An explosion in practice pharmacists has proven fruitful for GP practices across England that have turned to the profession for its expertise and support in medication reviews and patient consultations.

And it seems the benefits are reciprocated, with pharmacists among the most content profession within general practice teams and looking to stay long term.

But as funding continues to be squeezed and appetite for this workforce increases locally, GP practices are now sounding alarm bells over recruitment struggles.

Drawing on the findings of our publisher Cogora’s report into the general practice workforce crisis, Megan Ford explores the situation.

The ARRS

The additional roles reimbursement scheme (ARRS) – used to fund the recruitment of non-GPs to general practice – completely changed the make-up of the general practice team.

In the past, GP practices mostly comprised doctors, nurses and administrative staff. But in the 2010s, the idea of multidisciplinary working in general practice became more prevalent.

In 2014, NHS England launched its ‘Five Year Forward View’, which recommended GP practices becoming ‘multispecialty community providers’, who would employ ‘senior nurses, consultant physicians, geriatricians, paediatricians and psychiatrists to work alongside community nurses, therapists, pharmacists, psychologists, social workers, and other staff’.

In 2015, the first concrete policy change came in with a £15m scheme for GP practices to employ pharmacists.

This became turbocharged in 2019, with the new GP contact. Through the ARRS practices were incentivised to join ‘primary care networks’, groups of practices that would mainly cover populations of 30,000-50,000 patients. It committed £938m extra funding per year by 2023/24, with £1.79 billion directed towards these new PCNs, and predominantly through the ARRS.

This scheme funded the recruitment of non-GPs to general practice, with the 2019 contract providing pharmacists (building on the earlier scheme) and social prescribers in the first year, followed by physiotherapists, physician associates and paramedics in the following years. The scheme has since widened to include occupational therapists, dieticians, podiatrists and mental health practitioners among others, with newly-qualified GPs being added last year by the new government.

This has drastically changed the configuration of the general practice team, and it seems pharmacists have been and continue to be the most popular ARRS role.

Pharmacists now make up a bigger percentage of the workforce – 7% in 2024, compared with 2% in 2019 (chart 1), according to data from NHS Digital. And ‘direct patient care’ staff outside of GPs and nurses (including pharmacists) are also carrying out an increasing percentage of appointments – currently making up almost a third (chart 2).

Latest data from NHS Digital – based on National Workforce Reporting Service submissions – shows there were 5,494 full-time equivalent (FTE) pharmacists employed in December 2024 – with figures climbing month on month. And it suggests pharmacists continue to be the most popular ARRS role.

But while this latest data set shows the practice pharmacist workforce in England has increased by 7.5% between December 2023 and December 2024, it had grown by 32% in the year before – suggesting that recruitment has started to slow.

And of course, a recruitment shift into general practice has had consequences on community pharmacies and in some ways has left the sector vulnerable – but that is an issue that will be explored later in this analysis series.

A recruitment struggle?

Pharmacists are taking on wide responsibilities within general practice such as medication reviews and patient consultations and are developing their prescribing skills, and they are seen as an invaluable member of the team. Indeed, they are the most coveted profession for GP partners and practice managers, the Cogora report suggests.

But it seems that in recent times, GP practices are struggling to recruit pharmacists – largely because of local ‘competition’ and issues related to pay.

Survey findings within the report show there is a pharmacist vacancy rate of 32% across practices in England, as well as a 16% shortfall of GPs and 23% shortfall of nurses.

Practice managers and GP partners are warning that the recruitment of pharmacists had become difficult because of issues connected to pay, a lack of applicants and because local ‘competition’ is seeing pharmacists move between practices and PCNs.

One practice manager in Humber and North Yorkshire says: ‘We’ve been working to invest in our pharmacy team to relieve GPs from prescription admin and medication reviews. But clinical pharmacists and pharmacy technicians are like hen’s teeth.’

Another in Blackpool says they can’t afford to match salaries for pharmacists advertised elsewhere. ‘We had an advert out for a pharmacist for six months without a single applicant. Ideally four pharmacists would work for us.’ Cogora’s report warns ‘this competition leaves practices and PCNs vulnerable to them leaving’.

A GP partner in the Home Counties adds: ‘We have taken on several ARRS paramedics and clinical pharmacists, spent two to three hours per week of my time training them in the ways of primary care, only to have them leave for jobs in other PCNs.’ Another GP partner suggests ‘pharmacists get paid better elsewhere and don’t want to accept the pay being offered by PCNs’.

Much of the situation is pinned on core underfunding, as practices struggling financially are unable to offer competitive salaries or pay rises, and also cannot update their premises to hold more staff.

A workforce wanting to stay

By and large it seems practice pharmacists are content in their roles and want to stay long term.

A survey by The Pharmacist last year revealed almost three-quarters (72%) of those working in general practice or PCNs see themselves working in the sector in five years’ time. In comparison, just 31% of community pharmacist respondents plan to stay in their sector – either in a salaried or contractor role (chart 3).

The Pharmacist survey found that 58 of the 95 practice pharmacists who had left community pharmacy said they made the move because they preferred the work in general practice, while 42 said they wanted to develop their prescribing skills.

Utilising skills was a major factor for those who made the move. One pharmacist in Kent says: ‘I had completed independent prescribing training in community pharmacy, and I wanted to use this skill. I had also reached a glass ceiling in community pharmacy and unable to progress any further. I chose the practice role to allow for this personal development along with better salary and work/life balance.’

Another in Staffordshire says they moved due to ‘pressures in community, underfunded pharmacy contract resulting in fewer staff, with more stress and more services alongside a prescription factory system that didn’t make best use of clinical skills’.

What is to come?

Despite a significant expansion in the practice pharmacist workforce, it’s clear the demand for this workforce continues.

And it’s positive to hear that many practice pharmacists seem content and are pleased in their decision to jump ship to GP practices. With more than seven in 10 wanting to stay over the next five years, this will be music to the ears of practice managers and partners who face a shortage of many staff.

With almost 5,500 in post in England as of December 2024, it will be interesting to monitor how much this continues to climb (or not) over the next 12 months – especially as the trend seems to have slowed and as practices appear to be battling with recruitment issues.

Keep an eye on our dedicated section over the next few weeks for further content on the pharmacy workforce landscape across general practice and community settings.

The full Cogora General Practice Workforce White Paper can be downloaded here

Back to top