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Clinical pharmacy service Contract review: Which Quality Measures and Escalation Clauses Matter?

22nd October 2026
Clinically reviewed by: Adeem Azhar, MPharm, IPres

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What should a contract review checklist cover?
Which quality measures show how the service is performing?
How should unresolved clinical pharmacy actions be tracked?
Which escalation clauses matter most?
What should a remedial action plan contain?

A contract review should establish whether the clinical pharmacy service delivers safe, completed work, and what happens when it falls short. Delivered hours and processed tasks describe activity, not assurance. For PCN leaders commissioning clinical pharmacist services, that gap can leave clinical risks unresolved and responsibilities unclear.

Key takeaways

Activity is not assurance: task counts do not prove clinical work was completed.
Thresholds need a clock: agree the population, source and what counts as complete.
Unresolved work needs an owner: accepting a task is not the same as resolving it.
Escalation runs on two tracks: an escalation matrix should separate clinical urgency from contract process.

What should a contract review checklist cover?

A contract review checklist should cover five areas, from the governing documents to evidence that improvement held.

Confirm the governing documents.
Test completion, not activity.
Review unresolved actions.
Check escalation and remedial clauses.
Verify improvement before closing.

Five-step contract review checklist covering governing documents, clinical completion, unresolved actions, escalation and verified improvement. — Contract monitoring should test completed work, unresolved actions and evidence that remedial changes have held.

Treat contract monitoring as continuous, not annual. Service level agreement monitoring should show trends across months, and an escalation matrix should name a person and a deputy. Begin with your own agreement. Our clinical pharmacist services page explains how we deliver this work. Our comparison of clinical pharmacist providers covers provider selection.

Which quality measures show how the service is performing?

A balanced dashboard reveals more than one completion percentage.

Measure	What to test
Medicines reconciliation	Whether discrepancies were resolved, not logged
High-risk medicines	Whether overdue monitoring was identified and acted on
Medication reviews	Whether reviews show a decision and completed follow-up

NICE sets a benchmark: the GP record should hold a reconciled medicines list within one week of receiving discharge information, and before a prescription or new supply is issued (NICE QS120, quality statement 5). The clock starts on receipt, not discharge. In primary care services, task counts alone do not demonstrate clinical quality or completion.

Clinical pharmacy dashboard comparing activity with completed medicines reconciliation, monitoring action and follow-up from medication reviews. — Good measures test whether the clinical issue was resolved, not merely whether a task was logged or processed.

Need a clearer view of clinical pharmacy performance and unresolved work?

Discuss clinical pharmacy service review

How should unresolved clinical pharmacy actions be tracked?

“Reviewed”, “forwarded” and “awaiting GP” are different stages across primary care services, and none means the issue is resolved.

Status	Meaning to agree locally
Received	The work has entered the queue
In progress	Action has started, with a named owner
Awaiting another party	A named dependency is outstanding
Resolved	The agreed endpoint is recorded

A handoff closes only when a named person accepts responsibility for it. Accepting a task is not the same as resolving the clinical issue behind it. Show outstanding items by age and clinical urgency alongside overall performance.

Clinical pharmacy work moving through received, active, dependency and resolved stages with named ownership and urgency review. — A handoff is not closed until responsibility is accepted and the agreed clinical endpoint is recorded.

Which escalation clauses matter most?

GP, pharmacist and PCN leaders using separate clinical-safety and contract-performance escalation pathways with named owners and closure evidence. — Clinical urgency and contractual escalation need connected but distinct routes, owners and follow-up.

An escalation matrix should set out what happens when performance falls short, not just who to tell.

Clause	What it should make clear
Trigger	Safety concerns, repeated failures or missed deadlines
Interim safeguards	Who protects patients during the investigation
Response deadlines	Separate times for acknowledgement, decision and resolution
Repeated failures	What happens if the same failure returns
Evidence of closure	What proves the remedy worked

A patient-safety concern should not wait for the next service meeting. A contract review should test whether acknowledgement, clinical decisions and resolution meet their agreed deadlines.

Expert insight from Adeem Azhar, qualified Clinical Pharmacist and CEO

Contracts that protect patients name accountable roles and their deputies. When everyone assumes someone else is chasing an overdue action, nobody is.

Adeem Azhar, MPharm, IPres
Co-Founder and Chief Executive Officer – Core Prescribing Solutions
Qualified Clinical Pharmacist

What should a remedial action plan contain?

“Provide refresher training” is a weak remedy. A stronger plan names the cause, reviews affected patients and changes workflow, capacity or supervision. It sets an owner, deadline and evidence. Your clinical governance framework should make that routine.

Clinical pharmacy governance team reviewing root cause, affected work, assigned actions and evidence that a remedial change has been sustained. — Effective remedial action addresses the cause, assigns ownership and tests whether improvement is sustained before closure.

FAQs

What should a performance report include?

Clinical completion, outstanding items by age and urgency, escalation response times and evidence of learning.

When should a missed threshold trigger escalation?

When it breaches an agreed threshold, not only when harm occurs or a failure repeats. Agree that trigger in the contract, because it may be reached before either.

Does outsourcing remove the practice’s governance responsibilities?

No. Outsourcing does not remove the practice’s applicable regulatory responsibilities, including those under CQC Regulation 12. The service provider retains its own applicable obligations, and clinicians remain accountable under their professional standards. PCN governance should clarify ownership.

How often should primary care services review this?

Monitor performance continuously against agreed measures, with a formal contract review at a locally agreed interval proportionate to risk. Escalate unresolved concerns sooner.

Reviewing your clinical pharmacy service contract?

If your PCN needs an objective view of whether your clinical pharmacist services deliver safe, completed work, we can help.

Make clinical pharmacy contract performance measurable and accountable

Core Prescribing Solutions can provide Clinical Pharmacist support built around defined workstreams, clear ownership, governance and reporting. If you are reviewing an existing arrangement or commissioning a new service, we can discuss how completion measures, escalation routes and follow-up expectations should be reflected in delivery.

Discuss your clinical pharmacy service

Adeem Azhar, MPharm, IPres

Co-Founder and Chief Executive Officer
Qualified Clinical Pharmacist

Fervent about healthcare, technology and making a human difference.

Adeem writes about Healthcare, wellness, medicines management, medicines optimisation and workforce planning, drawing on his experience supporting GP practices and NHS organisations across nationally.

Adeem is a thought leader and is passionate about using healthcare and technology to improve patient outcomes, enhances access to healthcare services and to support NHS teams.