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Incorporating independent prescribing into Pharmacy First and the contraception service is a safe first step. But should the 2026-27 settlement have created the foundations for pharmacists to support patients with more complex conditions, asks Harry McQuillan?

One of the most significant developments in the 2026-27 funding settlement is the formal introduction of independent prescribing into the community pharmacy contractual framework.

For many of us, this has been a long-held ambition. The ability for community pharmacists to prescribe independently represents a fundamental shift in how pharmacy can support patients and the wider NHS.

It recognises the clinical expertise that pharmacists possess and creates opportunities to deliver more care closer to home, improve access and reduce pressure elsewhere in the health system.

In that respect, the settlement should be welcomed. It also raises an important question: are we being ambitious enough? The decision to incorporate independent prescribing into Pharmacy First and the contraception service is a logical and sensible starting point.

These are established services, the pathways already exist, and there is a clear opportunity to improve patient experience by reducing unnecessary referrals. It is, as I would describe it, a safe first step.

That said, as we approach a future where all newly qualified pharmacists will register as prescribers, it is fair to ask whether the sector should already be planning for something much wider.

Pharmacy cannot be limited to minor ailments and common conditions

Community pharmacy's value cannot ultimately be limited to treating minor ailments and common clinical conditions.

Every day, pharmacy teams support patients living with long-term conditions, manage increasingly complex medicines regimes and provide advice to people who often struggle to access other parts of the NHS.

We are seeing rising demand associated with mental health, cardiovascular disease, respiratory conditions and a range of other chronic health challenges that place enormous pressure on primary care services, most commonly general practice.

The question, therefore, becomes, ‘should this settlement have gone further in creating the foundations for pharmacists to support patients with more complex conditions?’

I believe that is a discussion the pharmacy sector and government need to have sooner rather than later.

Expansion of the hypertension case-finding service is an excellent example. Across the country, patients can face lengthy waits to access support or medication reviews, while GPs continue to manage growing demand.

Community pharmacists already have regular interactions with patients receiving antihypertensives and other cardiovascular medicines. They are often the healthcare professional patients see most frequently.

Prescribing in this area is already well supported by clinical guidelines and formulary availability, making its adoption and deployment a little easier.

Ambition requires investment

The same principle applies across a number of long-term conditions and I believe there is clearly an opportunity to explore where appropriately trained pharmacist prescribers could safely play a greater role in supporting patients, particularly in areas such as medicines optimisation, treatment continuation, routine reviews and ongoing management under agreed clinical frameworks.

The challenge is that ambition requires investment. One of the concerns raised during the negotiations was whether sufficient funding has been allocated to support the introduction of independent prescribing even within the limited scope currently proposed.

Prescribing brings a change in mindset and the management of clinical risk, additional clinical responsibility, governance requirements, workforce implications and infrastructure demands. The reality is that becoming a prescriber and operating as a prescriber are two very different things.

Having more pharmacist prescribers in the workforce is undoubtedly positive, but unless pharmacies have the capacity, infrastructure, technology and funding required to deploy those skills effectively, there is a risk that much of that clinical potential remains untapped.

This is why I do not see the current settlement as a missed opportunity; I see it as a first step on a quest. You know the end goal; it is the path to reach it that is less clear. Like any quest, to reach the end, you must begin.

The inclusion of prescribing within Pharmacy First and the contraception service establishes an important precedent. It creates the contractual mechanisms, operational experience and clinical confidence needed to demonstrate what pharmacist prescribing can achieve.

What matters now is what comes next. The government's commitment to a wider reform programme provides an opportunity to think much more strategically about the future role of prescribing within community pharmacy.

Rather than asking what pharmacists can prescribe today, we should be asking what healthcare challenges pharmacists are best placed to help solve over the next decade.

I still advocate for the community pharmacy network to truly manage repeat prescribing and deploy its prescribing skills there. The improvement in pharmaceutical care and efficiency gains across the supply chain would be transformational for the NHS.

Harry McQuillan is the chair of Numark. He was the chief executive of Community Pharmacy Scotland for 17 years.