Pharmacists in general practice are popular with patients and with GP employers – but their recruitment from a struggling community pharmacy sector has left its mark.

As community pharmacy looks towards a more clinical future, senior reporter Joanna Robertson speaks to community pharmacists to find out how they feel the Additional Roles Reimbursement Scheme (ARRS) has impacted them, and what could be next for pharmacist employment across both settings.

Analysis of GP workforce data suggests that 7,755 full-time-equivalent pharmacists (FTE) – including advanced pharmacist practitioners – are currently working in general practice and primary care network (PCN) settings.

Around 5,500 of those are employed by PCNs, suggesting that their roles might have been enabled by the ARRS funding.

The scheme was introduced in 2019, with the intention of recruiting six full-time equivalent clinical pharmacists per PCN, which equates to approximately 6,000 to 7,500 pharmacists in total.

But community pharmacists have said the scheme has directly led to staffing difficulties in the sector, with several reporting losses of pharmacists, pharmacy technicians and other pharmacy team members to ARRS roles.

PCNs can apply to their integrated care board (ICB) to receive funding for ARRS roles, which is additional to the core GP/PCN contract funding.

The role has proved popular with GP employers, with pharmacists the most coveted role under ARRS, valued for their expertise and support in medication reviews and patient consultations.

But community pharmacy leaders have argued pharmacies could and should be funded to do the same.

'ARRS has directly impacted our workforce in the community'

Andrew Hobson, Superintendent Pharmacist at Gompels Pharmacy in Melksham, Wiltshire, told The Pharmacist that in the last few years, he had seen two pharmacists, two checking pharmacy technicians and two accuracy checking dispensing assistants within his employer move to ARRS roles.

'It had quite an impact on our workforce directly,' he says, explaining that prior to the ARRS scheme, GP practices had not been looking to recruit pharmacy teams.

'At the moment, there doesn't seem to be any evidence that people are coming back from GP practice back into community,' he adds.

'There's still a lack of workforce within the GP surgery, and that is still draining community.’

The Pharmacist’s recent survey found that GP and PCN employers would want to recruit more pharmacists to work in general practice if they were able to.

And of 101 general practice and primary care network (PCN) pharmacists who had previously worked in community, 80% said new clinical services like Pharmacy First had not made them reconsider working in the community pharmacy sector.

'Community pharmacy needs to change to attract and retain the workforce'

Mr Hobson says the ARRS roles are good inasmuch as they helped pharmacists to develop more clinical skills.

'But equally, we can, and we do, develop those clinical skills in the community, and then retain that knowledge on the high street for patients to be able to consult and patients to get the benefits of,' he says.

But he said that community pharmacy needed to change to be attractive to pharmacists in the future.

'One of the main reasons [that pharmacists choose to work in GP surgeries] is that it's just a lot calmer,' he says.

And he suggests that pharmacies might also move to more appointment-based models with the development of more clinical services in the sector.

Mr Hobson also says that with pharmacists qualifying as prescribers at the point of registration in 2026, the community pharmacy sector needed to 'utilise' those skills.

'I'm passionate about community pharmacy. I've been offered jobs in surgeries, but I don't want them. I want to keep our foot in the high street; I think that's where we're most successful, and where we can do the best work. And I think we're slowly getting there, developing that professionalism and those opportunities in the community,' he tells The Pharmacist.

'We train pharmacy technicians and then they leave for ARRS roles'

Contractor Mitesh Patel, owner of Kirkby Pharmacy in Sutton, Greater London, says he has seen the impact of ARRS on both pharmacy technicians and pharmacist roles, with several within his local area leaving community pharmacy for ARRS roles.

'Initially, it did have a huge impact', he says.

'We're a training site for technicians, sponsored by NHS England. The problem is, you train somebody for two years, it's a big commitment, and then they leave to go into an ARRS role... you weren't really getting any return on investments,' he adds.

'It's not because they were unhappy with their job... we can't compete with some of the wages that the ARRS [pharmacy technicians] are getting paid,' he says.

'I can't say, “don't go for an ARRS role” because I have a foot in both camps'

But he says that although he owns a community pharmacy, he also works as an ARRS pharmacist two days each week.

'I have a foot in both camps... I can't blame them. I can't hand on heart say, "don't go for an ARRS role".

'It's a difficult one because I'm a prescriber, and I don't get to use my prescribing as much as I would like in community, because the structure is not there.

'[In an ARRS role] I get to do all sorts – heart failure and asthma and COPD and I'm able to prescribe fully for these things.

'But [ARRS has] definitely had an impact on my community pharmacy as well. And that's where the problem is.'

'I think we've reached an equilibrium'

However, Mr Patel says he thought the recruitment of pharmacists into general practice had stabilised recently.

When the scheme was first introduced, he said that pharmacist locum rates in community pharmacy became 'almost unaffordably high, due to simple economics of supply and demand'.

But more recently, locum rates have become 'more reasonable', suggesting that GP recruitment of pharmacists had 'reached an equilibrium'.

And he said he would be interested to see whether the removal of ringfencing for ARRS funding recently announced would lead to pharmacists being recruited in fewer numbers in favour of other roles.

The Pharmacist’s analysis of the latest workforce figures suggest that pharmacists remain the most popular ARRS role, but recruitment has slowed dramatically since the beginning of this financial year.

'It's a really exciting time in community pharmacy'

Changes in community pharmacy might also be making the sector more attractive to pharmacists, Mr Patel suggests.

'At the moment, it's a really exciting time. Lots of clinical services coming... the new graduates will be IPs, so they'll be keen to do that.

'We're an IP pathway site as well. So, we are prescribing in community, which is fantastic.’

Regulatory changes relating to supervision and skills mix, enabling less time spent dispensing, were also making community pharmacy 'a really exciting, vibrant place to be at the moment and really at the forefront of pharmacy', Mr Patel says.

'It's really wonderful to see this budding and fruition of the last few years of workforce planning,' he adds.

'Unless there's a drastic change in funding for community pharmacy, we won't be able to change'

'I feel optimistic about the future in one sense, in terms of what community pharmacy can offer, and how much impact it can have,' Mr Patel tells The Pharmacist.

'The flip side of that is it needs to be funded. It's great having the ability to offer these services, but without the correct funding and remuneration, we will continue to lose staff to other sectors, and we won't be able to do a good job – the job that we should be able to do as a first point of access.

'Unless there's enough funding, [community pharmacies] won't be able to offer the services, because they can't do everything. They still have their day-to-day traditional role of checking medications... [and with] the number of community pharmacies that are closing, [there is] less and less access to high street chemists.

'Unless there's a drastic change in funding for community pharmacy, that special place that community pharmacy holds acting as pillars of healthcare is going to disappear completely,' he warns.

We want to see clinical care 'coming back to community pharmacy'

Michael Lennox, integration lead at the National Pharmacy Association (NPA), suggests that the government's new NHS 10 Year Plan and plans for a new Community Pharmacist Prescribing Service could be an opportunity to see delivery capacity for pharmaceutical care ‘coming back to the community pharmacy setting’.

And he suggests that new neighbourhood guidance could be an enabler for GPs, PCN pharmacists and community pharmacy ‘to work in true multidisciplinary teams, rather than being in competition with each other for staff and some services’.

He tells The Pharmacist that ‘in many places’, the ARRS ‘has had the unintended effect of stripping skilled people from community pharmacy, the most accessible part of the healthcare system’.

‘Many GPs and local healthcare systems recognise the growing importance of pharmacists in helping to meet ever-increasing patient demand and optimising medicines use.

‘However, ARRS only makes sense where it adds to total capacity,’ Mr Lennox says.

The most recent Community Pharmacist Workforce Survey, conducted by NHS England in 2023, suggested a decrease in the number of qualified pharmacists and pharmacy technicians working in community pharmacy in England between 2022 and 2023.

'Not enough community pharmacists for the work that community pharmacists can and should be doing'

Marc Donavan, chair of the Community Pharmacy Workforce Development Group (CPWDG), says that a shortage of pharmacists was ‘almost impossible to prove one way or the other’.

‘It's a very complex picture, and we don't have enough visibility of the workforce dynamics to decide whether there's a shortage in one sector or not,’ he says.

‘The reality, though, is that there are not enough community pharmacists for the work that community pharmacists can and should be doing.’

Regarding funding, he says: 'We have to stabilise the network. We have to ensure the network is renumerated appropriately. And once that is the case, we should be looking at how we use our assets, mainly our workforce, brilliantly in the future, to deliver more services within community pharmacy.’

'Inherent unfairness' in allocating ARRS funding to PCNs

Mr Donavan says there is an ‘inherent unfairness’ in PCNs and GP practices receiving additional funding for pharmacists to work in these settings, when the same was not available in community pharmacy.

‘We would like to see more fairness in the allocation of ARRS, i.e., it's available to community pharmacy employers as well as PCN and GP practices,’ he says on behalf of the CPWDG, which brings together equal representation from the Company Chemists’ Association (CCA), NPA and Independent Pharmacies Association (IPA).

Portfolio working 'could be the next step of reform for primary care'

And he suggests that having ARRS funding available for community pharmacy employers, to encourage cross-sector portfolio roles, could be ‘the next step for reform of primary care’.

‘It would then lay the foundation for further community pharmacy services to be developed and commissioned,’ he says.

'That is quite an exciting model, because it evolves and transforms the role of community pharmacy,' he says.

The ARRS scheme 'encourages, at its core, cross functional working across primary care', says Nr Donavan.

'And we know that pharmacists want that, and we know that to reform primary care, we do need more interplay between the sectors.’

Since the ARRS, ‘we have seen the establishment of a third sector’ of an increased number of pharmacists working in general practice, Mr Donavan adds.

‘I think that is a sign of a healthy profession.’

Using ARRS to enable portfolio careers would also suit a changing workforce with a ‘completely different’ attitude to employment compared to older generations, Mr Donavan says.

‘They don't in the main work full-time in a single sector, and they want this diversity of experience and of capabilities.

‘We should, as employers from community pharmacy as well as general practice and PCN land, find mechanisms to encourage that,’ he says.