Pharmacy prescribing in England: past, present and future

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Until 2023, pharmacist independent prescribing in England was used mainly to provide private services — primarily travel vaccines. Then the NHS launched the Community Pharmacy Independent Prescribing Pathfinder Programme. 

Pathfinder sites were established in all ICB areas and operated a number of prescribing models including minor illnesses, deprescribing, CVD case finding and long-term condition management. That all came to an end in December 2025. 

Encouraging results

An evaluation carried out by the University of Manchester was encouraging and highlighted the patient benefit, as well as increased job satisfaction for the pharmacists involved. 

Community pharmacy prescribing was included in the NHS 10 Year Health Plan for England, but once the national pathfinder monies had dried up, individual ICBs were tasked with continuing the programme.

Despite the obvious success of the pathfinders, many sites were decommissioned after the programme ended. This was either because the ICBs, themselves in a state of flux and dealing with redundancies, were unable to support continuation, or because the paltry fee structure offered by them made the service unviable for pharmacy contractors.

The few pathfinder sites that continued did so with reduced funding, so what is going on in England now is more to do with goodwill and passionate individuals fighting for us within ICBs than the support of NHS organisations themselves. Indeed, ICB pharmacy leads had to push very hard to get any money at all.

Inadequate remuneration

While it was encouraging to see that the new contract settlement included NHS pharmacy prescribing, the financial resources provided for it was not. A set-up fee of £500 will neither pay for the necessary NHS prescribing infrastructure (currently £2,500 a year plus VAT), electronic consultation systems, nor additional indemnity insurance. 

Sure, there is a £525 per month payment promised – but with activity fees the same as for Pharmacy First, there is very little incentive for independent prescribers to step up and take the burden off GPs, NHS 111 or A&E. 

As an IP pathfinder site, I would have continued with any locally commissioned prescribing services, added in the new national service and increased private service income. A thinly veiled enhanced Pharmacy First scheme won’t keep this year’s new IPs in community pharmacy long, or encourage other pharmacists to take up prescribing for the NHS.

Obvious answer

So why is such an obvious answer to cutting GP waiting lists, improving patient access and increasing workforce satisfaction an afterthought at strategic level within the NHS? After all, those who took part in the IP pathfinders were certainly enthused, and patients got an appointment with a healthcare professional who gave them time, carried out appropriate observations, and prescribed or referred on as appropriate.

Meanwhile, GP practice staff received valuable support in helping patients to be seen; GPs gained trusted colleagues who could ease workforce pressures; pharmacists found immense satisfaction in using their clinical skills; and pharmacy teams felt empowered to take responsibility for their dispensing operations and regular patients. And, of course, community pharmacy helped relieve pressure on NHS 111 and A&E settings.

When the pathfinders were established, pharmacists had high hopes for the future. Even as they closed, all involved wanted to continue to prescribe, as they had evolved their practice. 

Heading down the private path

However, pharmacies with an independent prescriber tend to use their skills to provide private healthcare, such as weight management clinics, aesthetics, dermatology, travel health and minor illness consultations. In truth, these are far more lucrative than any NHS activity. 

All successful colleagues prioritise private over NHS income, and aim to ensure that at least 20% of their total income (including that from dispensing) comes from private services. It is the only way to run a profitable pharmacy business these days. If you are an IP, or employ one, and are not doing this already, then you need to.

Unfortunately for ministers, this does mean that NHS prescribing, unless properly supported and incentivised, will take a back seat. There are those who will try to do both NHS and private prescribing – but we all know pharmacies that have given up their NHS contract because it gets in the way of running a successful pharmacy.

Wasted potential

Community pharmacy can be a saviour for the NHS as the sector has a huge role to play in the three main strands of the health plan: hospital to community; analogue to digital; and sickness to prevention. The price of investing in pharmacy to support premises, IT infrastructure and workforce development is easily counterbalanced with the reduction in hospital admissions we can help to achieve.

We are part of the primary care health solution and complement other providers. The benefit of NHS prescribing in community pharmacy must not be measured against GP practices – we are not “GPs on the cheap” or acting as a “GP lite”.  We are highly trusted clinical professionals who, by providing appointments in the community, increase primary care capacity. 

Be ready

We have to make our workforce ready for the future. This includes empowering pharmacy teams to embrace digital solutions to support dispensing and prescribing processes. Existing NHS prescribers should be supported to pass on their knowledge and learning. Newly qualified IPs must be mentored and encouraged. 

I would urge pharmacists to get ready now – don’t wait for the NHS. The future viability of community pharmacy depends on it. Get qualified and, crucially, choose an IT provider that can meet all your needs, from clinical checking and comprehensive consultation records, to prescription production and claiming mechanisms.

Prepare your consultation space, whether that means online and telephone platforms, consultation rooms (ideally, you will need at least two), or both. Ask your ICB and any membership bodies to share their prescribing governance structures so you can start developing SOPs and risk assessments now. Speak to your insurance provider about specific indemnity cover for IP activity and make sure your team’s NHS smartcards are up to date. Sort out your appointment systems, website and booking apps too.

The road to NHS prescribing may still be uncertain, but private prescribing is thriving and you cannot afford to miss out. The future is in your control.