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It wasn’t envisioned that patient group directions would be a mainstay of private pharmacy services. I suspect the four chief pharmaceutical officers in the UK will try to minimise their use as they empower independent prescribers, says Terry Maguire…

This summer was a milestone for pharmacy. Newly registering pharmacists do so with full prescribing (IP) rights, so it marks the start of a bold and exciting journey for each one of them and an important departure for the profession.

Of course, it will take some time to truly appreciate the impact and importance of independent prescribing but we are now well on our way to the clinical future we sought, were promised, and needed to assure pharmacy’s relevance in the future.

And we must give credit to the pathfinder IPs who have already made an impact. Our chief pharmacist Cathy Harrison issued a letter through the Pharmaceutical Society of Northern Ireland (PSNI) welcoming all new registrants and celebrating the opportunity but equally, and rightly, identifying the need for caution and limiting prescribing activities to areas of individual competence.

How tightly the reigns are held will be crucial to empowering or restricting this cohort of practitioners and their success or otherwise in this emerging area of practice. We must trust them.

Support is being provided through the General Pharmaceutical Coincil, Northern Ireland Centre for Pharmacy Learning and Development (NICPLD) and Pharmacy Forum NI (PFNI).

The PFNI produced a comprehensive document, Bridging the Gap, that goes beyond prescribing and covers all aspects of the world that new registrants now find themselves in.

From January 2027, the NICPLD will launch the Enhanced Pharmacy Practice for Prescribers programme designed to give the necessary support for career development.

No matter what rules and regulations, guidance and guardrails are imposed, this cohort of pharmacists, by their practice, will evolve the future of pharmacy prescribing and ultimately the future of pharmacy practice.

I am greatly encouraged by the formation of the Early Years Working group within PFNI to give a voice to young pharmacists; a voice that has been silent for too long. I do worry that in our caution, we might kill their enthusiasm and this golden opportunity.

Perhaps it’s useful to remind ourselves of two guiding principles that say it all. 

-       The Code of Ethics and Performance states that a pharmacist must justify prescribing decisions. IPs must use their professional judgement in the best interest of the patient.

-       Helper and Strand’s definition of pharmaceutical care is still very important;

The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life.

The emergence of NHS and private services in recent years have kept to this definition. Private services are certainly more commercial but also clinically important.

The health of the nation won’t be changed by supplying a period-stopper drug and a treatment for erectile disfunction to a couple going on holiday but the travel vaccines they get are significant to public health.

Like in any gold rush, the real money is made selling the “shovels”.  The fees paid by community pharmacies to use patient group directions (PDGs) are significant, as are training events and the cost of hiring equipment. For NHS services, there are no costs.

The private services platforms selling PDGs will remain relevant for some time yet. They provide an important quality assurance function and I’m finding instances of IPs preferring to use private PDGs should something go wrong.

Useful at the start perhaps but for the competent professional, your ‘stabilisers’ must eventually come off and you must peddle on your own.

The best nuggets in this gold rush have been in weight management services. The scale of this has been enormous and, we are being told, it is a significant public health benefit.

All pharmacies involved claim that their weight management service is a full wraparound support service and for most, this will be true. New IPs, depending on PDGs or not, will rightly be careful of the commercial pressures in this clinical area.

The Royal College of General Practitioners is getting exercised by the expansion of pharmacy prescribing and if there are questions on quality, they are right to ask. Proper and proportionate scrutiny is always useful.

There is already some excellent work with GPs on developing prescribing pathways for acute and chronic conditions and these will need to be embedded with proper payment models.

The Crown Report of 1999 (yes, that long ago) is the basis on which non-medical prescribing was created. PDGs were only considered a stop-gap and a means of treatment in a time of national emergency, such as a pandemic or a nuclear war (supply of iodine to block up-taken in thyroid gland).

To see PDGs as a mainstay of private pharmacy services was not in the initial vision and I suspect chief pharmaceutical officers across the four health jurisdictions will seek, in the future, to minimise their use as they empower IPs.

The future is bright, the future is clinical. And it has just arrived at a pharmacy near you.

Terry Maguire is a leading pharmacist in Northern Ireland.