Independent prescribing has finally, after 25 years, got momentum and we need to do all we can to realise its potential, says Terry Maguire…

The Crown Review; Review of prescribing, supply and administration of medicines was published to great fanfare in March 1999. It was a landmark report set to change forever prescribing practice in the UK.

It offered great promise to community pharmacists as we eyed a more prominent and extended role in healthcare. I played a very small part reporting to one of the many sub-committees on pharmacy prescribing for common ailments.

This was in the context as director of Postgraduate Pharmaceutical Education and Training (NICPPET) and as a member of Queen's University Belfast’s (QUB) pharmacy practice research group.

The Pharmaceutical Society of Northern Ireland (PSNI) had just published Vision 2020, the profession’s strategy for pharmacy, and the Crown Review offered a major stepping stone to realising that vision. It all seemed so promising back then.

But it disappointingly came to nothing in the years that followed. Scotland rushed to train 1,000 community pharmacists as independent prescribers (IPs) but as director of NICPPET, I advised DoH that until there were services in place to utilise IP skills, then that training investment would be wasted.

My hunch was correct and most of the Scottish IPs quickly lost their competency due to lack of use.  So, for too many years independent prescribing retreated into the private sector addressing lifestyle issues such as erectile dysfunction, male hair loss and menstrual period management.

In this commercial zone, patient goup directives – also a product of the Crown Review – existed so pharmacists didn’t actually need to be IPs.

Things, thankfully, have moved on. The DoH is now funding IP placements for pharmacists and by 2026 all new pharmacists will qualify with an IP annotation and full prescribing rights. Some services utilise IP skills; EHC and UTI and we are hopeful for more.

But it’s difficult to retain a positive spin when you come to understand the chaos that is emerging.

After years of complaining about a lack of training places, in 2022 the DoH announced funding for 150 IP placements at NICPLD; 50 of which was for community pharmacy. However, by the autumn 2023, it was clear community pharmacists were finding difficulty getting a DPP to support them.  

For the IP training intake this year, only 24 community pharmacists out of a possible 50 have made a successful application. Getting a DPP (designated prescribing practitioner) is now, it seems, the rate limiting step.

Until recently DPPs were required to have three years’ experience but this is no longer a requirement and there was a rumour that DPPs would have liability for students for 10 years after annotation.

The PSNI recently issued a statement that this was not the case. But ultimately, DPPs are being expected to work pro bono and in the current zeitgeist that goodwill no longer exits. So, how is it being managed elsewhere?

Community Pharmacy Scotland has made a grant available to fund 16 DPPs allowing them to backfill in the workplace so they can support community pharmacists. Wales has made funding available for DPPs under its Prescription for Success strategy. This money is taken directly from the global sum and is not new money. 

There is currently a complete dependence on medical DPPs. Most pharmacist IPs eligible to act as non-medical DPPs are working in either hospital or in the federations but are not coming forward.

They might think they are ineligible because of a lack of experience or because sector managers have decided that due to current workload they don’t have the time. Certainly, this is the case in the GP federations.

Another fact impacting DPP availability is the foundation year training (FTY) for those new pharmacists coming out as IPs in 2026. All FYTs will work six months in hospital where a DPP will provide support.

This will be a huge logistical challenge to the FYT and create considerable disruption in the community pharmacy network.

The next intake of IP trainees is November/December 2024. For this cohort, it will be necessary to incentivise DPPs either through payments to their GP practices or payments to the DPPs individually.

This is just the ways things are as goodwill and collegiality has been largely excised from our health service due to sustained government indifference.

Also, federations must allow their pharmacist IPs to act as DPPs. And finally, community practice needs services to create and sustain its own cohort of competent IPs who can then act as DPPs.

Terry Maguire is a leading community pharmacist in Northern Ireland.