By Rajinder Phull on September 10, 2026
One of the things I have become increasingly uncomfortable with over the years is the way we describe savings in medicines optimisation.
We have all seen the business case. I know I have written and reviewed plenty of them.
An intervention saves 15 minutes of a clinician’s time. That 15 minutes is multiplied by an hourly staff cost, multiplied again across thousands of patients, and before long we have apparently “saved” the NHS £500,000.
Except, of course, we haven’t.
The clinician is still employed. The practice is still open. The hospital has not handed £500,000 back to anybody.
What we may have created is something different.
Time.
And I think we need to get much better at recognising just how valuable that is.
I have written before about the different kinds of value medicines optimisation can create. Some interventions genuinely release cash. Some avoid future costs. Some improve outcomes. And some release capacity by freeing up the time of people already in desperately short supply.
They are all valuable, but they are not the same thing.
If a medication review prevents an unnecessary GP appointment, the practice probably does not spend less money that afternoon. Someone else takes the appointment.
If better medicines support prevents an admission, the hospital probably does not close a bed. Another patient will use it.
If a better repeat-prescribing process removes hours of unnecessary work, the salaries of the people involved do not disappear.
But something important has still happened.
The value has simply appeared somewhere other than the bank balance.
In a health service where one of the greatest constraints is the availability of skilled people, that matters enormously.
I can already hear the finance director’s response – including my own.
A system in deficit does not need theoretical time savings. It needs to hit its financial target.
That is fair.
Time itself does not close a financial gap. Capacity only turns into cash if somebody chooses to bank it, perhaps by avoiding the next hire, reducing agency use or not expanding a service that would otherwise have required additional people.
That is a real, cash-releasing saving.
The important word is deliberately.
Otherwise, capacity simply fills up again.
But forcing every benefit into pounds does not solve the problem either. It just produces the kind of saving that looks impressive in a business case but never arrives in an actual budget.
We can be more honest than that.
And there are some good examples of what that might look like.
A practice example
At Trent Meadows Medical Practice in Staffordshire, the practice looked at the amount of time being consumed by repeat prescribing and medication-review processes.
Working with its clinical pharmacist and wider team, it redesigned those processes. Medication reviews were better planned, medicines-related work was directed towards the pharmacist and unnecessary steps were removed.
The result was more than 28 hours of GP time released every month.
But the interesting bit is what happened next.
The practice used that capacity to allow GPs to provide more 15-minute appointments for people with complex needs, long-term conditions and mental health problems.
That, for me, is a much more meaningful description of productivity.
Not:
“We saved 28 hours.”
But:
“We released 28 hours and used them to spend longer with the patients who needed us most.”
There are examples at much greater scale too.
NHS Dorset’s Only Order What You Need campaign reduced unnecessary repeat prescribing by more than 65,000 items over two months. Prescribing costs reduced by around £475,000.
Alongside the financial impact, Dorset estimated that processing those unnecessary items would have consumed around 1,085 hours of healthcare professional time across general practice and community pharmacy.
That is a lot of time.
And it raises what I think should become a routine question for medicines optimisation programmes:
What are we going to do with it?
Perhaps pharmacy teams spend more time with people living with frailty and polypharmacy.
Perhaps primary care catches the person whose diabetes, cardiovascular or respiratory disease is deteriorating before they present in crisis.
Perhaps clinicians undertake more structured medication reviews.
Perhaps somebody finally has time to help a person genuinely understand their medicines, rather than repeatedly dealing with the consequences when they do not.
Or perhaps the system deliberately converts some of that capacity into a genuine financial saving.
All of those can be legitimate choices.
What matters is that we make the choice rather than allowing the time simply to disappear back into an already overloaded system.
This changes how I think we should design medicines optimisation programmes.
At the beginning, alongside the usual questions about prescribing costs, outcomes and return on investment, we should ask:
- What avoidable activity are we trying to remove?
- How much clinical or operational capacity should that release?
- Where will that capacity appear?
- And, most importantly, what are we going to do with it?
Then we should measure the thing the time was redirected into.
Not just theoretical minutes multiplied by salary rates, but the additional reviews completed, the high-risk patients reached earlier, the longer appointments made possible, the proactive work undertaken or the avoidable activity that no longer happened.
“We released capacity” is only really interesting when we can also say what became possible because of it.
Medicines optimisation teams are particularly well placed to think this way because medicines run through almost every part of a person’s care – appointments, monitoring, admissions, discharge, adherence and long-term conditions.
Used well, medicines optimisation can influence not only the drugs budget, but how scarce clinical time is used across the system.
And that may be a much bigger prize than simply finding a cheaper product.
We should absolutely continue to find genuine cash-releasing savings and be rigorous about proving when they are real.
But we should stop pretending that everything valuable has to reduce a budget.
Sometimes medicines optimisation saves money.
Sometimes it prevents cost.
Sometimes it improves an outcome.
And sometimes the most valuable thing it creates is an hour.
The important question is what we choose to do with it.
