Every practice and PCN that needs clinical pharmacy capacity reaches the same fork. Recruit someone and hold the role in-house, or commission the work from a provider. The decision is usually framed as a cost comparison, and cost is the part that matters least.
This piece sets out what each model actually gives you, what each leaves you holding, and the questions that decide it.
What in-house means
In-house means the practice or PCN recruits a clinical pharmacist or pharmacy technician into the team. The practice owns the relationship and the day-to-day direction of the work. It also owns everything around it: recruitment, induction, clinical supervision, scope of practice, appraisal, indemnity checks, cover for leave and sickness, and the gap when the person moves on.
The upside is real. An in-house pharmacist becomes part of the team, learns the practice’s patients and habits, and can be redirected day to day without a conversation about scope.
What commissioned means
Commissioning means an external provider delivers a defined body of clinical pharmacy work and stays accountable for it. The provider holds the clinical governance, supervises its own clinicians, arranges its own cover, and answers for the quality of what is delivered. You agree what needs doing and to what standard.
The distinction that matters inside this model is between a managed service and staffing support, and providers use both words loosely.
- Staffing support supplies a person and hands the management back to you. You still carry supervision, cover, appraisal, governance and accountability. You have swapped a recruitment task for a management task.
- A managed service supplies a governed outcome. The provider is accountable for its service, including clinical governance, supervision and quality assurance. Individual pharmacists remain professionally accountable for their clinical decisions and any prescriptions they sign. The practice retains its own clinical and regulatory responsibilities.
The practical test is one question: who answers when a review is questioned, a monitoring panel is missed, or a CQC assessor asks about supervision? In a staffing arrangement the honest answer is the practice.
The four things that actually decide it
1. Can you recruit?
Clinical pharmacists are in demand and recruitment and onboarding times vary by role, location and employer. Practices in rural, coastal and island areas draw from a far smaller catchment and often cannot fill the post at all. Where recruitment is slow or has already failed, the comparison is not in-house against commissioned. It is commissioned against nothing.
2. What happens when that person is away?
This is where the models separate most sharply. With one in-house pharmacist, continuity depends entirely on that individual staying. Medication reviews stall during leave, monitoring slips during sickness, and turnover can require another recruitment and onboarding cycle.
A managed service is delivered by a team, so continuity is the provider’s responsibility and the work carries on through leave, sickness and turnover.
3. Who is going to supervise?
A clinical pharmacist in primary care needs clinical supervision, and a pharmacist prescribing independently needs supervision from a prescriber. PCNs without an in-house senior pharmacist frequently end up paying twice, once for the role and again for external supervision.
Under a managed service the supervision structure comes with the clinicians, along with scope-setting, peer review and audit.
4. How wide is the work?
Across a year the demand spans medication reviews, prescribing support, signing prescriptions where the pharmacist is an independent prescriber, discharge and clinic letter actioning, high-risk drug monitoring, audits, QOF medicines indicators and wider medicines optimisation. Resourcing all of that through one in-house hire usually means something gets dropped, because no single person is equally strong across every area.
Where each model wins
In-house works well where the practice can recruit reliably, already has a senior pharmacist who can supervise, has enough steady volume to keep a full-time role busy, and wants someone embedded who can be redirected day to day.
Commissioning works well where recruitment is slow or has failed, where there is no in-house supervisor, where the volume is real but variable, where a defined block of work needs delivering to a deadline, or where a PCN wants one clinical standard across member practices instead of a different position in each.
Plenty of practices run both. An in-house pharmacist covering the daily clinical flow, with commissioned capacity taking defined blocks such as a structured medication review programme, a QOF push at year end, or CQC search preparation.
The cost comparison, done honestly
A salary is not the cost of an in-house role. The real figure includes employer National Insurance and pension contributions, recruitment and advertising, induction time before the role is productive, supervision time from a senior clinician, indemnity, appraisal and CPD time, and the cost of any vacancy while a replacement is recruited and onboarded.
A commissioned service prices the delivered work. The useful comparison is cost per unit of work actually completed across a year, counting the weeks the in-house role was vacant, inducting or on leave.
For PCNs, ARRS reimbursement covers salary plus employer on-costs up to the maximum for the role, subject to the current eligibility, engagement and reimbursement rules. Our ARRS funding guide covers the mechanism.
Frequently asked questions
Is commissioning clinical pharmacy the same as hiring a pharmacist?
Hiring places an individual in your practice and leaves you to supervise, cover and account for them. A managed service delivers a defined body of clinical work with the provider holding governance, quality assurance and continuity, so you are commissioning the work done to a standard.
Who holds clinical governance and CQC responsibility?
CQC registration requirements depend on the regulated activities and delivery arrangements. Where work is delivered within a practice’s registered service, the practice retains its regulatory duties and the provider remains accountable for its own service. Pharmacists are regulated by the GPhC. A managed provider brings its own governance framework, supervision and quality assurance for the clinicians delivering the work.
Can commissioned pharmacists work in our clinical system?
Yes. The work is delivered remotely inside your own EMIS, SystmOne, Vision or Medicus instance against the live record, with documentation landing in the patient notes where your GPs expect to find it.
Does an in-house pharmacist know our patients better?
An embedded pharmacist builds familiarity with a practice’s patients and habits over time, and that is a genuine advantage of the in-house model. A managed service answers the same need through continuity of the clinicians assigned, one agreed pathway and shared documentation templates, which is what keeps quality consistent when an individual is away.
Can we start with a defined block instead of a full contract?
Yes, and many practices and PCNs do. A counted block, such as a set number of structured medication reviews delivered on a fixed fee, gives a measurable result before any longer commitment. Our case studies include several that began this way.
Where to start
Virtual Pharmacist is a managed clinical pharmacy service, commissioned by the practice or PCN. Our guide to outsourced clinical pharmacist support covers what to check before signing anything, and the benefits of a managed service sets out where the model earns its keep.
