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Achieving this requires strategic investment, robust governance and integrated working models, as Luvjit Kandula explains...

By 2026-27, pharmacy graduates will qualify as independent prescribers (IPs). This milestone aligns with the NHS 10-year plan which envisions community pharmacies as clinical hubs delivering advanced patient care.

However, achieving this vision requires strategic investment, robust governance and integrated working models.

Enablement and deployment of independent prescribing in community pharmacy

There is currently a lack of clear structures and funding to support large-scale implementation of independent prescribing in community pharmacies. The local resource and capacity that has been required to enable and deploy the pathfinder programme for 10 sites is extensive.

The involvement of integrated care boards (ICBs) and regional clinical leads, local pharmaceutical committees (LPCs), provider engagement and dedicated programme management resources is essential to ensure successful deployment.

This must be supported by national and local robust governance and safety frameworks, clear regulatory guidance and dedicated local ICB budgets for prescribing.

Uneven support across ICBs could lead to disparities in service provision and professional development, increasing the risk of widening inequalities.

Enabling integrated working between general practice and pharmacy

Collaboration frameworks and policies aligning general practice with community pharmacy are essential for effective deployment.

The engagement, alignment and joint working policies will need to commence nationally for local implementation. It is key that the relationship between general practice and community pharmacy is supported to enable integration and working together to maximise successful deployment and patient outcomes.

Supporting pharmacy contractors to innovate and deploy new clinical services

The NHS 10-year plan envisions community pharmacies as clinical service providers, moving away from solely dispensing. But achieving this requires significant investment to free pharmacists to deliver patient-facing clinical services.

The sector is embracing innovative models of care provision despite a challenging backdrop of financial, operational and workforce challenges.

Many of the IP pathfinder site clinical leads are exceptional in terms of their willingness to embrace new ways of working and develop new models of care. The level of support will vary and some people will require much more guidance and support on this journey as we deploy at scale.

The work required to establish integrated working and changing patient behaviours is considerable, therefore supporting continuity of provision will continue to support patient behaviour change and the confidence of general practice to engage.  

Whilst we will have newly qualified and existing independent prescribers in community pharmacy, we have a huge number of pharmacists and contractors who have not completed their IP qualifications or are struggling to find the time or a designated prescribing practitioner (DPP) to support them.

Future models must include clear guidance on regulatory, governance and clinical support to help contractors, pharmacists and teams deliver these services effectively.

In addition, there are several key factors which need consideration in the future service model. These include appropriate funding and remuneration to enable community pharmacists to deliver IP services, workforce to support administration, pharmacist time, education/training, clinical supervision and enabling a funded seamless IT digital infrastructure with access to local ICB prescribing budgets.

Robust support infrastructure is vital to help new prescribers build confidence in risk management, clinical decision-making, consultation skills and multidisciplinary teamwork.

Other factors such IT, estates and workforce costs, such as a second pharmacist, also need to be considered when costing the model. The ambition for pharmacists to shift to delivery of clinical services is welcome but many pharmacies are struggling to remain viable.

Support for independent prescribers

This programme needs to be supported with access to clinical mentors and supervision. The numbers of IPs in community pharmacy are steadily increasing and other sectors such as GPs and trusts may not have capacity to support supervision and clinical mentoring.

For existing qualified pharmacists, there is limited NHS England (NHSE) funding to undertake IP qualifications and there are barriers to access a DPP to support completion of the programme.

Some of the workforces are close to retirement or may have difficulties to find the time to undertake additional studies as this needs completing on weekends and evenings.

Pharmacists face mounting pressure as new services are commissioned annually, requiring them to train, create SOPs, upskill staff and implement processes to meet General Pharmaceutical Council and NHSE standards for safe clinical care. This adds increased workload to busy pharmacies with no additional funding or workforce to support delivery and implementation.

Leadership development

The development of leadership, influencing and communication skills to work across health and social care to build relationships for the benefit of the patient also needs to be supported as a critical competency and enabler to future ways of working as per the ambitions outlined in the NHS 10-year plan and integrated neighbourhood working.

Building the right support infrastructure to support new prescribers to become confident at managing risk, applying knowledge, developing consultation skills and working across multi-disciplinary teams in the new neighbourhood teams will also become key.

The 10-year plan envisions community pharmacies as hubs for clinical care as opposed to solely dispensing medicines. To achieve this, targeted investment is essential to release pharmacists’ time for patient consultations and advanced clinical services.

There needs to be additional investment to the baseline level of funding to remain viable and stabilise core operations. Community pharmacies require funding to invest in the infrastructure, workforce and operations to free pharmacist capacity to deliver clinical services and deliver the ambitions outlined in the 10-year plan.

Luvjit Kandula is the director of strategy and pharmacy transformation at Community Pharmacy Greater Manchester.