The Pharmacist will see you now: Independent Prescribing

Pharmacist independent prescribing services will be trialled across England in 2023 – a possible game changer for our healthcare system and one to watch for insurers.

Pharmacist independent prescribing services are set to be trialled across England this year. These trials will pave the way for further major change for UK pharmacists scheduled to come into effect in 2026; when all pharmacists will be able to independently prescribe at registration. 

NHS England have confirmed that trial 'pathfinder sites' will be set up in every region of England and consist of NHS-funded pharmacist prescribing services based in pre-existing community pharmacies. The sites will become "test beds" for a potential wider rollout of independent prescribing services via the community pharmacy contract in England. 

The pathfinder sites are to be the first independent prescribing service fully funded by NHS England and have been welcomed by many pharmacy contractors. The announcement was made just weeks after applications for 3,000 funded pharmacist independent prescriber ("IP") training places were opened in England. In addition, the General Pharmaceutical Council has removed the requirement for pharmacists to have been registered for two years before being eligible to undertake the independent prescribing training.

Pharmacist independent prescribers ("IPs") may prescribe autonomously for any condition within their clinical competence, thus alleviating the need for patients to be assessed by a GP before being prescribed certain medications.  The skills of an IP can help to build greater capacity and capability within the NHS workforce and ease pressure in areas such as acute, emergency, and primary care – including out of hours services. These benefits were fully realised by NHS funded schemes in both Wales and Scotland where IPs have been able to manage the treatment of patients with common clinical conditions. As a result of these schemes, IP numbers tripled between 2016 and 2021. There has been a multi-agency effort to continue this growth. 

Concerns have, however, been raised with respect to NHS England's decision not to provide any additional funding for designated prescribing practitioners to support and supervise the (anticipated) 3,000 trainees undertaking the IP course. It remains to be seen what impact this will have on supervisor numbers and whether a potential shortage will affect the quality of training provided. Questions have also been asked about the removal of the two-year eligibility requirement and whether this will have a negative impact on the calibre of IPs going into practice.  

It is hoped that the new scheme will lessen the burden on GPs, through the reduction of patients attending primary care providers simply to obtain prescriptions. This assumes, however, that patients will be understand and be trusting of the new system and avail themselves of this alternative new service. It may take several years for some patients to adapt to this sea change in the way they access this element of primary care.

For insurers in the healthcare industry, the implications of the new IP scheme could be significant. Pharmacists working at these 'pathfinder sites' will need to ensure that they have sufficient indemnity cover in place to work as IPs. They may face an increased risk of claims such of misdiagnosis and mis-prescribing. Insurers will want to consider whether indemnity will be provided for independent prescribing under the new scheme and review their policy wordings accordingly.