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This month's news from the National Pharmacy Association...

New Member Benefit:

Independent pharmacist prescribing: the road ahead

By NPA chair Sukhi Basra...

Independent prescribing represents one of the greatest opportunities community pharmacy has had in many years, although significant obstacles to rollout remain.

As more pharmacists qualify as prescribers, we have a great chance to bring more care out of hospital and into the community, to improve access for patients and make better use of capacity across the health system.

I have seen the difference this can make in my own practice.

As a prescriber, I'm able to support patients in ways that were not previously possible. Consultations that might once have required a referral or a long wait can now be completed there and then. When that potential is considered across thousands of pharmacies, the benefit for patients and the NHS could be enormous.

But potential alone is not enough, and this opportunity will not be realised without the right support. The National Pharmacy Association is leading a landmark research project to understand what needs to be in place for independent prescribing in community pharmacy to grow safely, consistently and sustainably. The aim is to move beyond recognising potential and set out a clear way forward for making it work in practice.

We have heard directly from pharmacists, other primary care professionals, commissioners and patients. Their views have

highlighted both the enthusiasm for independent prescribing and the practical issues that still need to be addressed.

Senior figures from the NHS, frontline practitioners including GPs, pharmacy leaders, patient representatives, and specialist health policy researchers from across the UK gathered in London in July to validate findings from initial survey-based research and start mapping out practical recommendations. We can now accelerate the next stages of the project:

a framework and roadmap for pharmacist independent prescribing that offers realworld support to the pharmacy community – to improve patient care and shift more clinical services into the community.

Your prescribing journey: we’re with you every step of the way!

The NPA has launched the UK’s most comprehensive prescribing support programme for community pharmacy. Whether you’re preparing to prescribe, launching your fi rst prescribing service or expanding your clinical offering, we give you everything you need in one place!

Learn Enrol on our training programme which provides a structured pathway that will build your confidence and capability in prescribing. This unique programme equips pharmacist independent prescribers (PIPs), and those who oversee prescribing activity, with the knowledge, skills, and resources to deliver safe, high quality prescribing services.

The ‘Clinical Excellence in Prescribing Practice – The Fundamentals’ course covers prescribing competency, the consultation, prescribing governance, risk assessment, advertising, and servicereview.

Launch

Our training programme provides resources and guidance to help you launch your prescribing service, including remote consultation considerations and key governance protocols. This unique programme is also suitable for those that oversee prescribing activity such as superintendent pharmacists and pharmacy managers or owners to help ensure that appropriate governance is in place.

Deliver

Resources and guidance to help you deliver your prescribing services, including a record keeping template, consultation checklist and more. Key resources include: • Prescribing Service Risk Assessment Templates • Prescribing Service SOP Template • Medical History Consultation Checklist • Prescribing Audit Template • Guidance articles covering best practice and current clinical topics • Prescribing competency resources • Business continuity template

Grow

Our unique training programme includes modules on advertising and service review. The service review module contains an audit template to help identify areas for improvement, as well as a key performance indicators template which can be used to track whether a prescribing service is achieving its objectives.

NPA Insurance for prescribing

NPA Insurance is the leading provider of indemnity insurance to over 60 per cent of pharmacies in the UK and has been providing indemnity cover for supplementary and independent prescribing for over 20 years. It provides cover for prescribers working in all settings, GP, hospitals, and community pharmacy and covers private prescribing in all areas of competence and current NHS schemes, such as PIPS in Wales and Pharmacy First Plus in Scotland.

Independent prescribing is not covered as standard by professional indemnity policies provided to NPA members but policies can be endorsed to cover this activity for an additional fee. Members should contact our membership department at membersupport@npa.co.uk or 01727 795914 if additional cover needs to be arranged.

Training Support

Clinical excellence in prescribing practice - the fundamentals programme

All the essential knowledge, skills, support and professional confidence you need to deliver safe, high-quality prescribing services. Build the confidence to prescribe safely and successfully.

By completing this programme, you will:

• Receive an NPA e-certificate on successful completion.

• Join a growing community of pharmacist prescribers to share knowledge and experiences.

• Access ready-to-use templates, guidance and supporting resources.

• Learn practical consultation techniques and risk assessment approaches.

• Understand the governance and regulatory requirements for prescribing in community pharmacy.

• Develop the knowledge and skills to deliver safe, effective prescribing services.

• Build the confidence to put your prescribing qualification into practice whether you’ve recently qualified or are ready to launch your prescribing service.

Communities of Practice

Included as part of your enrolment, Communities of Practice which enables you to connect with fellow pharmacist prescribers throughout your learning journey and continue building valuable professional relationships beyond the course.

Enrolment: Enrol anytime

Format: Self-paced online learning

Duration: Approximately 3–6 months

Assessment: Six module assessments

Qualification: NPA e-certificate upon successful completion.

Prescribing top tips: What needs to be documented?

It is good practice, and is strongly recommended, that detailed records of patient consultations are maintained. The following information is recommended to be recorded in the patient’s record:

• Patient consent (including consent/refusal to consent to the service, to access GP records and to share information with regular prescriber)

• Nature of presenting complaint (including signs, symptoms and assessing for ‘redfl ags’)

• History obtained (including past medical history, medication – including OTC medicines) – allergies, social and family history)

• Examinations/investigations undertaken and results

• Differential diagnoses and final diagnoses

• Agreed treatment and management plan, including prescription details

• Safety netting, follow up and monitoringplan

• Any referrals made

• If treatment is declined or the decision not to prescribe is made, record reason and justification

• Record of any information shared with thepatient’s GP.

Further information is available in the NPA Independent Prescribing Record Keeping guidance and template, which includes a structured framework to aid note taking during consultations. It is recommended patient records are kept electronically on a secure system that allows access to only authorised individuals, or if paper based, are stored securely and only accessible to those involved in the patientscare.

In England, good practice guidelines recommend patient medical records are retained permanently. In Northern Ireland, medical records should be kept for six years from the conclusion of treatment. In Scotland, it is good practice to retain the electronic patient medical record indefi nitely and in Wales patient records must be kept for eight years since the last interaction with the patient.

Any private (non-repeatable) prescriptions written as part of the consultation and dispensed within the pharmacy will need to be retained for a period of two years from the date ofdispensing.

Digital solutions for independent prescribing

NPA members can access an introduction to digital solutions for IP – giving a high-level, impartial overview of the types of digital capabilities available across the market and which platforms o er functionality in those areas:

• Key capability areas including booking systems, consultation recording, prescribing functionality and clinical decisionsupport

• Considerations around laboratory integration, GP record integration and patient communication

• Administrative and operational capabilities including billing and payment, security and compliance, training and onboarding

• Considerations around artifi cial intelligence and a supplier comparison overview based on supplier engagement and available information.

More prescribing top tips: IPversus PGD

Our Pharmacy Services Advice & Support team is often asked, can we supply medicines under a Patient Group Direction (PGD), rather thanprescribe?

PGDs are not a form of prescribing. A PGD is a written instruction permitting the supply and/or administration of a medicine to a defined patient group that meets the inclusion criteria set out in the PGD. The National Institute for Healthcare and Excellence (NICE) recommends providing clinical care on an individualised basis.

As PGDs are for a group of patients, this does not provide individualised care. The use of prescribing as a legal framework to supply medicines should be prioritised over the use of a PGD, as this provides personalised patient care, on a case-by-case basis, where a patient is individuallyassessed.

There may be certain scenarios where it is deemed more suitable for a pharmacist independent prescriber (PIP) to use a PGD, rather than prescribe a medicine. Where the PIP is not competent in prescribing within a particular clinical condition (including the individual assessment of a patient, diagnosis, prescribing and monitoring the prescribed treatment), then a PGD may be a suitablealternative.

What will GPhC/ PSNI inspectors be lookingfor?

Regulatory inspectors will expect to be able to review certain documents and processes on site to ensure any prescribing service is delivered safely. This includes:

• Service SOP – outlining the full service, including key areas such as obtaining consent to access a patient’s medical records and share information with regular prescriber, verifi cation processes (patient ID/ self-reported readings), follow up and monitoring policies, and referral/signposting processes

• A risk assessment addressing all components of the service

• Records of training, qualifi cations and indemnity cover for all prescribers

• Prescribing audits

• Consultation records which include adequate details of the consultations and outcomes

• Systems in place to identify and fl ag inappropriate requests, for example, multiple orders to the same home address

• Systems to monitor prescription approval rates to ensure appropriate prescribing. For a more complete list, and templates, go to the NPA’s online member hub.

Ask Your Pharmacist Week

Ask Your Pharmacist Week will take place from 2-9 November. This regular, UK-wide public awareness campaign for community pharmacy provides an annual platform for pharmacy promotional activities and a prompt for conversations with stakeholders at local level about community pharmacy services.

Many pharmacies also use the week as an opportunity to invite local politicians and dignitaries to visit, to learn about the skills and services on offer. Pharmacy owners, teams and stakeholders wishing to discuss how they can take part should email Stephen Fishwick, NPA head of communications, at s.fishwick@npa.co.uk

NPA Business Calculator

Want a clearer view of your pharmacy’s profitability?

Use the NPA Pharmacy Business Calculator to estimate monthly profitability from NHS income, locally commissioned and private servicerevenue. You can also track business costs and model how changes could a ect your profit. Note: the tool focuses on profitability and does not show cashflow impact.