Behind the Role: ARRS Clinical Pharmacist Role

Behind the Role: ARRS Clinical Pharmacist Role

The Additional Roles Reimbursement Scheme (ARRS) funds non‑GP clinicians in general practice, including clinical pharmacists, physiotherapists, paramedics, social prescribers and others. It was introduced in England in 2019 as part of the Network Contract DES.  

Clinical pharmacists became one of the first five roles funded under ARRS. Their purpose was to embed medicines expertise directly inside GP practices and Primary Care Networks (PCNs).  

‍

Why ARRS pharmacists were set up (the underlying drivers)

Three core pressures drove the creation of the role:

• Medicines complexity — ageing populations, multimorbidity, and polypharmacy (10–15 medicines per patient in many cases). Optimising this safely requires specialist time and prescribing authority.  

• Workforce sustainability — GP workload and recruitment pressures meant practices needed clinicians who could take on medicines‑related work previously done by GPs.  

• Policy direction — the NHS Long Term Plan emphasised prevention, proactive care, and multidisciplinary neighbourhood teams. Pharmacists fit this model.  

ARRS provided the financial mechanism, but the clinical rationale was medicines safety, optimisation, and reducing harm at scale.

‍

When it was set up

• 2019: ARRS launched; first wave of PCN clinical pharmacists appointed.  

• 2019–2024: Role expanded from medicines optimisation to long‑term condition management, care home support, and high‑risk monitoring.  

• 2025/26: ARRS funding merged into a single £1.7bn pot; role caps removed, giving PCNs full discretion to recruit more pharmacists.

‍

What the role looks like now (after ~5 years)

1. Massive workforce growth

• From a few hundred pharmacists in 2019 to over 8,000 by 2026, making pharmacists the largest ARRS workforce group.  

• Pharmacy technicians also expanded to support repeat prescribing and operational tasks.  

2. Shift from optimisation to clinical management

Pharmacists now routinely deliver:

• Structured Medication Reviews (SMRs)

• Long‑term condition clinics (hypertension, diabetes, AF, respiratory disease)

• CVD prevention work

• High‑risk drug monitoring (DOACs, methotrexate, lithium)

• Care home medication reviews under EHCH frameworks  

3. Independent prescribing becoming standard

Most pharmacists delivering SMRs now hold independent prescribing qualifications, and IP is now a recruitment priority for PCNs.

4. Evidence of impact

Published evidence (2025) shows ARRS pharmacists are associated with:

• Reduced opioid prescribing

• Reduced anxiolytic use

• Lower total medicines spend

‍

Overall feedback after 5 years

Positive outcomes:

• Strong evidence of clinical impact and medicines safety improvements.

• Pharmacists now central to chronic disease management and proactive care models.

• PCNs value pharmacists as core MDT members, not peripheral roles.

• Workforce scale allows strategic planning rather than “just getting someone in post”.

Challenges noted:

• Variation in training, supervision, and deployment models.

• Integration issues when pharmacists are subcontracted rather than directly employed.

• Some PCNs still unclear on optimal use of pharmacist time.

• Rapid workforce expansion created variation in experience and support needs.