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We are in danger of losing the skills of existing IP pathfinders plus hundreds of graduates from the community sector, an IP pathfinder tells Independent Community Pharmacist…

Keir Starmer announced in October 2024 that the government would accelerate the roll-out of independent prescribing.

Last May, the Pharmacists’ Defence Association announced that a third of pharmacists were now qualified as independent prescribers, yet very few are operating as prescribers for the NHS.

Indeed, most of those with prescribing qualifications in community pharmacy are using their skills to provide private services in order to prop up the NHS side of their businesses.

Without that they would have closed down. So, is there a future for NHS prescribing in community pharmacy?

Certainly, at a local level, it does not look so. Of IP pathfinder sites surveyed in England, about half will have their funding cancelled by their integrated care board on March 31; some areas had funds withdrawn at the end of December last year.

This is despite ICBs being mandated in the NHS Medium Term Plan to enable community pharmacy prescribing in 2026-27. In the sites that remain, current funding levels lie at around £200 per session, with a minimum delivery of four consultations.

IT infrastructure to enable NHS prescriptions has been paid for but from April 1, some ICBs are expecting sites to fund this themselves at £2,300 plus VAT.

At best, £25 is being offered per consultation after March, with a much lower level of activity allowed, often just 20 to 30 consultations per month compared to current activity of 20 to 30 per week or more.

As £25 is the current fee paid for providing oral contraception from community pharmacy under a patient group directive, and can be delivered by a pharmacy technician, is it appropriate to only pay the same for a consultation carried out by a highly skilled pharmacist independent prescriber?

Referred consultations could be for anything; there is no template to follow on the screen, all consultations have to be documented and copied to the GP, including clinical examination, often well beyond Pharmacy First conditions, and all patients have to be safety netted.

Additional insurance costs are incurred, plus costs of IT and infrastructure to provide clinical surroundings.

Manchester University’s evaluation of the IP pathfinder sites showed that ICB input was essential to ensure clinical governance.

However, it was the pathfinder sites themselves who built relationships with GP practices and navigated how a system of referral, diagnosis and treatment could work to ensure best patient outcomes.

The pharmacists involved had to be highly motivated but in return gained great job satisfaction and enhanced relationships with colleagues in primary care and with patients.

What is missing from the evaluation is a qualitative review of patients, GP practices and pharmacies to capture the successes and challenges in operating a prescribing model within a pharmacy.

The correct skill mix has been recognised as an essential tool to delivery but without real life examples and anecdotes, we are missing the emotional and social value of the pathfinders.

IP is undoubtably a success in England, so why are we losing sites and letting patients and GP practices down? The IPs working in pathfinder sites are feeling very disillusioned.

Having worked hard to support primary care and build a well accepted system from nothing, they are now being dropped from the team. Telling a GP practice that there is no longer a service has in most cases been left to the pharmacy itself.

A GP practice that has incorporated 40 or more referrals to pharmacy each week, giving patients greater access and appointments that they would otherwise not have had, may as well not bother if they can only send 20 to 30 patients per month. 

Just last week, the health minister Gillian Merron announced that independent prescribing might form part of the 2026-27 community pharmacy contract. That fits neatly with the 2026 Foundation Year pharmacists qualifying as prescribers this summer.

But with less than four months before the first of them become fully registered pharmacists, there is no known future for them. We are in real danger of losing the skills of existing IP pathfinders plus hundreds of graduates from the community sector.

What needs to happen?

1.     Enforce the NHS Plan and make sure all ICBs are commissioning independent prescribing in community pharmacy.

2.     Learn best practice and benefits of the pathfinders by commissioning research to capture the detail around management of systems, skill mix and delivery through speaking to the teams who delivered.

3.     Realise the patient, practice and pharmacy benefits through qualitative research and use the findings to influence MPs, ministers, the NHS and the Department of Health.

4.     Support all pathfinder pharmacists to act as mentors and advocates, buddying up with new sites as they come on board.

5.     Support all community pharmacy independent prescribers to mentor newly qualifieds beyond their foundation year and as they embark independently on their careers.

6.     Tell MPs and ministers that the pledges given in the NHS Medium Term Plan are not being met.

This article was written by a concerned IP pathfinder.