Why staffing supply is the wrong model — and what to replace it with.

By Amar — Founder & Managing Director, Bespoke Clinical Services · MPharm, 25+ years NHS primary care · Published 6 May 2026

When the Additional Roles Reimbursement Scheme opened up pharmacist funding to Primary Care Networks, the market did the obvious thing: it started selling pharmacists. Agencies placed them, PCNs paid for them, and everyone assumed that a qualified clinician in a seat would translate into medicines optimisation. In a meaningful number of networks, it did not.

The reason is structural rather than personal. The pharmacists are good. What is missing around them is everything that turns an individual clinician into a service: a defined patient cohort, a supervision line, an agreed scope of practice, a recall process, cover when they are on leave, CPD that keeps their prescribing current, audit that checks the work, and a report that proves the whole thing was worth the money. A staffing supplier sells the clinician and leaves all nine of those to the PCN — usually to a Clinical Director who is already running practices, chairing the board and doing clinical sessions.

So the pharmacist arrives, gets pointed at the queue of tasks nobody else wants, and within a quarter is doing medication queries and repeat authorisations. Useful work. Not the work ARRS is for.

The model we built at Bespoke Clinical Services starts from the opposite end. Before anyone is deployed, we agree with the Clinical Director what the pharmacy team exists to change over twelve months — typically frailty and polypharmacy in the over-75s, high-risk drug monitoring, post-discharge reconciliation, and one or two long-term condition domains where the network is behind. Everything else is designed backwards from that.

The clinician then arrives inside a structure: weekly supervision from a senior BCS pharmacist, a written scope of practice, standardised templates and search queries, a technician doing cohort identification and recall so the pharmacist's list is pre-sorted by risk, guaranteed cover for leave and sickness from the hub, an in-house CPD curriculum, independent quality assurance sampling the clinical work, and a monthly impact report that goes to the Clinical Director whether the numbers are flattering or not.

That last point matters more than it sounds. Quality assurance that reports into the delivery team is not quality assurance. Ours is deliberately separate, which occasionally makes internal conversations uncomfortable and consistently makes the reports credible when an ICB reads them.

PCNs comparing options often compare a supplier's day rate against a salary, which understates in-house cost substantially. The honest comparison includes employer on-costs, recruitment fees and the months a post sits vacant, the GP partner hours consumed by supervision, CPD and study leave, cover for absence, the cost of turnover in a competitive pharmacist market, and the management time spent on appraisal, governance and reporting.

Add those up and the gap narrows or disappears — and the risk profile is entirely different. A managed service does not stop delivering when one person resigns. That continuity, more than price, is what Clinical Directors tell us they were actually buying.

Whether you go in-house, use an agency, or commission a managed service, these four questions separate a service from a supply arrangement. First: who supervises this pharmacist, how often, and can I see the log? Second: what happens on the day they are off sick? Third: who audits their clinical work, and are they independent of the people who delivered it? Fourth: what will you report to me every month, and does it describe patient change or staff activity?

If a provider cannot answer all four crisply, you are buying hours. Hours are the wrong unit. Outcomes are the unit your ICB is asking about, your patients experience, and your ARRS allocation was created to produce.