Prescribing pharmacists are delivering beyond their pay grade

Across the country, prescribing pharmacists have become integral to delivering patient care in general practice. They are managing long-term conditions, running clinics, performing structured medication reviews (SMRs), supporting urgent care and meeting quality and outcomes framework (QOF) targets. Many are also designated prescribing practitioners (DPPs), supervising the next wave of prescribers and shaping safer prescribing systems across the board.

The Additional Roles Reimbursement Scheme (ARRS) was introduced in 2019 to help open the door for pharmacists in primary care. It brought pharmacists into general practice at scale, created new roles and gave the profession visibility. However, the same framework has begun to constrain that value over time. Capped salaries, rigid funding structures and a narrow scope of reimbursable activity risk reducing independent prescribers to box-tickers — rather than recognising them as autonomous, outcome-driven clinicians.

Under the latest GP contract, the maximum ARRS reimbursement for pharmacists is £66,972 — a 1.7% uplift. On paper, it’s an increase, but in practice, it does not reflect the scope or complexity of what pharmacists now deliver — nor does it match the flexibility or earnings available in alternative roles. While national data on locum rates vary, the perception is clear: ARRS is becoming a stepping stone, not a sustainable clinical career. 

If pharmacists feel boxed into static roles with capped earnings, the NHS may lose the very professionals it has invested in. If funding continues to lag behind clinical reality, ARRS may become a revolving door. Pharmacists join, gain experience and move on towards more rewarding roles in private remote clinics, consultancy or elsewhere. This creates instability for primary care networks (PCNs) and undermines long-term workforce planning.

At its core, this is about professional value. Pharmacists have always struggled with under-recognition and rigid frameworks, such as ARRS risk, reinforcing that mindset. When skilled clinicians manage entire patient cohorts, supervise others and improve outcomes — but are rewarded as if they’re still in supportive roles — it sends a clear message: your continuous development does not matter and your leadership is not needed. 

For pharmacists taking on additional responsibility, the lack of progression or incentive feels disconnected from reality. 

Mismatch between funding and reality

The ARRS was originally designed to introduce structured, supportive posts to reduce GP workload. At the time, this made sense. However, the role of pharmacists in general practice has evolved. Many now function as first-contact clinicians, managing chronic diseases, delivering QOF work and high-risk triage/clinic work — yet ARRS has been devalued to predefined outputs, such as SMR delivery, not the complexity or strategic value of care delivered.

The result is a structural mismatch. ARRS is too rigid to reflect real-world scope and autonomy. While other clinicians — including advanced nurse practitioners and allied health professionals — are also banded, they are increasingly deployed both within and outside of ARRS. What was once a funding mechanism has become the default career pathway, limiting not just pay but perception.

There’s also a legacy issue at play: ARRS arguably overcorrected in trying to distinguish pharmacists from GPs, but this distinction is now outdated. As prescribers, with long-term patient contact and clinical experience, pharmacists are increasingly able to assess, initiate and optimise treatment. Historically, referring on and sick notes were seen as boundaries of practice — now, we’re able to deliver those following an in-depth assessment. That shift improves patient access, accuracy and safety — but is yet to be recognised in funding terms.

Step one: raise the ARRS cap. The current ceiling of £66,972 is well below what’s fair for pharmacists delivering high-impact, patient-facing care. A more appropriate benchmark for England sits around £72,000–£75,000, aligning with the Agenda for Change upper Band 8a/early Band 8b range. This figure reflects inflation-adjusted earnings, increased responsibility and parity with similarly skilled clinicians.

Independent prescribing pharmacists typically earn £300–£350 per day. Adjusted for inflation since 2021 (16.2%), that’s £348–£406 — or £35-£41 per hour — before accounting for added responsibilities, such as DPP supervision, quality improvement leadership or any system redesign work.

These conversations are even more pressing now. From April 2025, newly qualified GPs and practice nurses will join the ARRS scheme, intensifying competition for the same capped funding. Without specific safeguards, pharmacist roles risk being deprioritised within PCNs.

Correcting the cap is only part of the solution. The bigger issue is the absence of a progression framework. We need a layered model that enables clinical advancement within salaried structures. That could include top-up payments to PCNs for pharmacists taking on training, leadership or population health work — or a revision of ARRS that recognises clinical complexity and scope. 

While partnership is a valuable route that can run alongside clinical work, it cannot be the default. Not all practices offer it, and not all pharmacists want to take on those responsibilities. Clinical progression must be possible within the roles that the NHS actively commissions.

Affordability is also a fair concern. Underfunding a role that improves outcomes, trains new clinicians and reduces pressure on GPs is not a saving — it’s a shortfall. Investment in pharmacists has already delivered results, now it’s time the funding model caught up.

Recognition, progression and the future

This conversation is about more than money, it’s about identity. Pharmacists in general practice have demonstrated their clinical value. Now the profession needs to advocate for recognition that matches it, even if it means we are stood next to our GP colleagues.

Pharmacy teams must push for flexible role design and share outcome data — including audits, QOF impact or patient experience metrics — to reinforce the clinical and economic value pharmacists bring. That might mean leading deprescribing initiatives or in-house treatment services. It means stepping into spaces not because we’re told to, but because we belong there and our clinical minds know that this is where change is most needed.

For those already in these roles and contributing to this work and this space: keep shaping them. Others are watching, so is the system.

Prescribing pharmacists are not just here to tick boxes — they’re managing complex care, improving access and driving change. ARRS was never meant to be the ceiling, and if it becomes one, we risk flattening the very progress it enabled.

With NHS England now absorbed into the Department of Health and Social Care, the responsibility to reform workforce funding sits firmly within government. If ever there was a time to rethink how we value clinical pharmacy, it’s now.

It’s time to raise the cap, build a pathway for progression and reward those taking on added responsibility.