Independent prescribing: getting started

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Lindsey Fairbrother, independent prescribing implementation specialist; and chief executive officer, Community Pharmacy Shropshire

This module provides a practical refresher on the requirements for setting up and delivering a safe, effective prescribing service in community pharmacy.

It covers NHS and private provision taking into account the prescriber and their pharmacy team, premises, IT and infrastructure, governance, quality assurance, risk management and local collaboration to support sustainable, patient-centred service delivery.

Introduction & module overview

Pharmacists were first able to qualify as independent prescribers (IPs) in 2003, but national provision in community pharmacy in England has developed gradually. In 2023, an estimated 8% of the community pharmacy workforce were IPs. By 2025, the GPhC reported that one-third of pharmacists were independent prescribers, with more than 3,000 expected to join the register in 2026 from this year’s foundation cohort.

Scotland and Wales have commissioned community pharmacy independent prescribing services for several years. In England, the NHS Community Pharmacy Independent Prescribing Pathfinder Programme concluded in December 2025. Since then, integrated care boards (ICBs) have been able to commission services locally and a new national prescribing service – an extension of the Pharmacy First scheme – is due to launch in late autumn as part of the agreed Community Pharmacy Contractual Framework (CPCF) for 2026/27.

In England, many qualified community pharmacist IPs still work under patient group directions (PGDs), while others use their prescribing qualification for private services such as weight management. Common barriers include lack of confidence and concerns about governance, particularly in owner-operated pharmacies where the pharmacist works single-handedly without support from colleagues or a head office function.

After completing this module, pharmacists will be familiar with the key components of a prescribing pharmacy. These include the responsibilities of the individual prescriber, team and employer; premises and infrastructure requirements; and systems for monitoring safety and quality.

Preparing to prescribe

Patient safety must underpin every pharmacy prescribing service. This module considers each element required to implement prescribing safely within community pharmacy.

First, the module considers the requirements of an individual prescriber, employer and wider pharmacy team, because everyone must understand and support the service. It then examines the systems and infrastructure required for safe, effective delivery of prescribing services, before outlining the governance and assurance frameworks needed to meet GPhC and NHS requirements. 

The prescriber

Independent prescribers in pharmacy must develop their role safely and with appropriate support. Community pharmacy can be isolating, with responsibility resting on the named Responsible Pharmacist. When that pharmacist is also the IP on duty, their accountability increases further.

The IP must be confident in their abilities and communicate that confidence to patients, who rely on their clinical judgement and decision-making. Although they may work remotely from other members of the primary healthcare team, their decisions directly affect patient outcomes and make them an integral part of that team.

Robust communication pathways and shared understanding between prescribers, patients and other care providers is essential. GP collaboration was considered in detail in a previous module, while Panel 1 provides a checklist for IPs.

Further guidance is available in the NHS professional assurance framework for delivering community pharmacy clinical services.

The employer

Prescribing provision within the pharmacy must be safe and sustainable. This requires systems that support the whole pharmacy team and maintain patient safety and confidence. Panel 2 provides a checklist for employers.

The pharmacy team

Safe and effective prescribing in community pharmacy depends on making full use of the skills of the wider pharmacy team. Because many community pharmacies have only one pharmacist on site at a time, clearly defined roles and robust SOPs are essential to manage appointments, while maintaining dispensing and other enhanced and advanced services.

The whole team should help to support booked prescribing appointments while continuing to care for walk-in and regular patients, including those seeking Pharmacy First consultations and prescriptions.

If the pharmacist is largely occupied with consultations, the pharmacy team will need to manage day-to-day operations, including prescription accuracy checking, OTC counselling, queries and bookings. A designated team member should oversee referrals from GP practices, NHS or private websites and patient contacts, arrange appointments, and prepare items such as travel vaccine stock for booked patients.

The employer must ensure that all team members understand the SOPs and should identify skills gaps and training needs. Prescribing must not compromise core pharmaceutical services, and wellbeing support is important because staff may feel more vulnerable or anxious when the pharmacist is less visible to regular patients and customers.

To maintain the smooth flow of prescriptions through EPS, relevant team members must have valid smartcards so that prescriptions can be downloaded. Confirm which staff can access national patient records and the EPS Tracker if a prescription needs to be located on the Spine and is not assigned to the pharmacy.

Premises

Consultation rooms must be fit for purpose, soundproof and private. As activity increases, additional consultation space may be needed, with calibrated diagnostic equipment available in each room to avoid interrupting appointments. Because prescribing pharmacists may spend much of the day seated at a desk rather than standing in the dispensary, comfortable seating should be provided for both patient and prescriber.

Consultation rooms often have a single door for both entry and exit, which may place the practitioner at risk from violent or abusive patients. Consider fitting a panic button to alert colleagues if assistance is required.

As pharmacist prescribing in community pharmacy is still relatively new, displaying IP qualifications in the consultation room may reassure patients who have not met the prescriber before or are unfamiliar with the role.

IT and infrastructure

Consultation software must support effective note-taking and enable records to be shared with the patient’s primary prescriber, usually at their GP practice.

Commercial platforms may be standalone or integrated with other pharmacy systems. They should record patient history, clinical observations, differential diagnoses, prescribing decisions, red flags and safety-netting advice. The system should also display previous consultations and, ideally, provide access to additional patient information through GP Connect or national care records.

Each consultation room should have a desktop or laptop with shortcuts to the consultation tool, prescribing system and patient records. For NHS prescriptions, a system such as Cleo Solo will need to be purchased and installed. Private prescriptions can be generated through the consultation software. Other NHS systems may become available in the future.

If the IP is also the Responsible Pharmacist, a PMR system that supports remote clinical checks can help protect time for this work between appointments. A live electronic calendar accessible to all staff is also essential for coordinating referrals and bookings from GP practices, the pharmacy’s private website and direct patient contacts.

Table 1 summarises key implementation checks.

Governance and assurance

A formal clinical risk assessment must be completed and documented, ideally with the independent prescriber. It should cover clinical, digital and operational risks to the prescribing, dispensing and other pharmacy services, as well as risks to patients and staff.

• Clinical risks include, for example, failure to identify sepsis, deep vein thrombosis (DVT) or pulmonary embolism (PE); inability to access patient records; failure to consider differential diagnoses; and missed red flags.
• Digital risks include software or hardware failure and loss of internet connectivity.
• Operational risks include absence of the IP, lack of dispensary checking staff, faulty examination equipment and double-booked appointments.
• Additional risks arise when the prescriber and dispenser are the same person. Refer to guidance from the Royal College of Pharmacy.

These examples are not exhaustive and risks will vary by site. Use a risk-scoring matrix to document each risk, assess its likelihood and impact, and record actions to minimise it. [See Figure 1 and Table 2 below]

Update the pharmacy business continuity plan to reflect the addition of prescribing services and the actions required if delivery is compromised.

Standard operating procedures

Review written SOPs to ensure that the prescribing service does not adversely affect core pharmacy services. Prescriptions require a pharmacist clinical check – pharmacists working on their own (i.e. with no second pharmacist) should consider IT solutions that support safe and efficient operation.

Additional SOPs should cover patient consent, chaperone arrangements, using and maintaining diagnostic equipment, prescribing policy, review and referral mechanisms. Prescribing should follow local formularies and support antimicrobial stewardship.

An SOP should also set out how to report patient safety incidents arising from consultations and prescribing. In England and Wales, incidents should be reported to NHS England’s Learn from Patient Safety Events (LFPSE) service: england.nhs.uk/​patient-safety/​patient-safety-insight/​learning-from-patient-safety-events/​learn-from-patient-safety-events-service

Audit

Auditing prescribing activity is good practice and demonstrates quality. The NHS Assurance Framework requires audit of clinical prescribing services. Examples include reviewing prescribing against local formularies and standard antibiotic treatment durations.

A prescribing mentor could coordinate a consistent audit across all IP sites. Single-handed pharmacist prescribers should work with their ICB and local practices to audit relevant activity and report findings, while all providers should use audit outcomes to review practice and support safer, more effective prescribing.

Insurance

The growth of prescribing, particularly online consultations, has led to new fitness to practise investigations and consequent changes in practice. For example, weight management clinics must now enable independent verification of information provided by patients to reduce the risk of misuse and harm. Discussing services with insurers and documenting all risks will provide further assurance.

Conclusion

Independent prescribing in community pharmacy will continue to expand in both clinical scope and geographical reach. This module has outlined the information and practical tools needed by community pharmacists and, where applicable, employers who are preparing to establish an IP service.

Getting pharmacists started with prescribing is important both for commissioned NHS pharmacy services and for diversifying pharmacy income through private provision.

Following the NHS 10 Year Health Plan and the prescribing extension to the national Pharmacy First service, pharmacists in England need to prepare for a model of community pharmacy in which prescribing is central to present and future practice.