Prescribing rollout in trouble

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Are the opportunities offered by independent prescribing going to pass community pharmacy by, particularly in England? It is a pressing question.

Discussions about a national prescribing service supposedly form part of the pharmacy contract negotiations for England in 2026/27, but where the talks will lead is still uncertain.

There are over 25,000 pharmacist independent prescribers (IPs) across the UK. Together with nurses and other allied health professionals, they now represent almost a quarter of the prescribing workforce. As a group they are envisaged to play an important role in shifting care from hospitals into the community and supporting people with chronic conditions.

But a report from the Nuffield Trust identifies numerous issues that could undermine the IP workforce, including lack of opportunity for prescribing in community settings, patchy training options, lack of access to clinical supervision for inexperienced prescribers, poor visibility of the work carried out by IPs, and quality and assurance concerns.

Published in April, the report highlights the significant disparities in opportunities for pharmacists to use their prescribing qualification. The evidence suggests that those working in community settings in England or Northern Ireland face limited opportunities to prescribe, disincentivising this role and risking deskilling.

Data on how many pharmacist prescribers currently use their qualification is limited. Pharmacists working in general practice are most likely to prescribe daily (77%), followed by hospital pharmacists (48%), with community pharmacists prescribing least often (just 30% prescribe daily), according to a 2025 survey.

No surprise, then, that IPs can be attracted to work for private health service providers, where opportunities are expanding. However, the Nuffield report says there is less visibility and oversight of the independent prescribing workforce in the private sector.

Private prescribing uptick

There has certainly been an uptick in independent prescribing outside NHS-funded care. Private prescriptions account for a growing proportion of dispensed medicines, reaching 4.7% in July 2025, an increase from 1.2% in July 2023. Services such as prescribing for ADHD, weight loss drugs and aesthetics are thought to be driving this increase.

There are, though, concerns about the strength of governance structures and assurance in place in the private sector. Companies may lack the support and supervision frameworks that are in place for NHS organisations. Overall, there was “felt to be a gap in data and evidence about the safety and effectiveness of independent prescribing in the private sector,” the report says.

Local concerns

Concerns from local healthcare leaders about the extent to which community pharmacists can use their prescribing qualification are identified by the Nuffield Trust report.

There is a risk that community pharmacist IPs will move to different sectors in order to utilise their prescribing skills, and some worry that the new cohort of pharmacist IPs entering the workforce in September 2026 will not want to work in a community setting due to the lack of opportunity to prescribe, the report says.

Then there are the differences across the UK in the NHS commissioning of community pharmacy independent prescribing. Wales has the Pharmacy Independent Prescribing Service (PIPS) and Scotland runs Pharmacy First Plus. It is unclear what will follow England’s pathfinder programme, while Northern Ireland plans to introduce independent prescribing to community pharmacy services subject to funding.

In December 2025, the report’s authors held focus groups with leads from NHS trusts, integrated care boards and regional NHS health boards to discuss their local priorities for independent prescribing. The majority of local leads talked both of the importance of expanding the number of IPs and how to make the best use of their expertise.

The challenge of finding designated prescribing practitioners (DPPs) to supervise trainee IPs was also raised. There was a strong consensus that access to a DPP varies significantly across settings, with those in the community sector facing larger barriers.

Historically, doctors have carried out the supervisory role for IP trainees. Regulatory changes in 2019 enabled this role to be carried out by IPs themselves to address growing demand.

Although formal training for the role is not required, DPPs must meet the competencies set out in the Royal College of Pharmacy’s DPP framework, be an experienced prescriber, usually with three years’ experience, and meet other requirements such as having spent time training or teaching.

Demonstrating that they have the requirements to be a DPP can be a barrier for pharmacists, and the additional work may be off-putting, the report noted.

Key questions remain around the supervision of the new graduate pharmacist IP cohorts. While the number of pharmacist IPs is growing, the pharmacy workforce is relatively inexperienced in prescribing. Roughly two-thirds of pharmacist IPs have under five years’ experience.

Beyond strengthened supervision, the new MPharm cohort will need specific continuing professional development and education within their chosen area of practice, the report points out.

Governance lacks clarity

Turning to wider issues, the Nuffield Trust report says the governance and regulation of independent prescribing is complex and lacks clarity of responsibility.

“There is a risk of deskilling for IPs who do not use their prescribing rights in practice, and additional assurances are needed to ensure those who do not prescribe often are up to date on their knowledge, competencies and skills,” the report notes.

“Access to structured supervision is limited, particularly in community pharmacy … there are clear disparities in the support available across settings,” it continues. “There is evidence that access to continuing professional development is challenging, leading to limited opportunities to maintain and improve competence.”

For community pharmacy, there is a significant gap between reality and the ambition to increase the number of active independent prescribers, the report concludes. This is despite the Medium Term Planning Framework, which NHS England published in October 2025, stating that ICBs must introduce prescribing-based services into community pharmacies during 2026/27.