The best way to manage winter pressures in primary care is to move planned medicines work forward. Reviews, monitoring and prescription changes that are finished by the end of November free GP and nurse time for the same-day demand that arrives in December and January. This article sets out what to bring forward, how to plan for the holiday period and how a practice or PCN can add medicines capacity for the season.
Why does winter change the medicines workload in general practice?
Winter adds urgent demand while the planned work stays the same. Respiratory infections, flu and norovirus bring more same-day appointments, and more patients are discharged from hospital with changed medicines. At the same time, blood monitoring, medication reviews and repeat prescriptions still fall due on their usual cycle.
NHS England’s winter planning letter for 2026/27 asks ICBs to commission enough primary care capacity for winter, including same-day urgent appointments and cover over Christmas, alongside the seasonal vaccination campaigns. For a practice, the practical response is to clear the medicines work that can be scheduled, so clinical time is free for the work that cannot.
Which medicines work should be finished before December?
Finish the work that has a fixed due date and a clinical risk if it slips. In most practices that means:
- High-risk drug monitoring that falls due between December and February, identified and booked in advance at the clinically appropriate intervals
- Structured medication reviews for patients with complex polypharmacy or frailty, who are more likely to need urgent care in winter
- Safety alert searches and any outstanding actions from them
- Medication review dates that will expire over the holidays, so repeats are not blocked when the practice is busiest
A single search for everything due in the next four months gives you the list. Our high-risk drug monitoring service works through that list inside your clinical system, books the tests and codes each outcome.
How do respiratory reviews help over winter?
Respiratory reviews completed in the autumn put patients into winter with the right medicines and the knowledge to use them. A review for a patient with asthma or COPD can check inhaler technique, confirm that the treatment matches current guidance and make sure the patient has a written plan for a flare-up agreed with the practice.
Reviews are also a good moment to check vaccination status and point the patient to the seasonal campaign. NHS England’s Core20PLUS5 approach names COPD as a focus area, with vaccine uptake as a way to reduce infective exacerbations and emergency admissions. Where respiratory reviews are planned by risk, the patients most likely to need urgent care in January are seen first.
How should practices handle repeat prescriptions over Christmas and New Year?
Plan repeat prescriptions around the closure dates. Two or three weeks before Christmas, send patients a clear message about ordering early, and make sure review dates will not block a repeat during the holidays. Requests that arrive early are easier to handle when the prescribing team has already cleared any backlog of queries.
Community pharmacies see the same spike, so agree with them how early and late requests will be handled. A short checklist for reception and prescription clerks, covering the last ordering dates and who handles queries on each day, keeps the process calm.
What happens to discharge letters and medication changes in January?
January brings a rise in discharge letters, and each one may carry a medication change that needs to reach the repeat record. Medicines reconciliation should be done promptly, so the next prescription reflects what the hospital changed. Planning for this means setting aside prescribing time in the first weeks of January and agreeing who picks up letters on each working day.
Triage all letters by clinical risk and the urgency of the required action, including changes to high-risk medicines, anticoagulants or insulin. A daily count of letters waiting, shared with the practice manager, shows early whether the pace is keeping up. Where the count starts to grow, extra prescribing sessions can be added for a fortnight before the backlog affects the next round of repeat requests.
How can a PCN add medicines capacity for winter?
Commission a defined block of medicines work with a clear scope and a finish date. A block can cover a counted number of medication reviews, a monitoring backlog or a set number of hours across member practices. Because the work is described in advance, it starts on patients and not on planning.
A managed service suits seasonal work because the provider is responsible for continuity. Our clinical pharmacist service is delivered by a core team that stays with your practice, with cover for leave and sickness arranged by us. We work remotely in EMIS, SystmOne, Vision and Medicus, so a PCN with a mix of systems can run one plan across every practice.
What we see in practice
Counted blocks of work suit the months before winter. In Norfolk and Waveney, a PCN commissioned 1,000 structured medication reviews to be delivered between October 2025 and March 2026, and they were delivered on time. In Somerset, a PCN commissioned a 287-hour block of medication reviews and then extended it. In both cases the scope was agreed at the start, so the work ran to a plan through the busiest months.
We have supported 375+ GP practices and 88+ PCNs in 23 ICB areas across all seven NHS regions since 2021. Our team of 100+ GPhC-registered pharmacists and technicians works under one clinical governance framework, and 85% of our pharmacists are independent prescribers.
Planning your medicines work for winter? Send us an enquiry and we will reply within one working day.
Frequently asked questions
When should a practice start planning medicines work for winter?
Start planning in September or October. Identify reviews and monitoring due over winter, prioritise by clinical need and book tests at the appropriate intervals.
Which patients should be reviewed first before winter?
Prioritise by individual clinical risk, including monitoring that is due, respiratory review needs, frailty and complex polypharmacy. Agree the order and timing with the practice.
Can remote pharmacists help with winter demand?
Yes. Our pharmacists work inside your clinical system by secure remote access, so they can review patients, reconcile discharge letters and handle prescription queries during the busiest weeks.
Can a PCN commission winter support for some practices and not others?
Yes. We size the work for each member practice, so a network can cover the practices under the most pressure first and add others later.
