Pharmacists working at scale deliver the same medicines workstream across many practices, PCNs or a federation, using one protocol, one set of searches and one governance framework. The approach makes results comparable across practices and lets a programme that works in one place be repeated in the next. National policy points the same way, with larger neighbourhood providers expected to take on work across whole footprints.
What does working at scale mean for pharmacists?
Working at scale means one clinical approach delivered across a population larger than a single practice. The scale might be a PCN, several PCNs in a neighbourhood, a federation or a programme running across an ICB area through its practices. Each practice keeps its own patient record, and the pharmacists apply the same protocol in each one.
The difference from practice-by-practice working is consistency. When every practice uses the same searches, the same review template and the same coding, the results can be added together, compared and used to decide where the work goes next.
Why is at-scale working growing?
At-scale working is growing because national policy is building larger delivery footprints. The 10 Year Health Plan, published in July 2025, describes multi-neighbourhood providers covering 250,000 people or more, working across all GP practices in their footprint and offering data analytics and quality improvement. It notes that GP federations already play this role in some places.
The Neighbourhood Health Framework, published in March 2026, adds a prescribing dimension. It states that from September 2026 all newly qualified pharmacists will be qualified to prescribe independently, and that managing demand in primary care will increasingly rely on pharmacy teams, including prescribers. The Medium Term Planning Framework asks ICBs to address problematic polypharmacy and to prioritise best-value medicines, both of which are population-level programmes.
Which medicines work suits an at-scale model?
Medicines work suits an at-scale model when the same clinical question applies to patients in every practice. Good examples include:
- Structured medication reviews for a defined cohort, such as frailty or multiple long-term conditions
- Problematic polypharmacy reviews
- High-risk drug monitoring sweeps
- Best-value switch programmes, applied only where clinically right
- Searches in response to medicines safety alerts
- Discharge medicines reconciliation
Our guide to structured medication reviews covers the review format, and our article on high-risk drug monitoring covers the monitoring side. Work tied closely to each practice’s own processes, such as repeat prescribing and medication queries, can still be delivered at scale, with each practice’s protocol written down first.
What makes at-scale pharmacy work safe and consistent?
At-scale work stays safe and consistent when the method is fixed before the first patient is reviewed. The elements that matter:
- One protocol, signed off by the commissioning organisation’s clinical lead
- Standard searches and coding, so results count the same way in every practice
- A clear escalation route to each patient’s GP
- Clinical supervision and peer review under one governance framework
- Regular audit of a sample of completed reviews
- Independent prescribers making agreed changes within their competence
Independent prescribing lets many agreed changes be completed within the review, which keeps work moving across a large number of practices. Our article on independent prescribing pharmacists explains how prescribing fits into primary care work.
How should results be reported at scale?
Results should be reported at every level the commissioning organisation needs: per practice, per PCN or neighbourhood, and for the whole programme. Useful measures include reviews completed, changes made, follow-ups due and patients kept on current treatment, with the outcomes coded in each practice’s record.
The same format each period makes trends easy to see. It also shows where practices differ: if one practice has far more patients waiting for monitoring than its neighbours, the programme can move capacity there in the next period. A short written summary alongside the figures helps a board or clinical lead read the results without going through every line.
Our article on aligning PCN medicines work with ICB objectives covers how to report outcomes in a form commissioners can use.
How does a managed service deliver at scale?
A managed service can deliver at scale because the governance, cover and method sit with one provider. Our clinical team includes more than 100 GPhC-registered pharmacists and pharmacy technicians working under one clinical governance framework, and 85% of our pharmacists are independent prescribers. We work in EMIS, SystmOne, Vision and Medicus, so one programme can span practices on different systems.
Delivery is remote, in each practice’s own clinical system, with a core team that stays with the programme and cover for leave arranged by us. Our remote clinical pharmacist services article explains how remote delivery works day to day.
What we see in practice
At-scale results come from repeating one method. In a nine-practice Lincolnshire PCN, we delivered 315 hours of medication reviews to one pathway across all nine practices, and the PCN then moved to a full-year contract. A Norfolk and Waveney PCN received 1,000 structured medication reviews between October and March. A Derbyshire practice claimed £2,960 through an ICB enhanced service for anticoagulant switches, with 37 of 65 screened patients switched, and we then ran the same model in a second ICB area.
We have supported 375+ GP practices and 88+ PCNs, with practices and PCNs in 23 ICB areas across all seven NHS regions. See our case studies for the detail.
Related reading
- GP federations and integrated neighbourhood teams: how medicines work is organised
- What ICBs are asking of medicines optimisation teams in 2026/27
- Medicines optimisation support for ICBs and PCNs: delivering it at scale
Planning medicines work across several practices? Send us an enquiry and we will reply within one working day.
Frequently asked questions
Does working at scale lose local knowledge?
Local knowledge is built into the protocol and read from each practice's record. Practice-specific ways of working are written down at the start, so the same standard fits each practice.
Can pharmacy technicians work at scale too?
Yes. Technicians take on work such as searches, reconciliation and monitoring recalls, so pharmacist time goes to clinical review and prescribing.
How many practices can one programme cover?
Programme size follows the scope the commissioning organisation sets. We size the work for each practice, so one programme can run to the same standard across a whole network.
Can one programme run across different clinical systems?
Yes. We work in EMIS, SystmOne, Vision and Medicus, and one programme can include practices on different systems.
Where does the patient record sit?
The record stays with each practice. Every review and change is coded in the practice's own system.
Does at-scale working suit a single PCN?
Yes. A PCN is often the first footprint for at-scale work, and the same protocol can later extend to neighbouring PCNs or a federation.
