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The National Pharmacy Association (NPA) yesterday launched its framework setting out the standards for expanding pharmacist independent prescribing safely across the UK.

A report, unveiled to the pharmacy press during a webinar hosted by the NPA alongside primary care and other stakeholders, laid out eight broad features of the framework which articulate how prescribing can be embedded within different neighbourhood health structures taking shape under the Government’s 10-year NHS plan. 

The first feature is putting patients’ needs, safety and voice “at the heart of every decision”. The second is ensuring systems, records and infrastructure for safe prescribing are in place and the third is making sure there is collaboration and trust between pharmacy, general practice and the wider system.  

The fourth feature is establishing confidence in professionals’ skills and the system supporting them, the fifth focuses on how “confidence, structural and relational conditions” vary across the system and the sixth is “flexible implementation” to help pharmacies put the standards “into practice in ways that suit their local context”.

Sustainable remuneration, not one-off or pilot-based funding

One “structural” condition that will catch the eye of those concerned prescribing is not worth doing given the poor funding attached to it is the report’s call for “sustainable remuneration and routine NHS commissioning rather than one-off or pilot-based funding”.

Clinical pathways and referral routes, the report said, must have “clearly defined scope, escalation routes and referral processes” and be “maintained and kept current as services evolve”, while service specifications need to “clearly define expectations for follow-up, responsibility and safety learning” and be aligned to pharmacy’s contract.

The seventh and eighth features are “ongoing cycle of learning so conditions improve as the system evolves” and outcomes focusing “on what matters most to patients, professionals and the system” respectively.

The report said the framework is “grounded in evidence” having drawn on 482 responses, including those from pharmacists, GPs, other prescribing professionals and commissioners. However, only 15 GPs responded and stakeholders at the webinar felt that number needed to be increased.

The survey and framework were commissioned by the NPA and launched alongside Thiscovery and Q and was tested at a roundtable of stakeholders including the Royal College of General Practitioners and Patients Association in July.

The report said the framework matters to patients because they “value faster, more convenient access to care, but trust it only once collaboration between professionals is visible”.

The report added: “Access to full medical history and shared records builds patient credibility and confidence in the pharmacist. Confidence depends on knowing the prescriber is properly trained and supervised, not just able to prescribe.”

Calling for “prescriber visibility” to extend to a shared single patient record, the report said: “This framework treats shared record access as a working ambition across all four nations, while recognising the specific mechanism differs by nation.

“What matters for safe prescribing is the underlying outcome: full record visibility for the prescriber and the digital readiness of systems and professionals to use it effectively, however that is delivered locally.”

The report also cautioned that “privacy and adequate consultation space remain longstanding, unresolved patient concerns”.

It added: “A private, appropriate space for confidential consultations (should be) in place before a prescribing service begins, so patients can discuss their health without being overheard.”

Most significant development in neighbourhood care in years

The report said “sufficient numbers” of prescribers and “supporting pharmacy team capacity” must be in place before the launch of a service and prescribers needed to see patient records to ensure “safe initial decision-making”.

It called for “core indemnity, incident reporting and clinical oversight arrangements” to be established from the start and more designated prescribing practitioners and protected training time.

NPA vice-chair Sukhi Basra said the framework will see pharmacist independent prescribing become “the most significant development in neighbourhood care in years, transforming how people experience healthcare”.

“It offers potential for millions of people to have easier access to treatment, additional clinical capacity across the NHS and new opportunities for community pharmacists, benefits that are too important to leave to chance,” she said.

“We need to put in place a clear framework now to realise the huge benefits pharmacy prescribing can bring, in a way everyone can understand and get behind.”

The report cautioned that although the framework is designed to cover the UK, “further strategic development work is needed to align community pharmacy prescribing policy and practice across the four countries”.

“The NPA look to the leadership of the four nations’ chief pharmaceutical officers to enable a more aligned roadmap of service development,” it said.