Medicines optimisation means slightly different things depending on where you sit. To a GP partner it might mean safer prescribing and fewer avoidable admissions. To a PCN clinical director it is structured medication reviews and meeting PCN incentive targets. To an ICB medicines lead it is system-wide spend, variation between practices, and getting the population onto the most clinically appropriate and cost-effective treatments. Each of those views is correct, and each describes the same underlying job at a different level.
This post sets out what medicines optimisation support for ICBs and PCNs actually covers, where the priorities really sit, and how a managed, governed clinical service delivers the work without adding to the burden on already stretched practices.
What medicines optimisation covers at scale
At its core, medicines optimisation is about making sure patients get the best possible outcomes from their medicines. The Royal Pharmaceutical Society frames it around four principles: understanding the patient’s experience, evidence-based choice of medicines, safe use, and making it part of routine practice. That framing holds up well, but at PCN and ICB level the practical work tends to cluster into a few clear areas.
- Clinical medication reviews, including structured medication reviews (SMRs) for patients with complex needs, polypharmacy, frailty, or who are on high-risk combinations.
- Prescribing support across the practice team, from query handling to switches, deprescribing, and formulary alignment.
- High-risk drug monitoring, making sure patients on DMARDs, lithium, amiodarone, anticoagulants and similar agents have the bloods and reviews they should.
- Cost-effective prescribing, including biosimilar and generic switches, reducing low-value prescribing, and aligning to local and national guidance.
- Reducing unwarranted variation between practices in a PCN or across a place.
- QOF and PCN incentive delivery, where medicines-related indicators carry real clinical and financial weight.
- Audit and assurance, so changes are measured and evidenced rather than assumed.
The list looks tidy on a page. In a busy practice it competes with everything else, which is why so much of it slips. The value of doing this at PCN or ICB scale is that the same clinical standards, protocols and reporting can run across many practices at once, so no surgery has to reinvent its own approach.
The priorities: safety, cost, variation, and contractual targets
Patient safety first
Safety is the anchor. Avoidable harm from medicines is a recognised cause of hospital admissions, and a meaningful share of that harm is considered preventable through review and monitoring. At scale, the priority is making sure no cohort falls through the gaps: the patients on three or more high-risk drugs, the ones overdue a lithium level, the elderly patients on a sedative load that no one has revisited in years. Systematic searches across a PCN or ICB surface these patients reliably, which is far harder to do practice by practice when capacity is thin.
Cost-effective prescribing
Prescribing is one of the largest controllable spends in primary care, and ICB medicines management teams are under constant pressure to deliver value without compromising care. Cost-effective prescribing is not about blunt switching to the cheapest option. It means clinically appropriate choices that happen to also save money: biosimilars where the evidence supports them, removing items of limited clinical value, and deprescribing where a medicine no longer benefits the patient. Done well, the saving and the safety improvement point in the same direction.
Reducing variation
Variation between practices is often the clearest signal an ICB has that medicines optimisation effort is needed. Two practices with similar populations can have very different prescribing profiles for the same condition. Some of that variation is justified; much of it is not. Bringing a consistent clinical approach across a PCN or place narrows the unwarranted gap, and it does so in a way that is defensible, because it rests on shared protocols and evidence.
QOF and PCN incentives
Contractual frameworks make medicines optimisation tangible. QOF rewards good chronic disease management, much of which is medicines-led. Incentive schemes delivered through the Network Contract DES, such as the Investment and Impact Fund, have carried medicines-related indicators that reward structured reviews and safer prescribing, and the detail of these schemes changes from year to year. Hitting these is partly a clinical exercise and partly an organisational one: you need the searches, the recall, the reviews, the coding and the reporting all working together. That coordination is exactly where a managed service earns its place.
Why a managed, governed service delivers this at scale
There are broadly two ways to resource this work. One is a staffing model, where individuals are placed into practices and the practice is left to manage, supervise, govern and cover them. The other is a managed service, where an external provider takes responsibility for delivering the clinical work and stands behind its quality.
Virtual Pharmacist operates the second model. We deliver a fully managed, remote clinical pharmacy service to GP practices, PCNs and ICBs, and we hold the clinical governance, quality assurance and accountability for that work. The practice is not handed another person to manage; it receives a governed service with defined outcomes. That distinction matters at scale, because the larger the footprint, the more the overhead of supervision, cover and assurance would otherwise fall on local teams who do not have the time to absorb it.
A few features make this work across a PCN or an ICB:
- Genuinely remote delivery inside your own clinical systems. Our pharmacists and pharmacy technicians work directly in EMIS, SystmOne, Vision or Medicus, so the work happens in the patient record where it belongs, without anyone needing a desk in the building.
- Clinical governance held by us. Supervision, competency, protocols and accountability sit with Virtual Pharmacist. You can see how we approach this on our clinical governance and data security page.
- A national network of GPhC-registered professionals. Because the service does not depend on a single local hire, delivery is resilient. Annual leave, sickness and turnover are our problem to solve, not yours.
- A full information governance stack. NHS Data Security and Protection Toolkit, Cyber Essentials, HSCN connectivity, ICO registration and data sharing agreements are all in place, which is what makes remote working into your systems safe and compliant.
- Breadth across the whole brief. From clinical medication reviews and high-risk drug monitoring to audits, QOF and PCN incentive delivery, and PCN management support, one service can address the full range of medicines work.
What it looks like for a PCN
For a PCN, the practical question is usually how to deliver structured medication reviews and PCN incentive targets consistently across member practices without each one carrying the burden alone. A managed service can run the searches centrally, agree the clinical priorities with the clinical director, deliver the reviews remotely in each practice’s system, and report progress back in a way that supports the Network Contract requirements. The PCN keeps oversight and direction; the delivery and governance are handled. Our medicines optimisation service is built around exactly this kind of multi-practice working.
What it looks like for an ICB
At ICB level the focus shifts towards spend, variation and assurance across a much larger population. A managed service can support place-based or system-wide programmes: targeted prescribing initiatives, high-risk drug safety work, and structured reviews delivered at volume, all under one governance framework with consistent reporting. Because accountability sits with the provider, the ICB gets one defensible, measurable programme. Our ICB medicines management support is designed for this scale, and sits within our wider NHS support offer.
Getting the most from it
Medicines optimisation works best when it is planned ahead. A few things tend to separate programmes that deliver from those that drift:
- Be clear on the priorities up front, whether that is safety cohorts, a specific spend target, or a contractual indicator.
- Use systematic searches so the right patients are found, not just the ones who happen to book in.
- Make sure the clinical work is coded properly so it counts towards QOF and any applicable PCN incentives and shows up in reporting.
- Build in audit so improvements are evidenced and the next round of work is better targeted.
- Keep governance explicit, so everyone knows who is accountable for what.
None of this is complicated. It is the difference between medicines optimisation as a label and medicines optimisation as a delivered outcome.
Frequently asked questions
What is medicines optimisation in primary care?
Medicines optimisation is the work of making sure patients get the best outcomes from their medicines. In primary care that means clinical medication reviews, safer prescribing, monitoring of high-risk drugs, deprescribing where appropriate, and cost-effective prescribing choices, all delivered consistently across a practice, PCN or ICB.
How does medicines optimisation support ICBs and PCNs differently?
For PCNs the emphasis is usually on delivering structured medication reviews and PCN incentive targets consistently across member practices. For ICBs the focus moves towards system-wide prescribing spend, reducing variation between practices, and assurance across a large population. The clinical work is similar; the scale, reporting and priorities differ.
Does Virtual Pharmacist supply pharmacists to our practice?
No. Virtual Pharmacist delivers a managed, remote clinical service and holds the clinical governance, quality assurance and accountability for it. This is different from a staffing model where individuals are placed into a practice for it to manage. You receive a governed service with defined outcomes rather than another person to supervise.
How is the work delivered without anyone on site?
Our GPhC-registered pharmacists and pharmacy technicians work remotely inside your own clinical systems, EMIS, SystmOne, Vision or Medicus, so the work happens directly in the patient record. This is underpinned by an information governance stack including the NHS Data Security and Protection Toolkit, Cyber Essentials, HSCN connectivity, ICO registration and data sharing agreements.
Can a managed service help with QOF and PCN incentives?
Yes. Medicines-related QOF and PCN incentive indicators depend on searches, recall, reviews, accurate coding and reporting all working together. A managed service coordinates that across practices, which is often where the gaps appear when capacity is stretched.
Related reading
- What ICBs are asking of medicines optimisation teams in 2026/27
- Pharmacists working at scale across PCNs and federations
If you are an ICB medicines lead, PCN clinical director, GP partner or practice manager looking at medicines optimisation across one or many practices, we would be glad to talk through what a managed, governed service could deliver for you. Contact Virtual Pharmacist to discuss your needs.
