The first 90 days of a managed clinical pharmacy service follow a set order: agree the scope, set up access and protocols, start the clinical work, then review it together. The pace of each stage is agreed with you, because it depends on the workstreams and the number of practices. This guide describes what happens in each stage, so you know what to expect and what to prepare.
What happens before the first clinical work?
A scoping conversation comes first. You tell us which medicines work you want taken off your GPs, and we agree the workstreams, the protocol and the reporting with you. For a PCN, that conversation is with the clinical director or PCN manager, and we size the volume for each practice.
Prepare three things for this call: your priorities, your list size and your clinical systems. With those, we can describe the service in writing and plan the next stage.
It also helps to say what success looks like at the end of the 90 days. That might be monitoring brought up to date, a first cohort of reviews completed or a QOF register worked to a plan. A clear aim makes the first review straightforward.
Weeks 1 to 2: how are access and protocols set up?
The early weeks set up access, protocols and escalation routes. Our team works remotely through secure, NHS-approved access, arranged through your existing systems in EMIS, SystmOne, Vision or Medicus. At the same stage, we agree:
- The local protocols the team will follow
- The escalation route to your GPs for clinical decisions
- How queries from patients, pharmacies and the practice team reach us
- The coding conventions, so every action lands in the record the way your practice expects
The practice’s part in this stage is mostly approvals: confirming access, signing off protocols and naming the GPs who take escalations. A short meeting with the practice manager and a lead GP usually covers it.
Weeks 3 to 6: what does the first clinical work look like?
The first clinical work usually starts with the areas that carry the most risk, then moves to the practice’s other priorities. Typical early work:
- High-risk drug monitoring that is due or overdue
- MHRA safety alert searches, worked patient by patient
- Discharge and clinic letters waiting for reconciliation
- A first block of structured medication reviews for the cohort you choose
Every patient is assessed individually and every action is coded in your record as it happens. GP actions come back to you through the agreed route.
The first report often arrives towards the end of this stage. It shows the early volume, the outcomes so far and the open GP actions, and it gives the practice a chance to adjust the format before it becomes routine.
Our clinical pharmacist service page describes each workstream in more detail.
Weeks 7 to 10: how does the service settle into a routine?
By this stage the service runs to a regular pattern. The same core team stays with your practice and learns your protocols, systems and patients. Prescription requests and medicines queries follow the agreed route. QOF registers and review cohorts are worked to a plan across the year. Planned work can run at a steady pace, with coordinated recall reviews where appropriate. Some patients need staged reviews, further information, referral or another appointment.
We manage cover for leave and sickness, with continuity arrangements agreed for your practice or network.
Weeks 11 to 13: what should the first review cover?
The first review should compare what was delivered with what was commissioned, and set the priorities for the next quarter. Bring the report, the list of open GP actions and any feedback from the practice team. Useful questions for the review:
- Which workstreams delivered the most clinical value?
- Which registers or cohorts should come next?
- Is the reporting reaching the person who acts on it?
- Should the service widen to more workstreams or more practices?
Write the agreed priorities for the next quarter into a short plan, and share it with the practice team so everyone knows what the service will focus on next.
What does the practice need to do during the 90 days?
The practice sets priorities, answers GP escalations and reads the reports. We run the governance, rota and cover for the service we deliver; the practice retains its own patient-care and governance duties. A named contact at the practice, usually the practice manager, keeps communication quick.
Keep a short record of decisions made during the 90 days, such as protocol changes or new priorities. It becomes part of the governance file the practice holds for the service.
What we see in practice
The first weeks can deliver clear results when the work is focused. Three practices in Northamptonshire came to us with CQC inspection dates already set. At each one, the medicines-safety searches were built, run and worked through inside two weeks. All three practices received medicines-safety support ahead of their inspections. In Lincolnshire, a nine-practice PCN started with a 315-hour block of medication reviews and then moved to a full-year contract.
More examples are on our case studies page.
Ready to plan your first 90 days? Send us an enquiry and we will reply within one working day.
Frequently asked questions
Who sets the priorities in the first 90 days?
The practice or PCN. We agree the workstreams with you at scoping and review them together at the end of the period.
Do we need to provide desk space?
Our team works remotely through secure, NHS-approved access, so no desk space is needed.
Will the same people work on our practice throughout?
The same core team stays with your practice, which is how it learns your protocols, systems and patients.
Can a PCN bring practices in one at a time?
Yes. We size the work for each practice, so a network can start with some practices and add others to the same standard.
What should we prepare for the scoping call?
Your priorities, your list size and your clinical systems. For a PCN, add the member practices and a named lead for the network.
