DES analysis
What the DES 26/27 means for PCN medicines optimisation.
The short version
Activity is no longer the currency. Outcomes are.
By Zac — Head of Service Development & Training, Bespoke Clinical Services · MPharm, Independent Prescriber · Published 14 April 2026
If you read only one paragraph: the Network Contract DES 2026/27 keeps the same medicines optimisation building blocks — structured medication reviews, high-risk drug monitoring, medicines reconciliation, long-term condition optimisation — but it hardens the expectation that a Primary Care Network can demonstrate clinical change, supervision and scope of practice for every ARRS-funded pharmacy role it claims. PCNs that report volume alone will look weaker at ICB assurance than PCNs that report movement in risk.
That sounds like a reporting problem. It is really a service design problem. You cannot evidence a change you never planned to produce. The PCNs that will have an easy year are the ones that spent Q1 deciding which patients their pharmacy team exists to change, and built the recording around that decision.
1. Structured medication reviews
Targeting is the whole game.
SMRs remain the flagship intervention, and the DES continues to expect them to be delivered to defined priority cohorts rather than to whoever happens to book in. In practice, four cohorts absorb most of the value: people aged 75 and over on ten or more medicines; people on medicines needing routine monitoring where monitoring has slipped; people recently discharged from hospital; and people living in care homes.
What has changed is how thin the margin for untargeted work has become. An SMR delivered to a low-risk, well-controlled patient still consumes 30–40 minutes of pharmacist time and still gets coded — but it will not move a single indicator your ICB is looking at. We now run cohort identification as a technician-led task ahead of the clinical diary, so the pharmacist's list is pre-sorted by risk rather than by availability. The effect on a typical network is not more reviews; it is roughly the same number of reviews producing two to three times the number of prescribing changes.
Practically, that means a searchable, repeatable cohort query in EMIS Web or SystmOne, a named person who runs it monthly, and a recall process that actually gets the highest-risk patients through the door. Most PCNs have the query. Fewer have the recall discipline, and that is where SMR programmes quietly underperform.
2. Supervision and scope
The evidence ICBs will ask for.
Every ARRS role needs a named clinical supervisor and a documented supervision record. This is not new in principle; what is new is how often it is actually being sampled. When an ICB asks a Clinical Director to evidence supervision for a clinical pharmacist, the acceptable answer is a dated log of supervision sessions, a current scope of practice document, an up-to-date GPhC registration check, and — for independent prescribers — a record of what they are and are not prescribing.
The failure mode we see most often is not absent supervision. It is real supervision that was never written down: a weekly conversation with a GP partner that nobody minuted. If you do one administrative thing this quarter, make it a standing supervision template that captures date, supervisor, cases discussed, actions and sign-off. It takes four minutes per session and it is the difference between a comfortable assurance meeting and an uncomfortable one.
Scope of practice matters just as much. A pharmacist without a written scope is a pharmacist whose clinical decisions have no agreed boundary — which is a patient safety issue before it is a contractual one. We define scope per clinician, review it at appraisal, and widen it deliberately as competence is evidenced.
3. Transfer of care
Discharge reconciliation is where the DES and patient safety agree.
Post-discharge medicines reconciliation is the single highest-yield safety intervention available to a PCN pharmacy team, and the DES continues to point at it. The evidence base on discharge-related medication discrepancies has not moved: a substantial proportion of discharge summaries contain at least one unintentional change, and the risk is concentrated in exactly the frail, polypharmacy population your SMR programme already targets.
A seven-day target for reconciliation after discharge is achievable in almost every network, but only if the workflow is owned. Ours runs as a daily technician sweep of discharge documents, triage by risk, pharmacist action on anything involving a high-risk drug or a stopped medicine, and a coded outcome on every case. It is unglamorous and it is the fastest route to a defensible safety story at your next ICB meeting.
4. Reporting
Build the report before you build the rota.
The most common planning mistake is to recruit capacity first and work out the measurement afterwards. Reverse it. Decide the six to eight numbers your PCN will report monthly — SMRs completed by cohort, prescribing changes made, high-risk drug monitoring compliance, discharge reconciliations within seven days, hypertension and lipid control movement, and prescribing efficiency — and then design the clinical week that produces them.
Every PCN we support receives a monthly impact report built on that principle, quality-assured independently of the delivery team. It exists because Clinical Directors are asked to justify ARRS spend in rooms where the pharmacist is not present. The report has to argue for itself.
None of this requires a bigger team. It requires the team you already have to be pointed at the right patients, supervised visibly, and measured on change rather than on throughput. That, in one sentence, is what the DES 26/27 is asking for.
FAQs
DES 26/27 — common questions
What changed for medicines optimisation in the DES 2026/27?+
The emphasis moved further from activity counting towards evidenced outcomes: structured medication reviews must be targeted at defined clinical risk cohorts, supervision must be documented for every ARRS role, and PCNs are expected to be able to show what changed for patients — not just how many reviews were coded.
Does the DES 26/27 change ARRS reimbursement for pharmacists?+
Clinical pharmacists, pharmacy technicians and independent prescribers all remain reimbursable ARRS roles. What has tightened is the evidence trail: PCNs need documented clinical supervision, a named supervisor and auditable scope of practice for each role claimed.
How should a PCN Clinical Director re-plan for DES 26/27?+
Start from the risk cohorts — frailty and over-75 polypharmacy, high-risk drug monitoring, post-discharge reconciliation and uncontrolled long-term conditions. Size pharmacist and technician capacity against those cohorts, then set monthly reporting that proves movement in each.
Related reading
The PCN DES 2026/27 explained
Plain-English summary of the full Network Contract DES.
Structured medication reviews: delivery guide
Cohort selection, workflow, supervision and outcome evidence.
Discharge medicines reconciliation
Running a seven-day reconciliation programme that prevents harm.
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