As John Warburton begins a three-year term as chair of the UK Clinical Pharmacy Association, he talks to Saša Janković about the current state of clinical pharmacy in the UK and his hopes for its future trajectory, including enhanced leadership, technology implementation and multidisciplinary working.
As clinical pharmacy in the UK continues to evolve, hospital pharmacists find themselves at the forefront of significant changes in practice, technology and service delivery.
For John Warburton, divisional director of professions at University Hospitals Bristol and Weston NHS Foundation Trust and chair of the UK Clinical Pharmacy Association (UKCPA), one of the most transformative changes in clinical pharmacy is the introduction of independent prescribing for newly qualified pharmacists from 2026.
‘Enabling pharmacists to take on greater responsibilities within therapeutic pathways is the biggest opportunity the profession as a whole will have seen in a long time,’ he says. ‘It’s really empowering that pharmacists will be able to prescribe from scratch and throughout their careers, which is a significant shift that not only strengthens pharmacists’ roles as clinical decision-makers but also enhances their ability to integrate with multidisciplinary teams.’
Another major area of development is pharmacogenomics and personalised medicine. ‘At UKCPA’s annual conference in Manchester last November, the room absolutely came alive when discussing the science, the application and the potential of pharmacogenomics,’ John recalls. ‘In fact, UKCPA has responded to this growing interest by commissioning a soon-to-be-published pharmacogenomics handbook, designed to offer specialist guidance and formulary support for pharmacists navigating this emerging discipline.’
Addressing funding challenges
Of course, all steps forward require an element of financial propulsion, and John acknowledges that funding remains a persistent challenge, requiring a shift in how the profession justifies its value.
‘Historically, if you could prove worth, you’d get a post, but now the decisions on funding revolve primarily around relative value and providing better value for patients,’ he says. ‘With increasing financial constraints in the NHS, we have to bear in mind that funding a pharmacy post often comes at the expense of another role, such as a specialist nurse or medical professional.’
To adapt, John advocates for closer collaboration within multidisciplinary teams (MDTs), with pharmacy moving beyond working in a professional vacuum and embracing a broader perspective of value within healthcare systems.
‘We need to consider how we augment MDTs rather than just forming a pharmacy part of them,’ he says. ‘This means thinking differently about how we deliver services, whether through hospital-at-home models, automation or artificial intelligence (AI)-driven efficiencies.’
Building clinical pharmacy workforce resilience
As the increasing pace of change within the NHS places immense strain on healthcare professionals, workforce resilience is another pressing issue.
‘Sickness rates, resilience to change and workplace pressures are concerns we recognise daily,’ says John. ‘So, in my hospital we have implemented a standard ‘day out’ every fortnight for our pharmacy leaders to focus on projects and thinking time, which is extremely difficult to do when you’re constantly in front of patients.’
Leadership development is also a key factor in resilience. ‘One of the biggest gaps in pharmacy is the lack of leadership training,’ he says, citing a recent survey carried out across hospitals in the south west of England, which found that while the average time to first formal leadership training for hospital pharmacists was eight years, many were managing teams within three to five years. ‘This mismatch contributes to stress and burnout, which is why we need to embed leadership development earlier in pharmacists’ careers,’ John explains.
A notable initiative in leadership development is the Professional Nurse Advocacy (PNA) programme, which John believes could be a valuable addition to pharmacy practice. Originally designed for nurses, the PNA programme provides restorative supervision sessions to support career development and offer guidance on handling workplace stress.
‘We’ve been running a pilot programme where professional nurse advocates provide these sessions to pharmacists, and the feedback has been very positive,’ he says. ‘I think there is potential for pharmacy to develop its own equivalent system.’
The role of digital transformation and AI
Digital transformation is another area poised to reshape clinical pharmacy, with electronic prescribing and AI-driven clinical decision support being major focuses. However, John warns that ‘the biggest challenge we see is the lack of interoperability between systems’, which can cause all manner of issues for the healthcare professionals using them and for the patients whose care can be impacted as a result. ‘Commercial providers are often not incentivised to ensure seamless integration, leading to inefficiencies,’ he adds.
Despite these hurdles, John is excited about the potential of electronic prescribing, particularly in critical care settings where it can improve patient prioritisation and clinical workflow efficiency.
‘We have dashboards that help us approximate which patients need to be seen first based on various metrics and this allows us to allocate pharmacy resources where they are most needed,’ he explains. ‘Of course, the growing role of pharmacy technicians in handling medicines reconciliation and clinical prioritisation is proving vital when it comes to freeing pharmacists to focus on more clinically complex interventions.’
Sustainability in clinical pharmacy
Sustainability remains a complex challenge in clinical pharmacy, particularly when environmentally friendly options are often more costly. ‘Decision making is hindered by a lack of reliable data,’ says John. ‘For example, we don’t have access to full manufacturing, transport and disposal lifecycle costs of medicines, which makes it difficult to make informed procurement choices, and until this data is standardised, sustainability efforts will remain limited.’
He believes that policy changes are necessary to prioritise environmental factors in purchasing decisions, adding: ‘At some point, sustainability will need to outweigh cost considerations in procurement frameworks, but we’re not there yet.’
UKCPA priorities
As the newly appointed chair of UKCPA, taking up this post in January 2025, John has set three key priorities for his three-year term.
The first is restoring the profession’s faith in professional leadership through membership and advocacy of the UK Professional Pharmacy Leadership Advisory Board.
‘UKCPA has a huge role to play in rebuilding trust within the pharmacy profession,’ John says. ‘We need to ensure that pharmacists feel supported by their professional bodies – whichever they choose to join – and have a clear direction for their careers.’
His second priority is enhancing collaboration across the profession. ‘Our members work across different specialties, so we want to enable collaborations that benefit professional standards, research and patient care through partnerships between UKCPA, higher education institutions, pharmaceutical industries and other professional bodies.’
The third focus is expanding access to world-class education and resources, with the enhanced development of generalist as well as specialist resources in the coming year. ‘We want to build the evidence base for pharmacy, ensuring that pharmacists have the resources to make informed, impactful clinical decisions,’ he says, which will arguably become even more important once independent prescribing for pharmacists becomes the norm in 18 months’ time.
RPS advanced pharmacist curricula
John is also highly engaged with the Royal Pharmaceutical Society’s (RPS) advanced pharmacist curricula, which have so far focused on critical care and mental health.
Looking ahead, he hopes the curriculum will expand into other specialist areas, ensuring that pharmacists across various fields can gain recognition for advanced practice. ‘We need a structured framework that supports pharmacists in every specialty, helping them achieve formal recognition and progress their careers,’ John says. ‘However, securing funding for these expansions remains a challenge.’
One solution could be collaboration with other specialist organisations to fund and develop these advanced curricula, and this is something that could be pursued in the coming months and years. ‘If we can align with industry partners and educational institutions, we can ensure that pharmacists have access to training that not only enhances their skills but also benefits patient care and healthcare system efficiency’, he says.
Adapting clinical pharmacy for the future
As for what’s coming next, John envisages a future where clinical pharmacy roles become more integrated with other healthcare disciplines and the key will be for the profession to adapt, evolve and expand their skills.
‘We’re moving to a place where there will be lots of transferable skills between professions, and we need to ensure that pharmacists are at the heart of clinical teams, adding value where it matters most,’ he says. ‘That means being open to new ways of working, upskilling in emerging fields like pharmacogenomics, and finding innovative ways to support patient care.’
