Making your ARRS pharmacist roles pay for themselves

Most PCNs now employ pharmacists through the Additional Roles Reimbursement Scheme, and most would say the results are mixed. Some roles transform a network's prescribing workload; others absorb the funding and deliver little that anyone can point to. The difference is rarely the pharmacist. It is almost always how the role was set up.

Define the role before you fill it

The single most common failure is recruiting a pharmacist into a role that was never defined. 'Medicines optimisation' is not a job description. Before the role starts, the PCN should be able to answer, in writing: which practices the pharmacist covers, which workstreams they own (structured medication reviews, repeat prescribing, high-risk drug monitoring, care home rounds), how many sessions go to each, and what they are explicitly not expected to do.

Without that definition, the role fills up with whatever is loudest: ad hoc queries, discharge summaries, tasks nobody else wants. The pharmacist is busy all week and the PCN cannot say what improved.

Supervision is not optional

A pharmacist new to primary care needs structured supervision: a named GP or senior pharmacist supervisor, regular clinical debriefs, and a clear route for prescribing questions. This is particularly true for pharmacists working towards independent prescribing, where supervision is a formal requirement, but it applies to every ARRS role. Networks that treat supervision as an afterthought get cautious pharmacists who escalate everything, or confident ones who escalate nothing. Neither is safe.

Measure output, not activity

ARRS reporting requirements mean every network collects some data, but activity counts (appointments held, tasks completed) do not show value. The measures that show whether a role pays for itself are:

• GP time released: hours of GP work per week now done by the pharmacist, agreed with the practices.
• Structured medication reviews completed, and the changes made as a result.
• Monitoring gaps closed and prescribing safety indicators improved.
• Prescribing cost work delivered against the network's medicines optimisation priorities.

Review these quarterly with the pharmacist. If the numbers are thin, the problem is the role design or the supervision, and that is what to fix.

Why roles underdeliver

Across the networks we work with, the same reasons recur: no defined workstreams, so the role drifts; no supervision, so the pharmacist stalls or overreaches; no protected time, so the role is eroded by practice-level firefighting; and no measurement, so nobody notices until the funding is questioned. All four are management problems, not pharmacist problems, and all four are fixable.

When to outsource the role instead

Employment is not the only way to use ARRS funding, and for some networks it is not the best one. Outsourcing the role to a provider is worth considering when:

• You cannot recruit: the local market has no suitable pharmacists, or previous appointments have not stayed.
• You need the role to work immediately, without a six-month bedding-in period.
• The workstream is defined and time-limited, such as a backlog of medication reviews or a care home programme.
• You want supervision, cover for leave and performance reporting included rather than built in-house.

A good outsourced arrangement delivers the same ARRS-funded sessions with the management overhead already done: defined workstreams, supervised pharmacists, cover arranged, and output reported monthly. For networks that have struggled to make employed roles stick, it is often the fastest route to a role that genuinely pays for itself.