Prescribing: Time to get serious

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The Warner paper points towards some important themes and recommendations essential to making the expansion of pharmacist independent prescribing a success. Namely:

• Prescribers are ultimately accountable for their own actions
• Ongoing support, both in real time and reflective, is critical and whilst a shared responsibility between prescribers, employers and commissioners, should be built into commissioning frameworks
• Newly qualified prescribers need to start prescribing, with support, immediately after qualifying
• Experiential learning should be built into all training programmes
• Recognised systems should be in place to facilitate widening scope of practice
• Additional scrutiny should be expected with new roles
• A multidisciplinary approach needs to be taken to pharmacist prescribing
• Pharmacists should receive training in becoming comfortable with risk
• There is confusion regarding liability associated with prescribing
• There should be specific revalidation requirements for prescribers
• A performance management framework should be in place for pharmacist prescribers.

The Warner paper recommends that commissioners take these points into account as they plan new services driven by pharmacist prescribers but they are also very relevant to education providers and employers. So let’s look at a few of the themes, starting with how pharmacist prescribers deal with risk.

Part of the equation

I would argue that risk is part of the equation but, ultimately, it is how pharmacists deal with uncertainty. In deciding that prescribing should be a central outcome to pharmacist training back in 2021, we knew that fundamental changes throughout the undergraduate course would be required to safely deliver that new outcome. 

At the heart of those changes is how pharmacists deal with clinical uncertainty. This is partly addressed by greatly enhanced clinical training but it is also a philosophy that should be at the centre of training. 

The paper argues that there is confusion about who is liable for what. This is something that must be addressed as a matter of urgency, otherwise employers will not want to provide prescribing services and pharmacists will be reluctant too. A standard framework that sets out the components of liability and balances those fairly and appropriately must be in place soon. 

“Policymakers need to take these findings very seriously indeed”

Ongoing support for prescribers should be agreed before services are commissioned, says the paper. This needs to be built into not just day-to-day practice, but also postgraduate education, ultimately driven by a Royal College of Pharmacy.

The paper also calls for a formal framework to expand scope of practice to deliver safe services – something a Royal College should be at the heart of, working closely with the GPhC. 

Warner also points out that prescribing must take place in a multidisciplinary environment.

I completely agree. Practitioners need to be comfortable such team working is in place, so they feel supported and able to call on a senior or specialist colleague if required. 

Checks and balances

Everyone involved at a national level in the expansion of pharmacist prescribing from 2026 needs to be sure it is ready to go. This is an enormous change for the pharmacy profession and policymakers need to be certain all the necessary checks and balances are in place, not only to ensure that it is a success, but to minimise risks to patients, the public and the taxpayer. 

There are already public concerns about how some online pharmacies prescribe and supply medicines. One strategy policymakers could consider is a staged approach to full implementation of pharmacist prescribing. Yet unless the NHS commissions pharmacist prescribing in a significant way, many new prescribers could end up providing private pharmacy services, including online. 

That said, given that it is the Government and taxpayers that provide most of the funding for undergraduate training and the NHS needs to expand access to clinical services to meet demand, then it seems inconceivable the NHS will not utilise most of this new prescribing workforce.

For these and other reasons, policymakers need to take the Warner findings very seriously indeed.