Lessons from the Primary Care Phased Investment Programme (PCPIP)
Authors: Dr. Farhana Haseen, Lead Health Services Researcher; Niamh Palmer, Improvement Advisor, and Colleagues from Primary Care Improvement Portfolio.
Author affiliations: Healthcare Improvement Scotland, NHS Scotland, UK.
When Scotland’s 2018 General Medical Services (GMS) contract set out a vision for multidisciplinary teams (MDTs) in primary care, pharmacotherapy services were identified as a key part of the team. Pharmacists, pharmacy technicians and pharmacy support workers (PSWs) were expected to work more closely with general practices, helping to manage medicines, improve medicines safety and patient care, while also supporting wider primary care capacity. However, despite significant national investment, implementation has varied across Scotland, and evidence on the most effective approaches has remained limited.
To help address this evidence gap, the Scottish Government commissioned the Primary Care Phased Investment Programme (PCPIP), led by the Primary Care Improvement Portfolio at Healthcare Improvement Scotland, to explore whether additional investment, combined with structured quality improvement (QI) support, could accelerate implementation of pharmacotherapy and Community Treatment and Care (CTAC) services. Between 2024 and 2026, four diverse sites (NHS Ayrshire & Arran, NHS Borders, Edinburgh City HSCP and NHS Shetland), contributed to a mixed-methods evaluation, combining qualitative and quantitative approaches to assess progress, understand implementation experiences, and generate learning to support future service development across Scotland.
Across the programme, pharmacotherapy services were delivered through a range of models, including practice-based teams, centralised hubs and hybrid arrangements. The variation in local approaches provided a valuable opportunity to understand how services operated in urban, rural and islands settings and to identify the practical challenges and enablers associated with implementation.
A service making a difference
Across the programme, pharmacotherapy teams demonstrated the important contribution the wider pharmacy workforce can make to primary care. GPs particularly valued the support provided by pharmacists and pharmacy technicians in delivering level 1 pharmacotherapy tasks, which helped to make their workload more manageable.
Understanding Pharmacotherapy Services in Scottish Primary Care
| Level | Pharmacists | Pharmacy Technicians |
|---|---|---|
| Level 1 (core) | Acute and repeat prescribing requests, hospital Immediate Discharge Letters, medicines reconciliation, medicine safety reviews/recalls, high-risk medicines monitoring and non-clinical medication review | Monitoring clinics, patient’s own home medication compliance reviews, care-home medication management advice and reviews, formulary adherence and prescribing audits |
| Level 2 (additional - advanced) | Medication reviews and resolution of high-risk medicine problems | Non-clinical medication review, medicines shortages and pharmaceutical queries |
| Level 3 (additional - specialist) | Polypharmacy reviews and specialist clinics | Medicines reconciliation and telephone triage |
Source: Scottish Government. GMS Contract 2018, Core and Additional Pharmacotherapy Services.
The expansion of pharmacotherapy hubs enabled teams to complete medicines reconciliations for a greater number of practices. Sites also increased the proportion of PSWs within their teams. By undertaking administrative and process-driven tasks, PSWs reduced the workload of pharmacy technicians and pharmacists, enabling them to concentrate on technical and clinical activities. This more effective use of skill-mix improved workforce efficiency strengthened service resilience and supported better deployment of professional expertise across the pharmacy team. As a result, pharmacy technicians and pharmacists were able to dedicate more time to complex pharmacotherapy care. Throughout the programme, opportunities to further develop the pharmacist role were explored. As services matured, many sites evolved workforce models beyond a primary focus on Level 1 activities. While Level 1 delivery provided an important foundation and often reflected local circumstances and workforce availability, the evaluation suggested that, where skill mix and capacity allowed, greater benefits could be realised by enabling pharmacists to undertake more advanced clinical activities. This included Level 2 activities, such as medication reviews and resolving high-risk medicine problems, and Level 3 activities, including polypharmacy reviews, specialist clinics and support for complex care. This highlighted the value of service models that enable pharmacists to make full use of their clinical skills and expertise, maximising their contribution within multidisciplinary teams.
Different service models also showed benefits. Practice-based teams, hub models and hybrid approaches improved efficiency, strengthened resilience and supported more effective use of workforce capacity. Services reported improvements in medicines reconciliation, prescribing workflows, medicines monitoring and polypharmacy reviews, alongside a clearer understanding of the role of pharmacy professionals within multidisciplinary teams. A key lesson from PCPIP was that successful pharmacotherapy services depend on effective team working. The greatest benefits are most likely to be realised where pharmacy roles are clearly defined, appropriately supported and fully integrated into wider primary care teams.
The workforce challenge
Despite these successes, workforce issues emerged as the greatest barrier to implementation across both pharmacy and general practice. Recruitment delays, vacancies and retention challenges affected all areas to varying degrees, influencing the pace of service development and contributing to variation in implementation across health boards. Fixed-term contracts often reduced the attractiveness of posts, while some staff moved into permanent positions during the programme, creating further vacancies.
The expansion of pharmacotherapy services is therefore not simply a matter of funding additional posts. Sustainable implementation requires workforce stability, clear career pathways, ongoing training, and opportunities for professional development. PCPIP also highlighted the importance of developing the wider pharmacy workforce rather than relying solely on pharmacists to drive transformation. Pharmacy technicians and PSWs played a key role in increasing service capacity, resilience, and continuity.
No single model fits every area
One of the most important lessons from PCPIP was that there is no single model of pharmacotherapy service that will suit every community. Geography, population needs, workforce availability, infrastructure and existing relationships all influenced service design and implementation.
While some areas benefited from practice-based teams that supported close collaboration with practices, others found hub or hybrid approaches provided greater efficiency and resilience. Rural, remote and island communities often faced challenges distinct from urban areas, including recruitment difficulties, travel distances and infrastructure constraints. These findings should be viewed as shared learning rather than a judgement of local approaches. Sites were working within different workforce, geographical and organisational contexts, highlighting the importance of local adaptation. Future policy should therefore support flexible, locally tailored approaches rather than a single national model.
Why quality improvement matters
A distinctive feature of PCPIP was its emphasis on QI. Teams were encouraged and supported to understand their systems, test changes on a small scale, measure impact and learn from experience before wider implementation. This approach helped services adapt interventions to local circumstances and reduce the risk of investing in changes that were unlikely to deliver sustainable benefits. Importantly, implementation was not a linear process. As services matured, teams refined workforce models and adapted approaches in response to emerging learning and local needs. This process of testing, learning and adaptation highlighted the value of a QI approach in supporting sustainable service development. Participants reported greater confidence in using improvement methods, a better understanding of local systems and stronger capability to lead change. The programme demonstrated that QI is not an optional add-on but a critical enabler of sustainable service development.
Data and digital systems need attention
Many teams encountered challenges related to data quality, coding and digital infrastructure. Inconsistent coding, limited interoperability between systems and difficulties accessing meaningful outcome measures made service monitoring and evaluation challenging. Some planned improvements were delayed or adapted because of IT constraints. Therefore, continued investment in digital infrastructure, integrated systems, and standardised approaches to data collection should be a priority. Without these foundations, it will remain difficult to monitor outcomes, evaluate impact and support ongoing improvement.
Looking Ahead
PCPIP highlighted that pharmacotherapy services can make a valuable contribution to primary care by improving medicines management, supporting safer prescribing and strengthening multidisciplinary working. However, the programme also demonstrated that successful implementation depends on more than funding alone. Effective implementation requires strong integration within primary care teams, clear role definition and the development of constructive working relationships between pharmacy professionals and general practices. These factors help create the conditions for pharmacists, pharmacy technicians and PSWs to work effectively together and maximise their collective contribution to patient care.
- Strengthening the wider pharmacy workforce, including pharmacists, pharmacy technicians and PSWs, through sustainable workforce planning, clear career pathways and ongoing professional development.
- Supporting flexible, locally responsive service models that reflect population needs, workforce availability and local context, rather than adopting a single national approach.
- Embedding QI approaches from the outset, with realistic timelines for planning, recruitment, testing, evaluation and sustainability.
- Investing in digital infrastructure, integrated systems and standardised data collection, enabling effective monitoring, evaluation and continuous service improvement.
- Creating the conditions for effective MDT working, including strong leadership, clear governance, stakeholder engagement and role clarity across primary care.
As Scotland continues to develop multidisciplinary models of care, the lessons from PCPIP provide an evidence-based foundation for future progress. The challenge is no longer whether pharmacotherapy services add value, but how the health system creates the conditions that allow them to thrive and realise their full potential for patients, practices and communities.
Key message: Pharmacotherapy services have demonstrated clear value in primary care. The next step is to build the workforce, infrastructure and improvement culture needed to support their long-term sustainability and impact.
Reference: Primary Care Phased Investment Programme Reports: June 2026 – Healthcare Improvement Scotland
Acknowledgements: PCPIP was commissioned by the Scottish Government. Thanks are extended to NHS Ayrshire & Arran, NHS Borders, Edinburgh HSCP, NHS Shetland, and the Healthcare Improvement Scotland operational teams for their contributions to the programme.