more time per patient — around 15–30 minutes. These might include:

• Hypertension optimisation (and sometimes deprescribing)
• Chronic pain reviews
• HRT and contraception prescribing
• Acute minor illness assessment

Alongside that, there’s governance work:

• Medication safety audits
• Preparing for CQC inspections
• Responding to MHRA alerts
• Training and supporting early-career pharmacists and GP registrars

The day usually wraps up around 5:30–6pm, ensuring any urgent issues are addressed before the next day.

Overall, the role blends frontline care, prescribing accountability, education, and governance.

What does all of this mean for hospital pharmacists?

There are several important implications:

• Patients are now discharged into practices with embedded prescribing expertise
• Increasingly, medicines optimisation is happening before referral thresholds are reached
• Specialist pharmacists have opportunities to influence prescribing at a neighbourhood level
• Governance is now distributed across settings and needs to stay aligned

The success of ARRS depends on clinical standards, supervision models, and cross-sector collaboration. Without strong interface relationships, there’s a risk of fragmentation — but with them, patient safety improves.

How are pharmacists being supported in this transition?

Through national education programmes, prescribing curricula, and workforce development initiatives. A key focus has been ensuring pharmacists in general practice are working at an advanced level — not in isolation, but as part of an integrated medicines system.

Some people see this as a shift away from hospital pharmacy. Is that fair?

Not at all. This isn’t about primary versus secondary care — it’s about redistributing medicines expertise across the patient journey. Pharmacists in general practice are influencing prescribing earlier than ever before. That shouldn’t create distance — it should bring us closer together.

Any final thoughts?

The system is changing. The question isn’t whether we should engage — it’s how.